Clinical Review

The management of interstitial cystitis or painful bladder syndrome in women

BMJ 2009; 339 doi: 10.1136/bmj.b2707 (Published 31 July 2009)
Cite this as: BMJ 2009;339:b2707

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  1. Serge P Marinkovic, female reconstructive surgeon and women’s medicine specialist1,
  2. Robert Moldwin, associate professor of urology2,
  3. Lisa M Gillen, urology research associate3,
  4. Stuart L Stanton, professor emeritus of urogynecology and reconstructive surgery4
  1. 1St Francis Hospital, 5255 Stop 11 Road, Indianapolis, IN 46259, USA
  2. 2The Arthur Smith Institute for Urology, Long Island Jewish Medical Center, 450 Lakeville Road, Suite M41, New Hyde Park, NY 11040, USA
  3. 3Division of Urology, Southern Illinois School of Medicine, Springfield, IL 62794
  4. 4St George’s Hospital, Tooting, London SW17 0QT
  1. Correspondence to: S P Marinkovic urourogyn{at}yahoo.com
  • Accepted 19 March 2009

Summary points

  • Interstitial cystitis or painful bladder syndrome is a chronic, often debilitating condition, typified by exacerbations, remissions, and varying degrees of symptom severity

  • Symptoms include urinary urgency and frequency, with pelvic pain that varies from abdominal tenderness to intense pain

  • Patients have a 100 times greater chance of having irritable bowel syndrome and 30 times increased likelihood of systemic lupus erythematosus

  • Other associated illnesses include migraine, asthma, fibromyalgia, incontinence, chronic fatigue syndrome, and vulvodynia

  • A history of abuse (domestic violence and emotional, physical, and sexual abuse) is higher than in controls (37% v 22%)

  • Drugs (amitriptyline, pentosan polysulfate sodium, prednisone, and ciclosporin) and minimally invasive surgery are effective treatments

  • In some patients symptoms are exacerbated by certain foods and drinks

Interstitial cystitis or painful bladder syndrome is a chronic, often debilitating, condition largely defined by symptoms of urinary urgency and frequency associated with pelvic pain that varies with bladder filling.1 Unlike bladder inflammation caused by bacterial infection, the condition occurs in the absence of urinary tract infection or other obvious pathology. Resulting discomfort may range from abdominal tenderness to intense pain. This difficult clinical entity has prompted debate with regard to definition, aetiology, and best methods of treatment. This review discusses the diagnosis and management of interstitial cystitis according to current best evidence. Few Oxford scale levels 1 and 2 evidence based research studies in interstitial cystitis are available because of the ethical difficulties in conducting randomised trials in this area. We have therefore referred to evidence that represents the majority opinion of researchers as being clinically relevant.

Sources and selection criteria

We conducted a Medline search for the years 1988-2009, using the key words “interstitial cystitis”, “painful bladder syndrome”, and “bladder inflammation.” We initially selected 118 references, but only 26 were used.

What is interstitial cystitis and who gets it?

The pathological features of bladder epithelial damage and related blood vessel …

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