Description

• A condition characterized by pain, pressure, or discomfort of the bladder or pelvic region associated with one or more of the following urinary symptoms: increased frequency, urgency, or nocturia
• A chronic inflammatory disease of unknown etiology, with associated urinary symptoms for >6 weeks without other identifiable causes such as infection or other pathology
• The symptoms in many patients are insidious, and the disease progresses for years with relapsing and remitting symptoms often before diagnosis is established.
• Types include interstitial cystitis/bladder pain syndrome without Hunner lesions and interstitial cystitis/bladder pain syndrome with Hunner lesions
• System(s) affected: renal/urologic
• Synonym(s): urgency frequency syndrome; IC/bladder pain syndrome; chronic cystitis; Hunner ulcer

Pregnancy Considerations
Unpredictable symptom improvement or exacerbation during pregnancy; may be associated with increased risk of preeclampsia and preterm birth but further prospective studies are needed; usual problems of unknown effect on fetus with medications taken during pregnancy

Epidemiology

• Occurs predominantly among white patients
• Predominant sex: female > male (5:1) in patients 25 to 80 years of age
• Most common in adults >30 years of age and diagnosis increases with age

Incidence
Difficult to estimate due to different diagnostic criteria and regional differences but 1-year incidence has been reported as:

• 21 per 100,000 female patients
• 4 per 100,000 male patients

Prevalence
In the United States:

• Prevalence is variable.
• Up to 1.2 million female and 82,000 male patients are affected, but many cases likely are undiagnosed.
• 0.052% but may be higher up to 10%

Etiology and Pathophysiology

• Etiology is unclear; pathophysiology likely multifactorial
• Potential causes include:
  • Disruption of urothelium, production of antiproliferative factor, and diminished glycosaminoglycan layer
  • Afferent nerve plasticity
  • Pelvic floor dysfunction
  • Mast cell infiltration, bladder nitric oxide
  • Reduced vascularization
  • Neurogenic inflammation
  • Autoimmune

Risk Factors

Unclear but some reported risks include:

• Female
• Recent UTI
• IBS
• Allergies
• History of sexual abuse

Commonly Associated Conditions

• Fibromyalgia/chronic fatigue syndrome
• Allergies
• Depression and panic disorder
• Vulvodynia
• Sexual dysfunction
• Sleep disturbance
• Migraines
• Chronic prostatitis
• Chronic pelvic pain and pelvic floor dysfunction
• IBS
• Anal/rectal disease
• Chronic scrotal pain
• Trauma
• Autoimmune conditions such as SLE and Sjögren syndrome