Interstitial cystitis

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Interstitial cystitis (IC) is a symptom complex of chronic pelvic pain and urinary frequency in the absence of any urologic or systemic pathology. It is an idiopathic hypersensory condition of the bladder characterised by epithelial dysfunction, sensory nerve upregulation and mast cell activation.

The initial description of IC was done by Skene in 1887. He described it as an inflammation of the urinary bladder mucosa, partly or wholly, which extends into the muscular parieties. Guy Hunner later defined it as a disease identified by characteristic bladder wall ulcers. At the National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) meeting in 1987, pain was considered a prominent aspect of the case definition. The terminology of painful bladder disease was first introduced by Gillenwater et al. ³

However, the fluctuations in symptoms, extreme variability in presentation and findings, diagnostic criteria, and treatment response leads to underdiagnosis of this condition. In addition, there is a lack of knowledge of the epidemiology of IC, the burden of the disease and the possible risk factors to be identified. It is frequently misdiagnosed in the clinical setting owing to the overlap with other gynaecologic and urologic diseases such as urinary tract infections, endometriosis, prostatitis, overactive bladder and chronic pelvic pain syndrome. The classical presentation of IC comprise flare-ups and remissions of excessive urgency and frequency of urination, suprapubic pain, dyspareunia, chronic pelvic pain, and negative urine cultures. ^1,2,4

Disease progression owing to a delay in diagnosis affects the quality of life. Successful management of IC necessitates prompt diagnosis with initiation of effective treatment interventions in the early stages of the disease. While traditional diagnosis was based on findings in severe and advances disease with procedures to establish the diagnosis, the current approach is based on patient history, physical examination, laboratory findings and symptom surveys. ^1,5

In spite of considerable research, there are no universal consensuses on treatment protocols for IC. It usually consists of supportive, behavioural and pharmacological measures. A surgical approach is rarely warranted. The identification of clinical markers in the future may aid in ascertaining the aetiology and pathophysiology of IC. ^2,5

An overview of the pathology, symptomatology, physical findings and management of painful bladder syndrome (PBS)/IC, is described in this review. It also aims at increasing awareness of IC with improvement in patient identification, diagnosis, and outcomes.