Improved Appreciation of Lidocaine’s Effects Could Improve Diagnosis and Treatment of IC/BPS
Henry RA, Morales A, Cahill CM.. Beyond a Simple Anesthetic Effect: Lidocaine in the Diagnosis and Treatment of Interstitial Cystitis/bladder Pain Syndrome. Urology. 2015 May;85(5):1025-1033. doi: 10.1016/j.urology.2015.01.021.
This review article details the evidence to date supporting the use of lidocaine, a local anesthetic, to treat interstitial cystitis-bladder pain syndrome (IC/BPS). Increasingly, clinicians are using a number of local anesthetics in a variety of combination treatments in patients with IC/BPS. Lidocaine, for one, has proven ability to block the cycle of nervous tissue inflammation found in IC/BPS. Moreover, when lidocaine is delivered intravesically (i.e., directly into the bladder through a catheter), in patients with pelvic pain, it can help identify the bladder as the source of pain. Authors of this review urged doctors and other healthcare professionals to gain a better understanding of how lidocaine works, and to better appreciate its anti-inflammatory effects as more than just a simple anesthetic effect. It is thought that a specific subset of IC/BPS patients, as yet unidentified, may particularly benefit from this type of treatment; therefore, more research on lidocaine in IC/BPS is warranted.
Specific Brain Activity Pattern Reported in Patients With Interstitial Cystitis
Matsumoto S, Matsumoto S, Homma Y. Measurement of oxyhemoglobin concentration changes in interstitial cystitis female patients: A near-infrared spectroscopy study. Int J Urol. 2015 Apr 27. doi: 10.1111/iju.12785. [Epub ahead of print] In a small but provocative study, investigators in Japan found that the frontal lobe of the brain becomes activated in interstitial cystitis patients whose bladders are becoming full. To investigate brain activity related to bladder sensation, brain activity was evaluated in 10 women with interstitial cystitis (average age 68 years) and 10 additional women without interstitial cystitis who served as control subjects. An imaging technique called near-infrared spectroscopy was used to measure blood flow in the frontal lobe of the brain, which in recent years has been identified as an important part of the brain with regard to controlling urination. The investigators found that, during bladder filling, the brains of the women with interstitial cystitis exhibited an increase in oxyhemoglobin concentration in both the right and left hemisphere of the frontal cortex, indicating that the region was activated. The difference was particularly observed in specific areas of the frontal cortex that have been linked to urination and sensory modulation.
New Concepts on Functional Chronic Pelvic and Perineal Pain: Pathophysiology and Multidisciplinary Management
Ploteau S, Labat JJ, Riant T, Levesque A, Robert R, Nizard J. New concepts on functional chronic pelvic and perineal pain: pathophysiology and multidisciplinary management. Discov Med. 2015 Mar;19(104):185-92.
In this article, authors suggest a new paradigm for thinking about where chronic pelvic and perineal pain come from and how the pain is expressed. They note that a variety of painful diseases such as bladder pain syndrome (BPS), irritable bowel syndrome (IBS) and chronic pelvic pain syndrome (CPPS) have a lot in common; for example, they may have the same type of triggering events or clinical background. However, the pain symptoms may vary from patient to patient. The authors suggest that rather than thinking of the pain as organ-based (e.g. bladder-based), clinicians should understand several types of complex pelvic pain that have been identified beyond just looking at the organ involved. These subtypes include: neuropathic pain, central sensitization (fibromyalgia), complex regional pain syndrome, and emotional components similar to what is seen in post-traumatic stress disorder. These four subtypes can be used to devise treatment options that are personalized to a specific patient.
In Absence of Pain, Physicians May IC Diagnosis, Leaving Patients Without Treatment
Nanri M, Nanri M, Nanri K. [Interstitial cystitis in urology clinic: current status and problems]. Nihon Hinyokika Gakkai Zasshi. 2014 Oct;105(4):178-82.
In this study, investigators wanted to learn more about complications in the diagnosis and treatment of interstitial cystitis (IC) in daily clinical practice. They found that of 67 patients they confirmed had IC, 29 (43%) had no pain. Moreover, the time taken to diagnose these patients was longer compared with the time to diagnosis for patients who did have pain. Based on these results, they concluded that general physicians often have difficulty diagnosing IC when pain isn’t present, and thus, aren’t recommending aggressive treatment. They recommended that physicians should keep in mind that IC patients may not necessarily experience pain. They also recommend general physicians obtain a working knowledge of Hunner’s ulcer, and understand how patients with IC might benefit from certain behavioral or dietary changes.
Botulinum Toxin (Botox) Effective for Some Urologic Conditions, But Questions Remain
Chung E. Botulinum toxin in urology: a review of clinical potential in the treatment of urologic and sexual conditions. Expert Opin Biol Ther. 2015 Jan;15(1):95-102. doi: 10.1517/14712598.2015.974543. Epub 2014 Oct 27.
This article provides a review of published medical literature on botulinum toxin (Botox) as a treatment for a variety of sexual or urologic and conditions, including interstitial cystitis/bladder pain syndrome (IC/BPS). The authors of the review concluded that botulinum toxin can be effective in carefully selected patient groups. Moreover, it is well tolerated by many patients and has minimal adverse effects. However, larger studies are needed to help answer many questions about the treatment; in particular, what the key factors are that lead to treatment success. Currently, botulinum toxin is approved for two different urologic indications: treatment of overactive bladder symptoms, and treatment of incontinence in patients who have overactive bladder due to a neurologic condition. It’s also been studied as a treatment for chronic pelvic pain and benign prostatic hyperplasia (BPH), among other conditions.
Metabolomics Provides a Fingerprint of IC’s Pathophysiological Mechanisms
Fiehn O, Kim J. Metabolomics insights into pathophysiological mechanisms of interstitial cystitis. Int Neurourol J. 2014 Sep;18(3):106-14. doi: 10.5213/inj.2014.18.3.106. Epub 2014 Sep 24.
This article provides an overview of the advanced techniques now used to find biomarkers in the urine of patients with IC. In particular, the article highlights the use of metabolomics, a process by which researchers are able to pinpoint specific chemical fingerprints that cells leave behind that can give clues to how a disease might work. By developing a unique fingerprint of IC using metabolomics, researchers hope to identify biomarkers (measurable substances at the cellular, molecular, or biochemical level) that can help clinicians diagnose IC, determine whether an IC patient will respond to a certain therapy, or help determine a patient’s prognosis. Metabolomics research has already yielded useful biomarkers in cancer, diabetes, and other diseases. One such example of a promising biomarker identified for IC is a molecule called an antiproliferative factor (APF), which seems to be elevated in the urine of IC patients.
Oral Medications Can Help, But Aren’t Effective Long Term, for IC, Researchers Say
Dancel R, Mounsey A, Handler L. Medications for treatment of interstitial cystitis. Am Fam Physician. 2015 Jan 15;91(2):116-8.
This evidence summary for family physicians was designed to evaluate which oral medications are effective for the management of interstitial cystitis. Based on systematic review of five randomized clinical trials including 569 patients in Europe, the researchers concluded that no oral medications available now are clinically effective in the long term. Pentosan (Elmiron) improve overall symptom scores for interstitial cystitis for three to six months, but for individual symptoms (dysuria, urgency, and frequency) scores weren’t improved compared with patients who received placebo. Likewise, cimetidine (Tagamet) can improve overall symptom scores for interstitial cystitis, and produces about a 50% improvement in nocturia and suprapubic pain; however, it doesn’t improve dysuria, urgency, frequency, relief after voiding, or incomplete emptying. Finally, the researchers recommended that amitriptyline and hydroxyzine (Vistaril) shouldn’t be used to reduce symptom scores for interstitial cystitis.
New AAFP Review Describes State-of-the-Art Diagnosis and Treatment for IC/BPS
Desrosiers L, Garely AD. Urogynecologic conditions: interstitial cystitis/painful bladder syndrome. FP Essent. 2015 Mar;430:17-22.
This review provided by the American Academy of Family Physicians (AAFP), provides need-to-know details on diagnosis and treatment of IC/BPS. They state that the best way to confirm a diagnosis of IC is by cystoscopy, a procedure in which an instrument called a cystoscope is used to examine the inside of the bladder. However, diagnosis can be challenging, and often requires that the physician rule out other potential causes of the symptoms. However, family physicians need not wait for a diagnosis to begin treatment of the symptoms. A variety of different drugs may help, including Elmiron (pentosan polysulfate), the only drug specifically approved for IC in the United States; Tagamet (cimetidine); amitriptyline; and hydroxyzine. The authors suggest treatment be “tailored” to each individual patient, rather than prescribing one medication across the board for every patient. If oral drugs don’t work, they suggest trying intravesical therapy (i.e., liquid treatment provided through a catheter) with dimethyl sulfoxide, heparin, or an anesthetic therapeutic combination containing lidocaine. Any Hunner’s ulcers found on cystoscopy can be treated via a process called fulguration (where an electrical current or laser is used to destroy the tissue). Finally, some treatments they classify as “sometimes useful” include hydrodistention (stretching the bladder with fluid), sacral neuromodulation (a type of electrical stimulation therapy), and injections of Botox (onabotulinumtoxin A).
Quality IC Information Online is Limited, but ICA Gets High Rating
Tirlapur SA, Leiu C, Khan KS. Quality of information on the internet related to bladder pain syndrome: a systematic review of the evidence. Int Urogynecol J. 2013 Apr 20. [Epub ahead of print] Patients often turn to the internet for information on IC and its management, so researchers from the University of London assessed the accuracy, credibility, readability, and quality of the information available online. Based on their criteria, they found 18 suitable English-language websites, of which four fulfilled their criteria for good quality information. The Interstitial Cystitis Association’s website, www.ichelp.org, was one of those four.
IC Doesn’t Always Occur First in Patients with Co-morbid Conditions
Clemens JQ, Elliott MN, Suttorp M, Berry SH. Temporal ordering of interstitial cystitis/bladder pain syndrome and non-bladder conditions. Urology. 2012 Dec;80(6):1227-32. doi: 10.1016/j.urology.2012.06.059.
We know that many of those with interstitial cystitis (IC) also have a non-bladder chronic illness, such as irritable bowel syndrome (IBS) or fibromyalgia. Researchers in the Department of Urology at the University of Michigan Medical Center wanted to know whether one type of disease tends to occur before the other. They surveyed over 3,000 women from the Rand Interstitial Cystitis Epidemiology (RICE) study and found 2,185 women who had IC and a diagnosis of at least one non-bladder condition (IBS, fibromyalgia, chronic fatigue syndrome, migraines, panic attacks, or depression). Survey data showed that the onset of bladder symptoms was not consistently earlier or later than the onset of non-bladder symptoms, which suggests that the progression from isolated bladder symptoms to regional/systemic symptoms is not a predominant pattern in IC (although it may occur in a subset of individuals).
IC Patients More Likely to Have a Variety of Other Conditions
Keller JJ, Chen YK, Lin HC. Comorbidities of bladder pain syndrome/interstitial cystitis: a population-based study. BJU Int. 2012 Sep 28. doi: 10.1111/j.1464-410X.2012.11539.x. [Epub ahead of print] According to researchers at Taipei Medical University in Taiwan, patients with interstitial cystitis/bladder pain syndrome (IC/BPS) are more likely than those without to have a variety of other illnesses as well. With 9,269 subjects with IC and 46,345 controls, the researchers conducted conditional logistic regression analysis to calculate the odds ratio for each of 32 other conditions: hypertension, congestive heart failure, cardiac arrhythmias, blood loss anemia, peripheral vascular disorders, stroke, ischemic heart disease, hyperlipidemia, hepatitis B or C, migraines, headaches, Parkinson’s disease, rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, pulmonary circulation disorders, chronic pulmonary disease, diabetes, hypothyroidism, renal failure, fluid and electrolyte disorders, liver diseases, peptic ulcers, deficiency anemia, depressive disorder, psychoses, metastatic cancer, solid tumor without metastasis, alcohol abuse, drug abuse, and asthma. Those with IC/BPS were consistently more likely to have all the medical conditions investigated except for metastatic cancer, and in particular, they had higher odds of co-existing neurological diseases, rheumatological diseases, and mental illnesses.
Depression Risk Increases with IC Diagnosis
Keller JJ, Liu SP, Lin HC. Increased risk of depressive disorder following diagnosis with bladder pain syndrome/interstitial cystitis. Neurourol Urodyn. 2012 Sep 21. doi: 10.1002/nau.22316. [Epub ahead of print] Researchers in Taiwan found that patients diagnosed with interstitial cystitis had a higher risk of having a depressive disorder within a year of diagnosis than the general population. Using data from the Taiwan Longitudinal Health Insurance Database, the study group included 832 patients with IC and 4,160 controls. Each participant was individually tracked for one year to identify anyone subsequently diagnosed with depression. During that year, the incidence of depressive disorder was 4.69 per 100 person-years in patients with IC, and 0.94 per 100 person-years among the controls, indicating that those with IC are about 5 times more likely than the general population to develop a depressive disorder during the first year after their diagnosis.
Understanding IC Leads to Better Self Care
Yeh HL, Kuo HC, Lin ZC, Lee RP. Correlations among disease perceptions, attitudes and self-care behaviors in patients with interstitial cystitis. Hu Li Za Zhi. 2012 Feb;59(1):30-40.
This study of 82 outpatients receiving IC treatment at a medical center in Taiwan looked at links between disease perceptions (understanding), attitudes, and self-care behaviors. They found that patients with IC who understand the condition tend to have a more positive attitude and do more to take care of themselves than those who don’t. They recommend that healthcare providers make sure that their patients with IC understand the disease, that they encourage a positive attitude, and that they teach proper self-care behaviors.
Review of Diet and IC Educates Urologists
Friedlander JI, Shorter B, Moldwin RM. Diet and its role in interstitial cystitis/bladder pain syndrome (IC/BPS) and comorbid conditions. BJU Int. 2012 Jan 11. doi: 10.1111/j.1464-410X.2011.10860.x. [Epub ahead of print] This review summarizes what we know about the link between diet and bladder pain and discusses the challenge of designing a diet for IC patients who have other conditions that may be sensitive to diet, such as irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, neuropathic pain, and headache. Previous work by these researchers showed that nearly 90 percent of IC patients are sensitive to a variety of comestibles (foods, beverages, additives, and supplements). Citrus fruits, tomatoes, vitamin C, artificial sweeteners, coffee, tea, carbonated and alcoholic beverages, and spicy foods are the items that most commonly tend to exacerbate symptoms, whereas calcium glycerophosphate (Prelief) and sodium bicarbonate tend to improve symptoms. Sensitivities vary from patient to patient and can be affected by the other conditions patients have. The authors recommend finding out in a controlled way what each patient’s sensitivities are, such as with an elimination diet.
Educating Israeli Primary Care Doctors about IC
Stav K, Lindner A. Interstitial cystitis/painful bladder syndrome: a comprehensive review of the current literature. [Article in Hebrew] Harefuah. 2011 Feb;150(2):168-74, 204, 203.
With this review article, these urologists aim to teach primary care physicians in Israel how to recognize IC early and to help manage a multidisciplinary approach to treatment. The article, the authors hope “will result in early diagnosis, saving unnecessary tests and pain to the patients.”
Review Reflects Changing Ideas about IC
Nordling J, Fall M, Hanno P. Global concepts of bladder pain syndrome (interstitial cystitis). World J Urol. 2011 Nov 5. [Epub ahead of print] IC should no longer be considered rare. It may affect up to 2.7 percent of adult women, and up to 20 percent of cases occur in men, said the authors. The article summarizes the literature on the terminology, diagnostic approaches, and treatment. The authors view IC primarily as one of a number of chronic pain syndromes that is distinguished by having bladder-related symptoms, not as a bladder disease itself.
OB/GYNs Can Help Manage Pelvic Nerve Dysfunction
Tu FF, Hellman KM, Backonja MM. Gynecologic management of neuropathic pain. Am J Obstet Gynecol. 2011 May 12. [Epub ahead of print] This article aims to help obstetrician/gynecologists (OB/GYNs) learn how to take the initial step in managing neuropathic pelvic pain, which can include pudendal neuropathy, a condition that may be mistaken for IC or be involved in IC. The authors note that this kind of pain can require team management and consultation with other specialists. Nevertheless, OB/GYNs can take critical first steps, such as a thorough exam to map the pain site and identify potentially involved nerves. Treatment generally involves a combination of surgical, manipulative, or pharmacologic methods. The authors adapted their approach to characterizing nerve dysfunction in pelvic pain from the guidelines of the International Association for the Study of Pain.
Educating Pain Practitioners on Pelvic Pain
Nelson P, Apte G, Justiz R 3rd, Brismeé JM, Dedrick G, Sizer PS Jr. Chronic Female Pelvic Pain, Part 2: Differential Diagnosis and Management. Pain Pract. 2011 Jul 31. doi: 10.1111/j.1533-2500.2011.00492.x. [Epub ahead of print] For evaluating and treating pelvic pain, these pain management specialists urge using a systematic approach to examining the pelvis and its organ systems to identify the painful structures and how function is limited, which will guide a program of treatment. They describe the gynecologic, urologic, gastrointestinal, musculoskeletal, and neurologic conditions that can cause or are associated with chronic pelvic pain. For management, they describe cognitive behavioral approaches, ways to address movement dysfunctions, and interventional pain technique possibilities.
Inflammation Is Major Target in IC Treatment
Grover S, Srivastava A, Lee R, Tewari AK, Te AE. Role of inflammation in bladder function and interstitial cystitis. Ther Adv Urol. 2011 Feb;3(1):19-33.
Although there are many theories about the cause of IC, inflammation plays a central role, according to these authors. They go on to detail the potential causes and describe management with multimodal therapy designed to break the cycle of chronic inflammation. Surgery is the last resort for irreversible damage such as bladder fibrosis—the thickening, hardening, and scarring of the bladder.
Article Educates Urologic Nurses about IC
Borch M, Baron B, Davey A, Hattala P, Kiernan M, Rust K, Schempp BA, Trzcinski B, Wasilewski A, Yovanovich J. Management of patients with interstitial cystitis: a case study. Urol Nurs. 2011 May-Jun;31(3):183-9.
For urologic nurses, this article gives an overview of the history, symptoms, diagnosis, and treatment of IC.
Connections Between Headache and IC
Hoffman D. Understanding Multisymptom Presentations in Chronic Pelvic Pain: The Inter-relationships Between the Viscera and Myofascial Pelvic Floor Dysfunction. Curr Pain Headache Rep. 2011 Jul 8. [Epub ahead of print] This article in a journal focused on headache helps raise IC awareness with healthcare providers who care for headache patients. The authors pointed out that patients with chronic pelvic pain often have symptoms involving more than one organ system. The theories to explain why this might be the case include such things as pain-signal “crosstalk,” too-tight pelvic floor muscles, and central sensitization.
Thinking in Syndromes
Tunuguntla HS, Tunuguntla R, Barone J, Kanagarajah P, Gousse AE. Voiding Dysfunction in the Female Patient: Is the “Syndrome” Paradigm Valid? Curr Urol Rep. 2011 Jul 5. [Epub ahead of print] The article emphasizes that voiding problems in women and girls significantly affect quality of life, but the problems are poorly understood, and the differentiation into “syndromes” is controversial. Nevertheless, the authors recommend a “syndromic” approach to overactive bladder, IC, and painful bladder syndrome.
Pain Specialists Get Pelvic Pain Education
Apte G, Nelson P, Brismée JM, Dedrick G, Justiz R 3rd, Sizer PS Jr. Chronic Female Pelvic Pain-Part 1: Clinical Pathoanatomy and Examination of the Pelvic Region. Pain Pract. 2011 May 26. doi: 10.1111/j.1533-2500.2011.00465.x. [Epub ahead of print] This article in a journal for pain specialists emphasizes the impact of chronic pelvic pain and recognizes that pelvic pain can have a urologic origin as well as gynecologic, gastrointestinal, and musculoskeletal ones. Fifteen percent of women experience pelvic pain at some point in their lives, and healthcare for pelvic pain costs some $2.8 billion a year. The article advises pain practitioners to treat various and possibly multiple pain generators.
Connecting Chronic Pains
Kindler LL, Bennett RM, Jones KD. Central sensitivity syndromes: mounting pathophysiologic evidence to link fibromyalgia with other common chronic pain disorders. Pain Manag Nurs. 2011 Mar;12(1):15-24. Epub 2009 Dec 2.
This review article for pain management nurses takes note of the growing medical literature connecting a number of chronic pain syndromes, such as IC, irritable bowel syndrome (IBS), fibromyalgia, and temporomandibular joint disorder as abnormalities of pain processing or “central sensitivity syndromes.”
Italian Review of Hyperbaric Oxygen Therapy
Passavanti G. The use of the hyperbaric oxygenation therapy in urology. Arch Ital Urol Androl. 2010 Dec;82(4):173-6.
This article in an Italian urology journal discusses how hyperbaric oxygen therapy is being used for urologic conditions, including IC. The treatment reduces inflammation and pain, increases the susceptibility of bacteria to antibiotics, enhances immune function, increases testosterone secretion in men, and aids wound healing. The therapy may be useful in IC and several other urologic conditions, including scroto-perineal fascitis, radiation-induced cystitis (and proctitis), and chronic pelvic pain. The promising technique deserves further research, said the author.
Italian Review Educates about Pelvic Floor Physical Therapy
Rosenbaum TY. Pelvic floor physiotherapy for women with urogenital dysfunction: indications and methods. Minerva Urol Nefrol. 2011 Mar;63(1):101-7.
This article in an Italian urology journal by a physical therapy specialist shows the value of pelvic floor physical therapy in women with urologic problems, including pelvic and sexual pain, incontinence, and prolapse. The article updates urologists on the medical literature about the therapy and describes the techniques.
Review Educates German-speaking Doctors about IC
Meyer D, Gregorin J, Schmid HP. Diagnosis and treatment of interstitial cystitis. [Article in German] Praxis (Bern 1994). 2011 Feb 16;100(4):221-7.
This article in a journal from Switzerland reviews IC diagnosis and treatment for German-speaking clinicians. The author points out that IC is now regarded as a very common disease that is underdiagnosed. Doctors can make a preliminary diagnosis based on a careful history and physical examination, and multimodal therapies are promising, said the author.
Review Educates Internists
Hanno P, Nordling J, Fall M. Bladder pain syndrome. Med Clin North Am. 2011 Jan;95(1):55-73.
This review article for internists goes over IC diagnosis, noting that the symptoms are now thought to affect up to three percent of the female population in the United States and that the ratio of females to males is five to one. Although diagnosis and treatment are challenging, it is not a psychological problem, overactive bladder, or chronic urinary infection—misdiagnoses that have plagued IC patients, said the authors.
Pelvic Floor Dysfunction, Perineal Pain Recognized in Gastroenterology Journal
Andromanakos NP, Kouraklis G, Alkiviadis K. Chronic perineal pain: current pathophysiological aspects, diagnostic approaches and treatment. Eur J Gastroenterol Hepatol. 2010 Nov 12. [Epub ahead of print] This article by Greek surgeons helps educate gastroenterologists about the disorders that can result from pelvic floor neuromuscular dysfunction, including anorectal incontinence, urinary incontinence and constipation resulting from obstructed defecation, sexual dysfunction, and pain syndromes. The most common disorders of the pelvic floor muscles that are accompanied by perineal pain are levator ani syndrome, proctalgia fugax, myofascial syndrome, and coccygodynia. Diagnosing these syndromes requires taking a thorough history and doing a thorough physical examination along with excluding similar conditions and doing some tests. Diagnosing these problems accurately helps physicians chose the appropriate treatment and avoid unnecessary and ineffective surgical procedures, which are often done in an attempt to alleviate the patient’s symptoms, said the authors.
Romanian Journal Reviews IC
Persu C, Cauni V, Gutue S, Blaj I, Jinga V, Geavlete P. From interstitial cystitis to chronic pelvic pain. J Med Life. 2010 Apr-Jun;3(2):167-74.
Romanian urologists helped educate their medical colleagues with this review of IC in a Romanian general medical journal. They wrote that, although many things are still unclear about IC’s cause, character, and treatments, the multidisciplinary approach is the best way to manage it. Doing that takes a good integration and knowledge of all pelvic organ systems and other systems, including musculoskeletal, neurologic, and psychiatric systems, they emphasized.
Pelvic Floor Disorders Described for Norwegian Doctors
Rognlid M, Lindsetmo RO. Overactive pelvic floor syndrome. [Article in Norwegian] Tidsskr Nor Laegeforen. 2010 Oct 21;130(20):2016-20.
This article in a general Norwegian medical journal gives Norwegian doctors an overview of “overactive pelvic floor dysfunction,” which we might call high-tone pelvic floor dysfunction here in the United States. The dysfunction can lead to a number of pain conditions, and it takes a multidisciplinary approach to help, wrote these authors. They noted that the main symptoms are pain and difficulties with defecation. They also said that the pain can be aggravated by micturition, sexual intercourse, orgasm, defecation, and sitting on hard surfaces and that it reduces the ability to work and quality of life in general. The authors noted that injection of Botulinum toxin (Botox) in the pelvic floor muscles seems to alleviate pain in many patients, but they also said that pelvic-floor directed physical therapy can be useful. It takes close cooperation between gastroenterologists, surgeons, urologists, gynecologists, neurologists, physiotherapists, and possibly pain clinics to improve the situation for patients, concluded the authors.
Review Educates Mexican Gynecologists
Flores-Carreras O, González-Ruiz MI, Martínez-Espinoza CJ, Calderón-Lara SA. Clinical and diagnostic evaluation in patients with interstitial cystitis. [Article in Spanish] Ginecol Obstet Mex. 2010 May;78(5):275-80.
These Mexican urogynecologists described the symptoms of IC for their colleagues, based on symptoms reported by patients who were treated for lower urinary tract symptoms at their clinic. The most common symptoms were urinary frequency (100 percent) nocturia (94 percent), urgency (72 percent), pain (67 percent), urgency-incontinence (17 percent); 55 percent of the patients had glomerulations, and 45 percent had Hunner’s lesions. Urogynecologists should consider IC when patients show symptoms of bladder irritability and associate pain with the bladder filling, said the authors. They also said that cystoscopy is enough to confirm the diagnosis, which differs from current thinking in the United States.
Review Helps Italian-speaking Providers Recognize IC
Galosi AB, Montironi R, Mazzucchelli R, Lacetera V, Muzzonigro G. Interstitial cystitis: minimal diagnostic criteria. [Article in Italian] Urologia. 2010 Oct 2;77(3):160-171.
These Italian urologists outline what’s needed for diagnosis of IC. Their recommendations reflect those commonly used in Europe, which generally include more tests than recommended in the United States.
Review Teaches Gynecologists about IC
Lau TC, Bengtson JM. Management strategies for painful bladder syndrome. Rev Obstet Gynecol. 2010 Spring;3(2):42-8.
This review in a gynecology journal aims to help gynecologists understand IC and the treatments available for it, even though there is no consensus on the definition and little high-quality evidence to back up therapies.
Article Educates Primary Care Doctors on IC
Martinez-Bianchi V, Halstater BH. Urologic chronic pelvic pain syndrome. Prim Care. 2010 Sep;37(3):527-46, viii.
This review article in a primary care journal will help educate primary care physicians about IC. The article emphasizes that ruling out other diagnoses is important. It also notes that, although FDA-approved treatment options are limited, many symptom-based treatments can reduce symptoms and improve quality of life. The abstract also includes “prostatodynia” as part of “painful bladder syndrome,” but prostatodynia is usually thought of as chronic prostatitis/chronic pelvic pain syndrome, which is often more broadly categorized as urologic chronic pelvic pain.
Patel BN, Evans RJ. Overactive Bladder and Pain: Management Strategies. Curr Urol Rep. 2010 Sep 7. [Epub ahead of print] This article reviews treatments for IC, referred to here as overactive bladder associated with pain. The article goes over medication and other treatments, including instillations and surgical treatments, and the concept of phenotyping in treatment.
Urologic Applications of Botox Are Taking Off
Hanchanale VS, Rao AR, Martin FL, Matanhelia SS. The Unusual History and the Urological Applications of Botulinum Neurotoxin. Urol Int. 2010 Jul 27. [Epub ahead of print]
This article outlines the history of the identification of botulinum toxin and its medical use. It also discusses the applications in urology, including IC and prostate pain. Applications have evolved “exponentially,” said the authors, who expect botulinum toxin’s use to continue to broaden in urology.
Primary Care Primer Raises Awareness Among Nonspecialists
Martinez-Bianchi V, Halstater BH. Urologic Chronic Pelvic Pain Syndrome. Prim Care. 2010 Sep;37(3):527-546.
This article about urologic pelvic pain in a major publication for primary care physicians will help raise IC awareness among doctors who are not specialists and help them learn how to help diagnose and treat IC and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). The authors emphasized careful history taking, physical exams, and laboratory tests to rule out other conditions. They also noted that FDA-approved treatments are few, but that symptom-based treatments can be very helpful. The abstract included IC and “prostatodynia” under the term “painful bladder syndrome.” Many IC and chronic prostatitis/chronic pelvic pain syndrome specialists, however, distinguish between these conditions in men and treat accordingly.
South American Medical Journal Educates on IC
Young P, Finn BC, González M, Comercio LP, Quezel M, Bruetman JE. Interstitial cystitis. A challenge for the clinician. Medicina (B Aires). 2010;70(4):364-6.
This Spanish article in a general medical journal, published in Argentina, describes IC, noting that ulcerative and nonulcerative IC can be distinguished cystoscopically and are treated differently. The authors emphasize starting treatment with the least invasive therapy that offers relief. The article also reports on a case of IC that responded well to amitriptyline.
Pelvic Pain Calls for Multidisciplinary Treatment
Romão AP, Gorayeb R, Romão GS, Poli-Neto OB, Dos Reis FJ, Rosa-E-Silva JC, de Freitas Barbosa H, Nogueira AA. Chronic pelvic pain: multifactorial influences. J Eval Clin Pract. 2010 Jul 13. [Epub ahead of print]
These clinicians argue for interdisciplinary care for chronic pelvic pain because it likely results from a complex interaction of the nervous, musculoskeletal and endocrine systems and is also influenced by psychological and sociocultural factors. The authors encourage more research to clarify what the interactions are and to come up with more effective treatment. Meanwhile, interdisciplinary care can minimize the impact of the disease, helping patients cope with symptoms and improving their quality of life.
Article Educates Women’s Healthcare Professionals about IC
Butrick CW, Howard FM, Sand PK. Diagnosis and Treatment of Interstitial Cystitis/Painful Bladder Syndrome. J Womens Health (Larchmt). 2010 May 22. [Epub ahead of print]
These urogynecologist and gynecologist authors raised awareness and knowledge of IC among their colleagues with this article on IC etiology, diagnosis, and treatment. They pointed out that the symptoms overlap with other conditions such as endometriosis, recurrent urinary tract infection, chronic pelvic pain, overactive bladder, and vulvodynia. They emphasized that taking a thorough history and performing a physical examination are critical for diagnosing IC and that patients need education and frequent follow-up. Moreover, they said, a multimodal approach to therapy can provide optimal relief.
Most Primary Care Doctors Know About IC
Clemens JQ, Calhoun EA, Litwin MS, Walker-Corkery E, Markossian T, Kusek JW, McNaughton-Collins M; Urologic Pelvic Pain Collaborative Research Network. A Survey of Primary Care Physician Practices in the Diagnosis and Management of Women With Interstitial Cystitis/Painful Bladder Syndrome. Urology. 2010 Mar 18. [Epub ahead of print]
A survey of primary care doctors highlights an IC awareness success—most of them are familiar with IC. They may not use standard treatments, however, and they usually refer patients to specialists. Nearly 300 primary care providers (PCPs) responded to a questionnaire mailed to more than 500 PCPs in Boston, Los Angeles, and Chicago. The questionnaire described a woman with typical IC symptoms and asked questions about the potential causes of the condition, how to manage it, and how familiar the doctors were with it. Only 19 percent of the PCPs said they had never seen a patient like the one described. Two-thirds correctly identified the hallmark symptom—bladder pain and pressure. Nearly all (90 percent) also knew that IC is not an infectious disease, 76 percent correctly reported that it was not caused by a sexually transmitted infection, and 61 percent correctly indicated that IC is not caused by a psychiatric illness. Common treatments the PCPs used included antibiotics and nonsteroidal anti-inflammatory agents. Often, the dotors referred patients to specialists.
Computer Trainer Boosts Med Students’ Pelvic Floor Knowledge
Hampton BS, Sung VW. Improving medical student knowledge of female pelvic floor dysfunction and anatomy: a randomized trial. Am J Obstet Gynecol. 2010 Apr 27. [Epub ahead of print]
Adding a computer trainer to usual teaching about female anatomy and the pelvic floor boosted medical school students’ knowledge and attitudes. The authors had students fill out questionnaires after some had the usual training and others who got computer training in addition. The ones with the additional training got significantly higher scores.
Pain Practitioners Learn About IC
Moldwin RM, Allen P, Gordon B. Pain practitioners: critical partners in interstitial cystitis care. Pain Practitioner 2010 Spring;20(1):34-40.
Aimed at helping pain practitioners learn about the role they can play in the treatment of IC pain, the article reviews the current understanding of what IC is, what the common treatments are, and the more out-of-the-box pain therapies that top IC experts are using for IC pain. Because IC patients’ community doctors may not use these therapies or more traditional treatments pain specialists are trained to use, such as opioid therapy, pain management specialists can play an important role in providing these helpful therapies to IC patients.
International Committee Reviews Everything IC
Hanno P, Lin A, Nordling J, Nyberg L, van Ophoven A, Ueda T, Wein A. Bladder pain syndrome international consultation on incontinence. Neurourol Urodyn. 2009 Dec 18;29(1):191-198. [Epub ahead of print]
A committee of the International Consultation on Incontinence did a comprehensive review of what is known about IC and made decisions about the name, the potential causes, the epidemiology, the disease process, diagnosis, and more. This group decided to use the name “bladder pain syndrome (BPS).” Treatment should start with “conservative management,” stepping up to various oral medications and bladder instillations. Most surgical therapies should be reserved for cases that don’t respond to any other treatment. The group emphasized that pain management is critical throughout the treatment process. The committee said that IC is best viewed as one of a group of chronic pain syndromes rather than, primarily, as an inflammatory bladder disorder.
Evaluating, Treating Pelvic Floor Disorders
Butrick CW. Pelvic floor hypertonic disorders: identification and management. Obstet Gynecol Clin North Am. 2009 Sep;36(3):707-22.
This review for gynecologists discusses IC and many other pelvic and genital disorders that are related to high-tone pelvic floor dysfunction. In the review, this urogynecologist spells out what the symptoms and findings are for each, the kinds of diagnostic studies that can be done, and the treatment options. The treatments described include physical therapy, medications, trigger point injections, and botulinum toxin (Botox) injections.
Pelvic Floor Dysfunction Is Common Denominator in Many Conditions
Butrick CW. Pathophysiology of pelvic floor hypertonic disorders. Obstet Gynecol Clin North Am. 2009 Sep;36(3):699-705.
Disorders related to high-tone pelvic floor dysfunction are common, but doctors often don’t consider the pelvic floor when they evaluate and manage these conditions. [read more] High-tone pelvic floor dysfunction is related to stress urinary incontinence, fecal incontinence, pelvic organ prolapse, chronic pelvic pain, bladder pain, retention, and more. That’s because the pelvic floor muscles are key in basic functions: storage of urine and feces, evacuation of urine and feces, support of pelvic organs, and sexual function. Damage to these muscles or too-tight dysfunctional muscles contribute to these disorders.
A How-To for Clinicians on Pelvic Floor Dysfunction
Wieslander CK. Clinical approach and office evaluation of the patient with pelvic floor dysfunction. Obstet Gynecol Clin North Am. 2009 Sep;36(3):445-62.
This article can help doctors learn how to evaluate and treat pelvic floor dysfunction in the clinic. The goal of treatment is to give patients as much symptom relief as possible, noted this author.
Approaches to IC, CP/CPPS Still Changing
Le BV, Schaeffer AJ. Genitourinary pain syndromes, prostatitis, and lower urinary tract symptoms. Urol Clin North Am. 2009 Nov;36(4):527-36, vii.
Pain and urinary symptoms commonly overlap. The genitourinary pain syndromes, such as IC and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), probably have multiple causes, including disorders of the bladder and/or prostate. Evaluation and treatment is still changing, but the authors summarize a general approach.
Mathieu N. Somatic comorbidities in irritable bowel syndrome: fibromyalgia, chronic fatigue syndrome, and interstitial cystitis. [Article in French] Gastroenterol Clin Biol. 2009 Feb;33 Suppl 1:S17-25.
These gastroenterologists note that IC and other conditions, including fibromyalgia and chronic fatigue syndrome, often overlap with irritable bowel syndrome (IBS). The more associated conditions patients have, the more they seek health care and have reduced quality of life and increased mood disorders. That suggests some common cause or causes, and “central hypersensitization” is one of the latest theories for it.
Neis KJ, Neis F. Chronic pelvic pain: cause, diagnosis and therapy from a gynaecologist’s and an endoscopist’s point of view. Gynecol Endocrinol. 2009 Nov;25(11):757-61.
Unfortunately, this article carries the message that if a laparoscopist finds no endometriosis or adhesions, women with pelvic pain should be sent to psychosomatic physicians. The authors rightly noted that chronic pelvic pain is a significant problem and that women often consult various physicians without getting a correct diagnosis. The authors said that in one-third of cases, the reason for pain is endometriosis and, in another third, adhesions, and that if no reason for the pain can be found laparoscopically, patients should be sent to a psychosomatic physician.
Providers for Midlife Patients Get IC Education
Dasgupta J, Tincello DG. Interstitial cystitis/bladder pain syndrome: An update. Maturitas. 2009 Oct 16. [Epub ahead of print]
This update on the latest ideas about the cause, the terminology, and the treatments for IC appeared in a journal aimed at a broad cross-section healthcare professionals who take care of patients at midlife. The article noted that the mainstays of treatment are bladder instillations and oral drugs.
Review Helps Educate Kidney Specialists Worldwide
Moutzouris DA, Falagas ME. Interstitial Cystitis: An Unsolved Enigma. Clin J Am Soc Nephrol. 2009 Oct 1. [Epub ahead of print]
This review article in an international journal for kidney specialists informs them about IC and reminds them to keep the IC diagnosis in mind when they see patients with chronic urinary symptoms. The article pointed out that the diagnosis is still one made after ruling out other more common conditions and that “supportive” therapies (psychosocial, behavioral, and physical), instillations, and oral medications are the mainstays of treatment. Neuromodulation and surgery are reserved for difficult cases that don’t respond to other treatment.
Recognition of IC as Potential Cause of Pelvic Pain Growing Worldwide
Siedentopf F. Chronic pelvic pain in women from a gynecologic viewpoint. [Article in German] Urologe A. 2009 Oct;48(10):1193-4,1196-8.
This article by a gynecologist in a German urology journal shows that awareness of IC is growing among gynecologists worldwide. Chronic pelvic pain has a number of possible gynecologic causes, but the author also included irritable bowel syndrome, IC, and fibromyalgia as potential causes.
Spasm of Pelvic Floor Muscle Can Cause Pelvic Pain
Hull M, Corton MM. Evaluation of the levator ani and pelvic wall muscles in levator ani syndrome. Urol Nurs. 2009 Jul-Aug;29(4):225-31.
This article encourages nurses to learn about pelvic floor muscles and how to identify spasm, which can cause pelvic pain. Specifically, levator ani (one of the pelvic floor muscles) spasm syndrome is discussed in the article.
Article Raises Awareness, Reviews Skills for Pelvic Floor Dysfunction Practice
Prather H, Dugan S, Fitzgerald C, Hunt D. Review of anatomy, evaluation, and treatment of musculoskeletal pelvic floor pain in women. PM R. 2009 Apr;1(4):346-58.
This article is a review of skills for physical therapists who treat musculoskeletal dysfunction of the pelvic floor and a resource for physical therapists who are interested in expanding their practice to pelvic floor disorders. If healthcare providers can recognize pelvic floor dysfunction better, impairment and disability for women with pelvic floor pain will be reduced. Further research, awareness, and care are needed, said the authors.
Gynecologists Urge Colleagues to Consider IC
Dell JR, Mokrzycki ML, Jayne CJ. Differentiating interstitial cystitis from similar conditions commonly seen in gynecologic practice. Eur J Obstet Gynecol Reprod Biol. 2009 Jun;144(2):105-9. Epub 2009 May 5.
IC looks similar to many other conditions gynecologists see in women, so consider IC as a diagnosis when patients have urinary symptoms or pelvic pain, said these gynecologists. Their review pointed out that IC has similarities with recurrent urinary tract infections, endometriosis, chronic pelvic pain, vulvodynia, and overactive bladder and that IC may exist along with these conditions. Patients need a correct diagnosis to get treated appropriately.
Helping GYNs Recognize IC
Dell JR, Mokrzycki ML, Jayne CJ. Differentiating interstitial cystitis from similar conditions commonly seen in gynecologic practice. Eur J Obstet Gynecol Reprod Biol. 2009 Apr 29. [Epub ahead of print]
This article is a lesson in how to tell IC apart from other conditions gynecologists see. These gynecologists let their colleagues know that diagnosing IC correctly is critical for their patients’ well-being. IC shares features with many conditions gynecologists commonly see, including recurrent urinary tract infections, endometriosis, chronic pelvic pain, vulvodynia, and overactive bladder, and can often coexist with these conditions. Gynecologists should consider an IC diagnosis when patients have bothersome voiding symptoms and/or pelvic pain. Tools to aid diagnosis and effective therapies are available, the authors emphasized.
APF Has Potential for IC, Cancer
Barchi JJ Jr, Kaczmarek P. Short and sweet: evolution of a small glycopeptide from a bladder disorder to an anticancer lead. Mol Interv. 2009 Feb;9(1):14-7.
This review article in a journal for basic medical scientists describes the glycopeptide antiproliferative factor (APF) and its role in IC. APF is unusual because small glycopeptides secreted in the body rarely play a role in the progression of a disease. APF dramatically inhibits normal bladder cell proliferation and is thought to cause some of the characteristic pathological changes in the bladders of IC patients. APF also strongly inhibits the growth of certain tumor cells. How APF interacts with cellular receptors and the structural features critical for its activity are beginning to be understood. This interesting molecule is a powerful model for the design of new treatments and diagnostic tests for IC, as well as an unprecedented lead agent for novel anticancer drugs, said the authors.
Japanese Society Develops Guidelines for IC Diagnosis, Treatment
Homma Y, Ueda T, Ito T, Takei M, Tomoe H. Japanese guideline for diagnosis and treatment of interstitial cystitis. Int J Urol. 2009 Jan;16(1):4-16.
The need for standardized interstitial cystitis guidelines for diagnosing and treating IC has become very apparent over the past few years and has generated a lot of heated debates. There has been much discussion surrounding what exactly IC is, what are its causes, what to call it, how to best diagnose it, and what treatments are most effective. Several countries and professional medical associations are now in the process of developing their own IC Guidelines, including Japan.
IC Experts See Disappointments But Also Promise
Theoharides TC, Whitmore K, Stanford E, Moldwin R, O’Leary MP. Interstitial cystitis: bladder pain and beyond. Expert Opin Pharmacother. 2008 Dec;9(17):2979-94.
These IC experts looked for trends in research and treatment in the literature and found no new effective treatments but promise for finding causes and treatment targets from the growing evidence of connections with other conditions, nerve-generated inflammation, and stress. Oral pentosan polysulfate (Elmiron), amitriptyline (Elavil), hydroxyzine (Atarax, Vistaril), and quercetin as well as heparin, bicarbonate, and lidocaine instillations are being used with variable success. Although many promising treatments have not withstood more rigorous testing, some pilot studies of new treatments are nevertheless encouraging.
IC Experts Inform through Global Clinical Journal
Forrest JB, Moldwin R. Diagnostic options for early identification and management of interstitial cystitis/painful bladder syndrome. Int J Clin Pract. 2008 Dec;62(12):1926-34.
For a worldwide readership of clinicians, these two IC experts discussed the pros and cons of different diagnostic methods and laid out treatment options, including oral medication, bladder instillation, dietary modification, and physical therapy. The authors emphasized early diagnosis and treatment as well good follow-up. Early diagnosis and treatment, they said, can bring better outcomes, and follow-up can be an opportunity to educate and empower patients to participate in their treatment. They also argued that multimodal therapy with an emphasis on patient education can help ensure success in treating IC. This paper is available free-of-charge online.
Medical Student Urges Training in IC
Hazzard MA. A medical student perspective on interstitial cystitis: a view from the womb. Int J Clin Pract. 2008 Dec;62(12):1825-6.
In this editorial, a fourth-year medical student describes his experience studying IC and the stark contrast with his medical education, in which IC was barely mentioned. He said it would be like not noticing the elephant sitting in your living room. Polling his fellow students from other medical schools showed that his experience wasn’t unique. One student asked, “Isn’t that some type of lung disease?” He stated, “As long as medical educators fail to stress the importance and prevalence of IC in the general population, students will continue to advance through their graduate medical training, be deployed onto the front lines of our nation’s medical fields, and millions of patients with IC will continue to suffer needlessly mis- or undiagnosed.” Medical students, he believes, should know what a average bladder capacity, rate of urine production, and, therefore, normal number of voids per day are, just as they know what normal blood pressure is. Although he noted that review articles, like the one above, to educate practicing physicians are good, they are not enough, and that IC leaders should teach medical students, at the very least, to recognize IC. He, like the authors of the educational article above, believe that early diagnosis and treatment is the key to the best outcomes for patients.
Revised Tuesday, May 12th, 2015