Interstitial Cystitis

Interstitial cystitis is a chronic, noninfectious bladder disorder predominantly diagnosed in women. Symptoms mimic those of a UTI (urgency, frequency) with the addition of chronic pelvic pain, dyspareunia, or both and varying with bladder filling. Although not associated with cellular change, epithelial inflammation and prolonged symptoms can lead to epithelial damage (Kahn et al., 2005). Two forms are identified: "classic" interstitial cystitis, demonstrating inflammatory bladder wall changes identifiable on cystoscopy, and painful bladder syndrome, defined by the symptoms of interstitial cystitis in the absence of any objective cystoscopic findings (Marinkovic et al., 2009).

The main impact of interstitial cystitis is on quality of life. Patients often express somatization and depression or anxiety; as with other somatic pain syndromes, its pathogenesis is unclear. Differential diagnosis includes other somatic syndromes such as fibromyalgia, irritable bowel, and chronic pelvic pain, as well as UTI, overactive bladder, uterine fibroids, and endometriosis. Interstitial cystitis should be considered in any patient presenting frequently with UTI symptoms. There may also be association with autoimmune disorders.

Pentosan polysulfate sodium (Elmiron), 100 mg three times daily, is the only FDA-approved medication for interstitial cystitis. Adjunctive medications include antihistamines, TCAs, gabapentin, anticholinergics, prednisone, and cyclosporine (Marinkovic et al., 2009). Urologic consultation should be considered. Physical therapy, counseling, and bladder training may help (Kahn et al., 2005). Many dietary avoidance recommendations have focused on acidic, high-potassium foods and drinks with acid, caffeine, or alcohol. However, prospective data on dietary interventions are lacking, so such restrictions should be individualized to each patient.

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