What is interstitial cystitis?

Interstitial cystitis, or what is now commonly called bladder pain syndrome, affects approximately 5-7% of all women in the United States.  It involves symptoms of urinary frequency, and pelvic pressure and discomfort that are typically worse when the bladder is full.  Since its original description more than 100 years ago our understanding of this pain disorder has become much clearer.  Patients can present with episodes of symptoms that appear to be a bladder infection but once a urine culture is done the test returns negative.  Some patients will have symptoms that are continuous-like a bladder infection that never resolves.  We now understand that there are many types of this bladder pain syndrome including a unique type associated with ulcers that affects approximately 5-10% of all patients with this pain disorder.  The majority of patients, 75%, have bladder symptoms that are a part of a diffuse pain disorder.  This means that not only is the bladder causing symptoms but there are many other pain generators. Those other pain disorders might be pelvic floor pain, irritable bowel disease, vulvodynia or even fibromyalgia.  Many patients have symptoms that primarily revolve around the bladder including urinary frequency, urethral pain and voiding dysfunction. This is referred to as bladder centric painful bladder syndrome.  What is extremely clear is that more than 85% of patients who are diagnosed to have IC/BPS also have significant high tone pelvic floor dysfunction.  This can be the cause of the bladder symptoms and in some patients this problem occurs as a result of the pain that originates in the bladder.  It is like the classic question of which comes first “the chicken or the egg?”.  Now that we know what IC/BPS is, we have a much better understanding of how to treat it.  I see patients from around the country with this problem and I stress that each patient must have an individualized approach to the management of this pain disorder.