Interstitial Cystitis

Question 1

What is interstitial cystitis/bladder pain syndrome (IC/BPS)?

Answer 1

• an unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms of more than 6 weeks duration, in the ABSENCE of infection or other identifiable causes.
• diagnosis of exclusion

Question 2

Does IC/BPS consist of chronic pelvic pain, often exacerbated by bladder filling?

Answer 2

YES and associated with urinary frequency.

Question 3

Is there a specific test or marker that is diagnostic for BPS/IC?

Answer 3

• NO :(

Question 4

What symptoms are associated with IC/BPS?

Answer 4

• voiding symptoms (frequency, urgency)
• pelvic pain
• nocturia (getting up in the middle of the night to pee).
• dyspareunia

Question 5

Do more males or females suffer from IC/BPS?

Answer 5

• FEMALES (5:1 female to male ratio)

Question 6

*** What is associated with 40% of people with interstitial cystitis (IC)?

Answer 6

• multiple ALLERGIES

Question 7

How do you differentiate overactive bladder from painful bladder syndrome (aka IC or BPS)?

Answer 7

• bladder PAIN

Question 8

What other conditions can mimmic IC?

Answer 8

• endometriosis
• urinary tract infection
• vulvodynia (pain in the vulva)
• chronic pelvic pain

Question 9

What will you find on physical exam of a patient with IC?

Answer 9

• TENDERNESS of bladder, suprapubic, levator ani, cervical motion, posterior vaginal, and rectal.

Question 10

** What causes IC?

Answer 10

• Don’t know, but MAST CELL ACTIVATION and histamine release often occur.

Question 11

What is the best circumstantial evidence for urine abnormality?

Answer 11

• late occurrence of pain and bowel segment contraction after substitution cystoplasty and continent diversion. (aka pts still have pain after removal of bladder).

Question 12

What do we think happens with IC?

Answer 12

• breakdown of bladder mucosal lining, leading to irritation and subsequent inflammation of the urothelium

Question 13

How do we diagnosis IC?

Answer 13

• frequency/volume chart
• focused history and physical exam
• urinalysis
• urine culture
• cytology and cystoscopy are recommended if clinically indicated.

Question 14

Does cystometry in conscious IC patients generally demonstrate normal function?

Answer 14

YES, with the exception of decreased bladder capacity, hypersensitivity, and pain with bladder filling.

Question 15

What is score is considered relevant for IC when using the O’Leary-Sant or PUF screening questionnaires?

Answer 15

• O’Leary-Sant= 6 or higher

- PUF= 10 or higher

Question 16

Are glomerulations (pin-point hemorrhages) of the bladder wall seen on cystoscopy consistent with IC?

Answer 16

NO, bc they can be seen in many clinical situations.

Question 17

What is a Hunner’s ulcer?

Answer 17

• rare positive finding that can confirm the diagnosis in patients who meet the definition criteria for IC.
• acute= inflamed, firable, denuded area
• chronic= blanched, non-bleeding area
• provides a therapeutic ulcer.

Question 18

What is a possible marker that may help with diagnosis of PBS/IC?

Answer 18

• antiproliferative factor (APF)

Question 19

*** What is the first approach to treatment for IC?

Answer 19

CONSERVATIVE:

• pt education and support groups
• reassurance
• timed voiding
• stress reduction
• biofeedback, pelvic massage

Question 20

What foods should you avoid with IC?

Answer 20

• caffeine
• alcohol
• foods high in citric acid (tomatoes, oranges…)

Question 21

*** What are the 2nd line treatments?

Answer 21

• manual physical therapy (OMM)
• pain managment from expert in this area.
• oral medications (amitriptyline, cimetidine, hydroxyzine, or pentosanpolysulfate)
• intravesical medications (DMSO, heparin, lidocaine)

Question 22

*** What is Amitriptyline?

Answer 22

• central and peripheral anticholinergic actions
• block the active transport system in presynaptic nerve ending that reuptakes amine neurotransmitters (serotonin and noradrenaline).

Question 23

*** What is Pentosanpolysulfate (sodium pentosan polysulfate)?

Answer 23

• heparin analogue (oral formulation) used based on theory of epithelial permeability barrier that targets the glycosaminoglucan layer of the urothelium in IC patients.
• usually takes at least 3-6 months to see effects.

Question 24

What is an ADR of Pentosanpolysulfate with a higher does?

Answer 24

• GI side effects (nausea and diarrhea).

Question 25

**** Are antihistamines (Hydroxizine) used for treating IC?

Answer 25

YES

Question 26

What analgesics are used for treating IC?

Answer 26

- acetaminophen - NSAIDs - Gabapentin

Question 27

*** What is the 3rd line treatment?

Answer 27

- cystoscopy + 1-2 mins of hydrodistention (under anesthesia)

Question 28

*** What is the 4th line treatment?

Answer 28

- neurostimulation via permanently implanted electrode at S3 foramen.

Question 29

*** What are the 5th line treatments?

Answer 29

- cyclosporine A | - intradetrusor BOTOX

Question 30

*** What is the 6th line treatment?

Answer 30

- SURGERY= cystectomy with urinary diversion

Question 31

What therapies should be avoided for IC?

Answer 31

- long-term ABX | - long-term steroid administration

Question 32

What are some new clinical trials being done for IC?

Answer 32

- hyperbaric oxygen treatment - intranasal oxytocin - lidocaine ring

Question 33

Is IC a lifelong, incurable disease?

Answer 33

YES, but symptoms can be managed.

Question 34

Does IC likely represent more than one disease?

Answer 34

YES