Overactive bladder (OAB)

IC symptoms can mimic the symptoms of unresolved overactive bladder (OAB)

Consider IC in patients who present with

  • Urinary urgency and frequency (≥8 voids/day)2
  • Urgency associated with bladder pain2
  • Pelvic pain relieved upon urination2
  • Pain during sexual intercourse2
  • Symptoms unresponsive to anticholinergic therapy for presumed OAB3

Pain is a characteristic symptom of IC, but not OAB, and may help differentiate between the 2 conditions4

  • In patients with OAB, urgency is associated with fear of leakage, whereas in patients with IC, urgency is associated with bladder pain2

Findings suggest a high prevalence of IC in patients with OAB symptoms refractory to anticholinergic therapy3

  • A study showed that 25 of 47 patients with detrusor overactivity did not respond to therapy with 1 anticholinergic medication3
    • 96% (24 of 25) of those patients were diagnosed with IC*

*Based on a positive Potassium Sensitivity Test (PST).

Patient with OAB-like symptoms

References:

  • Hanno PM. Bladder pain syndrome (interstitial cystitis) and related disorders. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology. Vol 1. 10th ed. Philadelphia, PA: Saunders Elsevier Inc; 2012;357-401.
  • Rosenberg MT, Moldwin RM, Stanford EJ. Early diagnosis and management of interstitial cystitis: what nonspecialists should know. Women’s Health Gynecol Edition. 2005;5:108-115.
  • Minaglia S, Özel B, Bizhang R, Mishell DR Jr. Increased prevalence of interstitial cystitis in women with detrusor overactivity refractory to anticholinergic therapy. Urology. 2005;66:702-706.
  • Dell JR. Chronic pelvic pain of bladder origin: a focus on interstitial cystitis. Int J Fertil. 2003;48:154-162.

Urinary tract infection (UTI)

IC symptoms can mimic the symptoms of a urinary tract infection (UTI)

Consider IC in patients who present with

  • Urinary urgency and frequency (≥8 voids/day)2
  • Pelvic pain, usually relieved upon urination2
  • Pain during sexual intercourse2
  • A negative urine culture2
  • A history of recurrent UTIs unresponsive to antibiotic therapy1

Millions of women seek treatment for UTI symptoms every year3

  • A study showed that 60% of patients (18 of 30) with IC were initially diagnosed with a UTI4

Patient with UTI-like symptoms

References:

  • Hanno PM. Bladder pain syndrome (interstitial cystitis) and related disorders. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology. Vol 1. 10th ed. Philadelphia, PA: Saunders Elsevier Inc; 2012;357-401.
  • Rosenberg MT, Moldwin RM, Stanford EJ. Early diagnosis and management of interstitial cystitis: what nonspecialists should know. Women's Health Gynecol Edition. 2005;5:108-115.
  • Childs SJ, Egan RJ. Microbiology and epidemiology in recurrent lower urinary tract infections. Infect Urol. 1998;11:88-92.
  • Porru D, Politanò R, Gerardini M, et al. Different clinical presentation of interstitial cystitis syndrome. Int Urogynecol J Pelvic Floor Dysfunct. 2004;15(3):198-202.

Endometriosis

IC symptoms can mimic the symptoms of endometriosis

Consider IC in patients who present with

  • Pelvic pain and flares associated with menstruation3,4
  • Pain during sexual intercourse3,4
  • Symptoms unresponsive to endometriosis therapy5,6

Endometriosis and IC may coexist

  • 86% of patients (115 of 134) diagnosed with endometriosis at a pelvic pain referral center were also diagnosed with IC5
  • 96% (58 of 60) of women with chronic pelvic pain were diagnosed with IC, and 80% (48 of 58) had biopsy-confirmed active endometriosis6
  • In those patients with unresolved endometriosis who had surgical therapy, IC should be considered if symptoms recur within the first 12 months7

Patient with endometriosis-like symptoms

References:

  • Hanno PM. Bladder pain syndrome (interstitial cystitis) and related disorders. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology. Vol 1. 10th ed. Philadelphia, PA: Saunders Elsevier Inc; 2012;357-401.
  • Rosenberg MT, Moldwin RM, Stanford EJ. Early diagnosis and management of interstitial cystitis: what nonspecialists should know. Women’s Health Gynecol Edition. 2005;5:108-115.
  • Hanno PM, Burks DA, Clemens JQ, et al; Interstitial Cystitis Guidelines Panel of the American Urological Association Education and Research, Inc. AUA guideline for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome. J Urol. 2011;185(6):2162-2170.
  • Parsons CL. Interstitial cystitis: epidemiology and clinical presentation. Clin Obstet Gynecol. 2002;45(1):242-249.
  • Chung MK, Chung RP, Gordon D. Interstitial cystitis and endometriosis in patients with chronic pelvic pain: the “Evil Twins” syndrome. JSLS. 2005;9:25-29.
  • Chung MK, Chung RP, Gordon D, Jennings C. The evil twins of chronic pelvic pain syndrome: endometriosis and interstitial cystitis. JSLS. 2002;6:311-314.

  • Butrick CW. Patients with chronic pelvic pain: endometriosis or interstitial cystitis/painful bladder syndrome? JSLS. 2007;11:182-189.

Chronic pelvic pain (CPP)

IC symptoms can mimic the symptoms of chronic pelvic pain (CPP)

Consider IC in patients who present with

  • Generalized pelvic pain for ≥6 months3
  • Pain during sexual intercourse2
  • Pain with bladder filling4
  • Urinary urgency2

Pelvic pain may be an indicator of IC

  • 79% of patients (88 of 111) at a regional pelvic pain center who suffered from persistent pelvic pain (pre- and post-hysterectomy) were diagnosed with bladder dysfunction consistent with IC3
  • In a study of 45 women scheduled to undergo laparoscopy for CPP, 38% (17 of 45) were diagnosed with IC5

Patient with CPP-like symptoms

References:

  • Hanno PM. Bladder pain syndrome (interstitial cystitis) and related disorders. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology. Vol 1. 10th ed. Philadelphia, PA: Saunders Elsevier Inc; 2012;357-401.
  • Rosenberg MT, Moldwin RM, Stanford EJ. Early diagnosis and management of interstitial cystitis: what nonspecialists should know. Women’s Health Gynecol Edition. 2005;5:108-115.
  • Chung MK. Interstitial cystitis in persistent posthysterectomy chronic pelvic pain. JSLS. 2004;8:329-333.
  • Sant GR, Nickel JC. Interstitial cystitis and chronic prostatitis: the same syndrome? In: Nickel JC, ed. Textbook of Prostatitis. Oxford, England: Isis Medical Media Ltd; 1999:169-176.
  • Clemons JL, Arya LA, Myers DL. Diagnosing interstitial cystitis in women with chronic pelvic pain. Obstet Gynecol. 2002;100:337-341.

Vulvodynia

IC symptoms can mimic the symptoms of vulvodynia

Consider IC in patients who present with1,3

  • Chronic pelvic pain
  • Pain during and after sexual intercourse
  • Vulvar pain

IC and vulvodynia may have overlapping symptoms due to a common etiology1

  • Patients presenting with vulvodynia may have underlying IC that is causing or contributing to their pain4
  • Vulvodynia and IC may occur concomitantly
    • In a study of 46 women with IC or symptoms of vulvodynia (focal vulvitis), 24% had both conditions5

Patient with vulvodynia-like symptoms

References:

  • Hanno PM. Bladder pain syndrome (interstitial cystitis) and related disorders. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology. Vol 1. 10th ed. Philadelphia, PA: Saunders Elsevier Inc; 2012;357-401.
  • Rosenberg MT, Moldwin RM, Stanford EJ. Early diagnosis and management of interstitial cystitis: what nonspecialists should know. Women’s Health Gynecol Edition. 2005;5:108-115.
  • Parsons CL, Stanford EF, Kahn, BS, et al. Tools for diagnosis and treatment. Female Patient. 2002;(May Suppl):S12-S17.
  • Siegel JF, Sand PK, Sasso K. Vulvodynia & pelvic pain? Think interstitial cystitis. Nurse Pract. 2008;33(10):40-45.
  • McCormack WM. Two urogenital sinus syndromes: interstitial cystitis and focal vulvitis. J Reprod Med. 1990;35:873-876.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)

IC symptoms can mimic the symptoms of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)

Consider IC in patients who present with1,3

  • Voiding symptoms (urgency, frequency [≥8 voids/day], nocturia)2
  • Generalized pelvic pain2
  • Pain during sexual intercourse2
  • Pain with bladder filling3
  • Unresolved symptoms after empiric antibiotic therapy1

Men presumed to have CP/CPPS who are unresponsive to antibiotic therapy may suffer from IC

  • In 3 separate retrospective studies, 58% to 90% of men with CP/CPPS had cystoscopic findings consistent with IC4-6
    • 58%, N=60; 60%, N=20; 90%, N=30

Patient with CP/CPPS-like symptoms

References:

  • Hanno PM. Bladder pain syndrome (interstitial cystitis) and related disorders. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology. Vol 1. 10th ed. Philadelphia, PA: Saunders Elsevier Inc; 2012;357-401.
  • Rosenberg MT, Moldwin RM, Stanford EJ. Early diagnosis and management of interstitial cystitis: what nonspecialists should know. Women’s Health Gynecol Edition. 2005;5:108-115.
  • Sant GR, Nickel JC. Interstitial cystitis and chronic prostatitis: the same syndrome? In: Nickel JC, ed. Textbook of Prostatitis. Oxford, England: Isis Medical Media Ltd; 1999;169-176.
  • Berger RE, Miller JE, Rothman I, et al. Bladder petechiae after cystoscopy and hydrodistension in men diagnosed with prostate pain. J Urol. 1998;159:83-85.
  • Miller JL, Rothman I, Bavendam TG, Berger RE. Prostatodynia and interstitial cystitis: one and the same? Urology. 1995;45:587-590.
  • Sant GR, Kominski A. Interstitial cystitis in men is frequently misdiagnosed as prostatitis/prostatodynia. Bethesda, MD: National Institutes of Health. 1997 International Research Symposium on Interstitial Cystitis; October 1997.