Cath Lab Digest

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  According to the Interstitial Cystitis Association (ICA),¹ interstitial cystitis (IC), a painful and puzzling bladder disorder, “is a condition that consists of recurring pelvic pain, pressure, or discomfort in the bladder and pelvic region, often associated with urinary frequency and urgency.” The RAND Interstitial Cystitis Epidemiology study² reported in 2009 that approximately 3 to 8 million women and 1 to 4 million men suffer from IC.

  Historically, IC was considered a chronic pelvic pain syndrome originating in the bladder, but epidemiological studies comparing IC with similar conditions belie the simplicity of this statement. International researchers working to describe what is happening to an IC bladder are including other syndromes similar to IC; hence, IC is referred to alternatively as painful bladder syndrome (PBS), bladder pain syndrome (BPS, used primarily in Europe), and hypersensitive bladder syndrome (HBS, used primarily in Asia). Men also may be diagnosed with chronic prostatitis (CP), which shares similar symptom characteristics with IC. For the purpose of simplicity, in this article the condition will be called IC.

Clinical Presentation

  Patients with IC experience urinary pain, frequency, urgency, and nocturia that cannot be attributed to other causes; thus, diagnosis frequently is by exclusion.^3-5 Although symptoms of IC can be confused with a urinary tract infection, urine from an IC patient does not show any bacteria when cultured. The fundamental pathophysiology of IC is a damaged or wounded bladder lining. Both the glycosaminoglycans (GAG) layer (the protective mucous coating on the surface of the bladder) and the urothelial layer (the skin-like barrier that transmits the messages of pain and urgency to the brain) can be damaged in a bladder, causing IC symptoms. Diagnosticians may observe glomerulations, or petechial hemorrhages, when a patient undergoes a cystoscopy under anesthesia; however, there is some concern this damage could be caused by the procedure itself. Approximately 7% to 9% of patients actually have ulceration (Hunner’s ulcers) in the bladder lining.⁶ Mastocytosis (akin to having hives in the bladder) is also a common finding.⁷

Assessing Bladder/Urethral Symptoms

  For diagnostic purposes, IC pain generally worsens as the bladder fills with urine and is relieved upon emptying the bladder. The pain may or may not be perceived as coming from the bladder. Many patients report their pain is urethral, with varying degrees of pelvic pain. Other patients report back pain, shooting pain down the legs, and pain that is positional — for example, sitting in one place too long can trigger symptoms. In addition, both men and women report pain with intercourse. Men with IC often experience penile pain at the moment of ejaculation; women can experience pelvic pain up to 24 hours after intercourse. Women’s symptoms also may increase premenstrually and at ovulation.⁸ Brookoff⁹ explains that IC is primarily visceral. The messages for visceral pain travel to the same area of the brain where emotions are generated, so IC patients may appear to be highly emotional. In addition, IC pain can be neuropathic; the person is in pain for so long, the nerves become damaged, resulting in more intense pain signals over time. Patients considering cystectomy need to weigh the perceived and potential benefits of bladder removal with fact that many continue to experience neuropathic pain after surgery.

  The other two cardinal symptoms of IC are frequent urination and an unexpected urge to get to the bathroom immediately. Patients have reported having to use the bathroom up to 60 times a day. Nocturia and the resultant sleep disruption become a major cause of distress for patients.