Practice Uncertainties Page

What is the most effective treatment of interstitial cystitis?

BMJ 2008; 337 doi: (Published 27 November 2008) Cite this as: BMJ 2008;337:a2325
  1. Joseph L Onwude, consultant gynaecologist and medical statistician
  1. 1Springfield Hospital, Chelmsford CM1 7GU
  1. Correspondence to: J L Onwude, Community Gynaecology Ltd, Chelmsford CM1 3RW jlonwude{at}
  • Accepted 2 April 2008

The treatment of interstitial cystitis has many uncertainties, including which treatment is the most effective. Interstitial cystitis is a chronic inflammatory bladder disease that mostly affects women. It can present as recurrent non-bacterial cystitis or as chronic pelvic pain associated with frequency and urgency. It can take up to five years and five doctors to reach the correct diagnosis.w1 Patients with interstitial cystitis are not a homogeneous population. Two distinct types of disease—classic and non-ulcer interstitial cystitis—have been described on the basis of pathological findings, and some treatments might work better for one type than for the other.1 Currently no treatment ladder exists. Oral treatments should be first line and intravesical therapies second line.

Interstitial cystitis can be a debilitating disease and has been described in the United States as a major health problem.w2 The prevalence ranges from 5 per 100 000 women in Japan to 197 per 100 000 women and 41 per 100 000 men in the US.w3 w4 We have no prevalence estimates for the United Kingdom.

Because interstitial cystitis is a distinct pathologic entity, a biopsy can provide definitive diagnosis.w5 However, criteria from the US National Institute of Diabetes and Digestive and Kidney Diseases, which required cystoscopy and bladder distension, need no longer be used.w6 Instead, validated questionnaires like the O’Leary-Sant symptom index and the University of Wisconsin symptom index are now used to diagnose this condition and measure response to treatment.w7

In addition, the International Continence Society now recommends the term interstitial cystitis/painful bladder …

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