Interstitial Cystitis (Painful Bladder Syndrome)

Last updated 10.08.12

 

Definition

-  Chronic debilitating painful bladder condition of unknown cause

 

Features

- Clinical Dx

- Variable response to Mx

- No cure

-  Women 9:1 men

- Occurs at any age  

-  Average age of onset 40yrs

Causes

- Idiopathic but several theories

- Leaky bladder

- Histamines (allergic response)

- Autoimmune response

- Toxic urine

- Post-surgical

- Anti-inflammatory: Tiaprofenic acid

- Infection: viral

DDx

-  Overactive bladder

- Endometriosis

- UTI

- Cancer

Associated S/S

-  Pelvic pain when bladder is full

-  Feeling of relief on voiding

-  May also be addominal or vaginal pain

- Pain may be worse when bladder is filling, voiding or during sex

- Men may feel pain in prostate, scrotum or penis

- Urgency

-  Not usually associated with urinary leakage

-  +/- constant desire to pass urine

-  Urinary frequency

-  Frequent nocturia

-  May be up to 40-50 times per day

Ix

-  Urine MCS: Exclude UTI

- +/- Cystoscopy

- Hunners Ulcer (rarley seen)

- +/- Hydro-distension (saline dilation of bladder)

- +/- Biopsy

 

Mx

- Supportive

-  Support Group: Interstitial Cystitis Support Group of Australia

- Screen for Depression

- Sleep management

- Diet Modification

-  Avoid potenial aggravators: tomatoes, citrius fruit, bananas, chocolate, cheese, mayonaise, nuts, onions, raisins, sour cream, yoghurt, spicy food, coffee, wine, beer, carbonated drinks...

- Variable response

-  Medications

- +/- Ural

-  Amitryptiline: analgesia, anti-chlinergic (reduces urge to void), sedating

- Gabapentin

- Anti-histamines

- Pentosan polysulfate (Elmiron)

-   $200 per month (not on PBS)

- Does not work for many people

- Urology referral

-  Hydro-distension

-  Both Dx & Mx

- 50% patients get some relief

- May be repeated

- ntil surgical Mx

- Bladder instilation

-  DMSO (Dimethyl Sulfoxide)

- Heparin

- Steroids + DSO

- BCG

- Chlorpactin

- Surgery

-  Sacral neuromodulation (electrodes)

- Urinary diversion (ileal conduit)

- Bladder reconstruction (from bowel)

- Cystectomy

 

 

 

References

 

Female Urology Special Advisory Group: Interstitial Cystitis