Defining Interstitial Cystitis Based on Symptoms
Abstract & Commentary
By Frank W. Ling, MD, Clinical Professor, Dept. of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, is Associate Editor for OB/GYN Clinical Alert
Dr. Ling reports no financial relationship to this field of study.
Synopsis: Ninety-seven percent of women with IC/PBS described pain that worsened with certain drink or food and/or improved with urination and/or worsened with bladder filling.
Source: Warren JW, et al. Evidence-Based Criteria for Pain of Interstitial Cystitis/Painful Bladder Syndrome in Women. Urology. 2008;71:444-448.
The authors hypothesized that certain pain symptoms characterize IC/PBS. They reviewed criteria used in two recent studies to look for commonalities. In both the 2004 "Events Preceding Interstitial Cystitis" case-control study and the Interstitial Cystitis Database, the aforementioned triad of findings was found in 97% of subjects with IC/PBS. These results may well help define the condition as differentiated from other disease states with similar symptomatology.
Commentary
Finally! Maybe we're getting somewhere with interstitial cystitis, referred to here as Interstitial Cystitis/Painful Painful Bladder Syndrome (IC/PBS). As the Hall of Fame catcher Yogi Berra expressed, "If you don't know where you're going, how do you know when you get there?" Since there are no diagnostic physical signs or urologic findings or laboratory tests in IC/PBS, symptoms appear to be the best current approach to making the diagnosis.
Historically, the 4 symptoms that were felt to characterize IC/PBS were pain, urgency, frequency, and nocturia. Unfortunately, these same symptoms appear in many other conditions such as vestibulodynia, overactive bladder, endometriosis, and urinary tract infections. These 4 do accurately describe IC/PBS, but are not specific, ie, they do not exclude other conditions with similar symptoms.
With the 3 new findings, some important aspects should be explored. The dietary links to IC/PBS appear to be drinks (tea, alcohol, coffee, carbonated beverages) and food (chocolate, tomatoes, citrus fruits). Simply asking the patient whether her pain is relieved with voiding is simple enough. Increasing pain with bladder filling can easily be extrapolated from a patient's symptom pattern.
Although not in this study, those of us who see lots of patients with IC/PBS know that all 3 of the new criteria as well as the traditional quartet can be helpful in some patients. In addition, dyspareunia may well be a presenting symptom for many patients. All it takes sometimes is an index of suspicion. For many of us, our clinical problem-solving essentially boils down to seeing if a patient (the proverbial square peg) can be fit into a corresponding square hole or can forced in a proverbial round hole. We are all too often forced into the latter scenario because we don't have a sufficient number of holes to try to fit the peg into. It is critical for us, often serving as the patient's last resort, to have many different holes in which to try and fit the pegs.
To help support the diagnosis, a tender bladder base on pelvic examination might be found. Of particular help is the ability to rule out tenderness of the vestibule (using a cotton-tipped swab), the pelvic floor, and the uterus (or the vaginal cuff) as well as the adnexal regions. The thing that we absolutely don't want to do is to ascribe the pain to psychosomatic causes or phantom pain unless we have truly fully evaluated the entire spectrum within the differential diagnosis. This includes the elusive conditions related to neuropathic pain that we have written about in the past in this column.
The authors have done us a great service by saving us lots of time. If they are correct that the findings of worsening symptoms related to dietary intake and/or improvement with emptying the bladder and/or worsening with bladder filling are present in 97% of patients with IC/PBS, the time that we take to ask a multitude of questions may well be cut down considerably. Thank you! Every time saver that we can find is certainly appreciated.
The authors hypothesized that certain pain symptoms characterize IC/PBS. They reviewed criteria used in two recent studies to look for commonalities.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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