A BRIEF Synopsis of AFP's "Interstitial Cystitis/Painful Bladder Syndrome"

A BRIEF SYNOPSIS of: Interstitial Cystitis/Painful Bladder Syndrome 
LINDA M. FRENCH, MD, University of Toledo College of Medicine, Toledo, Ohio, NEELAM BHAMBORE, MD, University of California–Davis Medical Group, Sacramento, California
Am Fam Physician. 2011 May 15;83(10):1175-1181.
http://www.aafp.org/afp/2011/0515/p1175.pdf

     Interstitial cystitis (AKA painful bladder syndrome) consists of painful symptoms such as dyspareunia, dysuria, urgency, frequency, suprapubic and pelvic pain. It affects women more than men. The cause is unknown, but it is thought that damage to the urothelium produces cytokines and puts excess K into the bladder interstitium.  This causes mast cell activation and degranulation. 
     The differential diagnosis is broad and there is no standard test for interstitial cystitis. There are two screening questionnaires (O'Leary-Stant Symptom and Problem index and the Pelvic Pain and Urgency/Frequency Symptom Scale [PUF] ). A physical exam (bimanual pelvic or DRE) may show pelvic floor spams, rectal spasms, or subrapubic tenderness. 
     As far as laboratory testing is concerned, a UA and urine culture can be done to rule out infection and other illnesses. An intravesical potassium sensitivity test is a commonly used procedure to diagnose interstitial cystitis. Basically, water is inserted into the bladder with a catheter. It is drained out after 2-3 minutes and a second infusion is added. The second infusion is water with 40 mEq of K. If the potassium infusion causes increased pain, then the test is positive for cystitis.  The anesthetic bladder challenge (where an anesthetic solution is added to the bladder) that relieves pain is an indication that the bladder is the cause.  Direct visualization of the urothelium may be helpful in documenting the bladder inflammation. 
     Treatment effectiveness for interstitial cystitis is limited, thus it is important to set realistic goals and expectations with the patient. Dietary triggers, such as coffee, alcohol, citrus fruits, and spicy foods, should be removed. Pentosan polysulfate sodium is supposed to repair the urothelium. Hydroxyzine is supposed to control mast cell degranulation. TCAs are supposed to inhibit neuronal activation. These three can be taken orally. Intravesical therapies include dimethyl sulfoxide, pentosan polysulfate sodium (hello again!) and hyaluronic acid (not approved in the US-sad face). Physical therapy to treat pelvic floor spasms may also be helpful.