Also referred to as Painful Bladder Syndrome (PBS). It typically causes pain below the umbilicus, specifically in the pelvic region. It can manifest in individuals of any age. The condition may persist for years or become a lifelong affliction. The exact etiology remains unknown. It is a chronic disorder characterized by a hypersensitive bladder in the absence of other identifiable underlying causes, such as urinary tract infections.

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ℹWhat is Interstitial Cystitis (Painful Bladder Syndrome)?

What Is Interstitial Cystitis?

Interstitial cystitis (IC) is now also commonly referred to as a collection of symptoms known as painful bladder syndrome (PBS). Interstitial cystitis/painful bladder syndrome is a chronic condition characterised by varying degrees of bladder pain and discomfort. This pain can typically get worse as the bladder fills and may decrease after urination, resulting in increased frequency and urgency of urination. The symptoms of IC may stay the same over time or get worse. Some patients may go into remission for extended periods.

Common Symptoms

Pelvic pain, pressure, or discomfort

Persistent pain, pressure, or discomfort in the pelvic region.

Urinary frequency and urgency

A frequent urge to urinate day and night, which can occur up to 20 to 30 times a day.

Pain that increases as the bladder fills

Burning, stinging, or pain that typically worsens as the bladder fills and may decrease after urination.

Flare-ups and remissions

Symptoms may undergo intermittent flare-ups. Stress, specific dietary triggers, the menstrual cycle, and physical or sexual activity may contribute to exacerbations.

Symptoms in women

Pain may be localized to the pelvis, vulva, and/or vagina; sexual intercourse may increase pain (dyspareunia).

Symptoms in men

Pain may be localized to the scrotum, penis, testicles, and rectum; pain during or after ejaculation may occur. Because it can clinically mimic prostatitis, a thorough prostate evaluation is recommended.

Diagnosis Methods

Diagnosis of exclusion

There is no definitive test for interstitial cystitis; diagnosis is usually made by excluding other urinary conditions. In men, prostatitis is evaluated as an alternative diagnosis.

Detailed history

A complete medical history is taken, including nocturia, diurnal frequency, urgency, and pain, stinging, or burning with the urge to void.

Urinalysis

A standard urinalysis typically reveals the absence of bacterial infection. In interstitial cystitis, urinalysis is normal in about 95–97% of cases and urine culture is sterile.

Cystoscopy

Cystoscopy, preferably under general anesthesia and especially after hydrodistention, is used to identify Hunner’s lesions (ulcerations) or glomerulations (petechial hemorrhages) on the bladder wall.

Causes

Damage to the bladder lining

Injury to the inner lining of the bladder may allow urine to come into contact with nerve fibres.

Abnormal immune response or nerve hypersensitivity

The exact cause is unknown. Proposed mechanisms include an abnormal immune response and nerve hypersensitivity.

Occult chronic infection

A prolonged infection that is not detected by standard urine tests may also contribute.

Treatments

Lifestyle modifications and therapies

Avoidance of bladder irritants such as caffeine, alcohol, and acidic foods; smoking cessation; stress and fluid management; pelvic floor physical therapy; and bladder training.

Pharmacotherapy and medical interventions

NSAIDs (e.g., ibuprofen), antihistamines, glycosaminoglycan analogues, bladder instillations such as sodium hyaluronate with local anesthetic and heparin, and sacral or tibial nerve stimulation.

Surgical options

Prolonged anti-inflammatory hydrodistention, transurethral resection of Hunner lesions, and pudendal nerve block. In severe refractory cases, cystectomy and creation of a neobladder from bowel segments may be indicated.

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