Interstitial Cystitis

General Overview

  • Chronic bladder pain syndrome, no clear etiology, no cure
    • Rule out
      • Endometriosis (worse during menses)
      • Non-infectious cystitis (radiation, NSAIDs, cyclophosphamide, ketamine)
      • Vulvar (pain only during voiding and sexual intercourse)
      • Overactive bladder (voids to avoid incontinence - not to relieve bladder pain)
      • Pudendal nerve entrapment (positional pain, worse on sitting)
      • Prostate-related (related to ejaculation, tender prostate)
      • Pelvic floor disorder (muscle tenderness on palpation)
  • Consider UA, urine culture
  • Consider cystoscopy
  • Goal: Symptom relief

Treatment

  • Treat comorbid (UTI, chronic pain)
  • Patient education
    • Local heat/cold on bladder/perineum
    • Avoid triggers (food, beverages -eg. caffeine, alcohol, spicy, vitamin C)
    • Fluid management
  • Bladder training
  • Psychosocial support
    • Stress management
  • Physical therapy if pelvic floor muscle tenderness on palpation
  • Pharmacologic: Amitriptyline, pentosan polysulfate sodium, antihistamine (hydroxyzine)