Interstitial cystitis

Interstitial cystitis or bladder pain syndrome (BPS) or painful bladder syndrome (PBS) - hence the abbreviation IC/BPS - is a non-curable disease of the bladder that is associated with chronic inflammation of all layers of the bladder walls. Interstitial cystitis is characterized by pollakiuria, urogenital pain, and constant urination. Synonyms for the condition are: Chronic interstitial cystitis, Guy Hunner's cystitis, non-bacterial cystitis, abacterial cystitis, painful bladder syndrome, bladder pain syndrome.

To date, there is no uniform worldwide definition of the disease. In international nomenclature, the term Bladder Pain Syndrome is usually preferred. This term is also used in the guidelines of the European Association of Urology (EAU) and by the European Society for the Study of Interstitial Cystitis / Painful Bladder Syndrome (ESSIC).

In the S2K guidelines for the diagnosis and treatment of interstitial cystitis initiated by the Interstitial Cystitis Association (ICA) Deutschland e. V. and published by the Deutsche Gesellschaft für Urologie e.V. (DGU), the S2K guideline Diagnostics and Therapy of Interstitial Cystitis (IC/BPS) states: "The sole designation Bladder Pain Syndrome (BPS) or Painful Bladder Syndrome (PBS) limits the clinical picture of IC/BPS too much, as they focus exclusively on pain. In Germany, the term Interstitial Cystitis (IC) or also (IC/BPS) is common. The term "interstitial cystitis" is the primary term used in ICD-10 and Medical Subject Headings.

The DGU defines IC as follows: "Interstitial cystitis (IC/BPS) is a non-infectious chronic bladder disease characterized by pain, pollakiuria, nocturia and imperative urination in varying degrees and combinations of symptoms and with simultaneous exclusion of differential diagnostic diseases. The diagnosis of IC/BPS is not tied to a specific bladder volume or persistent pain."

The symptoms of IC/BPS often resemble those of an acute or even chronically recurring cystitis and symptoms of other diseases. Therefore, and because the disease is relatively rare and also unknown, there are often misdiagnoses. The diagnosis of interstitial cystitis is a diagnosis of exclusion. This is made on the basis of the symptoms, the findings of a cystoscopy and a micturition protocol. Often the correct diagnosis of IC is only made at a very late stage. By then, those affected have already gone through years of suffering and numerous visits to the doctor. The diagnosis of IC is based on the clinical appearance and a cystoscopy in which characteristic mucosal bleeding and tearing (mucosal cracking) occur after hydrodistension (stretching of the bladder with saline solution).

The quality of life of those affected is significantly impaired. In particular, the massive pain and the often constant urge to urinate have a strong impact on the patients. Since the urge to urinate also exists at night, restful sleep is also not possible. Many patients suffer from severe exhaustion due to the stress. 79 percent are repeatedly or permanently unable to work.

Common concomitant diseases and symptoms include muscle and joint pain, migraines, depressive moods, allergies, and gastrointestinal disorders.

Distribution/epidemiology

IC/BPS affects men and women of all cultures, socioeconomic backgrounds, and ages. Available figures on the prevalence and prevalence of IC vary widely, probably due to low awareness of the condition as well as frequent misdiagnosis and differences in recording methodology. In the United States and Europe, it is estimated to affect about 0.5% of people. Women are 9 times more likely to be affected than men. The highest prevalence is in middle-aged individuals; however, one-third of patients have symptoms before the age of 30.

In Germany, the disease is very rarely diagnosed.

Research Methods

The diagnosis is based on several pillars: Medical history, micturition and pain diary, urine examination, urological and gynecological examination, biopsy of the bladder wall, molecular diagnostics of specific cell proteins.

Differential diagnosis

The symptoms of IC/BPS are similar to those of other urological and gynaecological conditions, including urinary tract infections (UTIs), overactive bladder, sexually transmitted infections, endometriosis, bladder cancer, chronic pelvic pain syndrome and chronic prostatitis. This is one reason why it often takes a long time to establish interstitial cystitis as the correct diagnosis. Differential diagnoses can be used to rule out other diseases with similar or consistent symptoms.

Guideline of the American Urology Association (AUA)

AUA guidelines recommend starting with a careful history, physical examination, and laboratory tests to assess and document symptoms of IC/BPS as well as other possible disorders.

IC Guideline of the European Society for the Study of Interstitial Cystitis (ESSIC)

In 2008, the ESSIC Society proposed stricter and more demanding diagnostic methods with specific classification criteria. The condition is that a patient must have bladder pain accompanied by another urinary symptom. A patient with the sole symptom of frequent or urgent urination would be excluded from this diagnosis. In addition, the exclusion of diseases with similar symptoms is strongly urged by a comprehensive series of tests: these include (A) a history and physical examination, (B) urinalysis with test strips, various urine cultures, and a serum PSA in men over 40 years of age, (C) measurement of flow and post-luteal residual urine volume by ultrasound, and (D) cystoscopy. Often, the diagnosis of IC is confirmed or ruled out by cystoscopy under anesthesia, during which hydrodistension (dilatation of the bladder with saline) is performed. In the presence of IC, characteristic mucosal bleeding and tearing (mucosal cracking) occur during this procedure.

Guideline German Society of Urology

This guideline also recommends a detailed anamnesis at the beginning. Differential diagnoses follow in order to exclude diseases with similar or concordant symptoms. These include diseases of the musculoskeletal system and connective tissue, gastrointestinal diseases, gynecological findings, neurogenic causes, psychological disorders, urological causes. Biomarkers for diagnosis are still being researched, currently there are no accepted biomarkers available for the diagnosis of IC/BPS. The recommended physical examination also includes pain mapping in the genital region and rectal examination. A urinalysis should also be performed. Other additional investigations that should be performed are urosonography, uroflowmetry (in men), cystoscopy. Other possible investigations include hydrodistension (distension of the urinary bladder with sterile saline to determine the anatomical capacity of the bladder) and flow EMG (urine flow measurement with pelvic floor drainage). Consideration may be given to a potassium chloride (KCI) test. The KCl test, also known as the potassium sensitivity test, uses a mild potassium solution to assess the integrity of the bladder wall. Consideration may also be given to a biopsy of the bladder wall and a stool diagnostic test.

Questionnaires and documentation forms such as "O'Leary-Sant interstitial cystitis symptom and problem indices (ICPI/ICSI)", "Pelvic Pain and Urgency/Frequency (PUF) patient symptom scale" or "Bladder Pain/IC Symptom Score (BPIC-SS) are used to record and evaluate IC/BPS symptoms such as pain and urinary symptoms.