- defined as
- an unpleasant sensation (suprapubic pain, pressure, discomfort)
- related to bladder filling
- associated with urinary symptoms – urinary urgency and frequency, nocturia, dyspareunia
- absence of infection or other identifiable causes
- > 6 months
- exact cause of this condition is unknown
- ?infection
- ?toxins – noxious stimuli causing injury to the bladder or epithelium
- ?bladder wall defects
- ?pelvic floor dysfunction
- ?autoimmune disorders
- diagnosis is one of exclusion
- 90% of affected people are women
- commonly in their 20s to 40s
- Without a thorough investigation, BPS/IC can be easily misdiagnosed as vaginitis, vulvodynia or pelvic floor dysfunction in female patients.
- The diagnosis
- Initial investigations
- Urinalysis to exclude infection, haematuria and glycosuria
- Urinary tract ultrasound and measurement of postresidual volume (>30ml)
- Frequency/volume chart for at least 3 days – exclude 24-hour polyuria due to diabetes insipidus, and nocturnal polyuria
- Bladder diary for a minimum of 3 days
- Secondary investigations
- Cystoscopy- Hunter’s ulcers
- Hydrodistention – may reveal petechial haemorrhages (glomerulations) in symptomatic patients which are indicative of disease state
- Urodynamic testing – are not always essential and are sometimes used to investigate bladder function particularly if blockage/ retention problems or problems with the nerve supply to the bladder are suspected
- Management
- multidisciplinary approach
- dietary modification
- Some foods and drinks are known to make symptoms worse in many patients.
- These include tomatoes, citrus fruits, bananas, chocolate, cheese, mayonnaise, nuts, onions, raisins, sour cream, yoghurt, spicy foods, coffee, wine, beer and carbonated drinks.
- try an elimination diet, cutting out suspect foods one by one to see which may cause symptoms.
- behavioural modification
- Addressing stress, depression, anxiety and relationship difficulties that occur in combination with IC /PBS
- Relaxation techniques that can help improve overall coping
- Medications
- Amitriptyline, an antidepressant used to block pain – anticholinergic (suppression of urge to urinate) effects.
- Anti-histamines, believed to reduce inflammation in the bladder.
- Pentosan polysulfate (Elmiron), a drug specifically approved for IC which is designed to restore the GAG layer of the lining of the bladder wall to protect it from irritants in the urine which cause inflammation. This is not on the PBS and costs about $200 per month.
- Gabapentin, a pain modifier
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