Interstitial cystitis (IC) is a clinical syndrome of urinary urgency, frequency, and bladder or other pelvic pain in the absence of bacterial infection or other defined etiology. Many patients are diagnosed with urinary tract infections; however, the urine culture is usually negative in patients with IC.
Symptoms of IC tend to develop gradually and typically progress (over several months) to the classic triad of pain, urgency, and frequency, until a stable plateau of severity is reached. Patients can be symptomatic for many years before a correct diagnosis is made. Some patients experience chronic symptoms, which flare and then improve. Often, these symptoms may mimic those of endometriosis and it is difficult to discern symptoms related to IC or endometriosis. In many cases, endometriosis and interstitial cystitis co-exist and should be considered if pain persists despite adequate treatment.
The pathology of IC usually involves the epithelial layer that forms the bladder's mucosa and can include the muscular layers of the bladder. Cystoscopy with hydrodistention under anesthesia in patients with IC may reveal tiny areas of petechial hemorrhages (glomerulations). In 6%-8% of IC patients, hemorrhagic lesions known as Hunner's ulcers are present.
Although the exact etiology of IC has not been established, several possible causes for the symptoms have been proposed.
. Infectious agents
. Neurogenic dysfunction
. Autoimmunity
. Mast cell activation
. Glycosaminoglycan (GAG) layer dysfunction
Although the exact number of people with IC is unknown, current estimates suggest that there may be as many as 2 million people in the United States with this condition. Interstitial cystitis can affect people of any age, race, or sex. Approximately 25% of patients are under 30 years old when they first develop symptoms, and the mean age at diagnosis is 44 years. Interstitial cystitis is most commonly diagnosed in women.
Interstitial cystitis has many of the same symptoms as other urologic and gynecologic conditions. There are several tools available that can assist you in making an accurate diagnosis of IC. Identifying IC is based on a combination of history, physical exam, negative urine cultures and a PUF questionnaire done in the office. Once IC is suspected, referral to a specialist for further management is warranted. Successful management of patients with IC depends on early detection and treatment. |
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Blue Ridge OB/GYN
541 Sunset Lane
Suite 301
Culpeper, VA 22701
Phone: (540) 825-4557
Web: bluerigeobgyn.com |
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