Pocket ObGyn – Interstitial Cystitis
See Abbreviations
Definition
- Syn characterized by chronic pelvic pain, urinary urgency & frequency, dyspareunia, nocturia
Epidemiology
- Prevalence 10–67/100000 women in US (Obstet Gynecol 2002;100:337)
- Up to ~40% women w/ chronic pelvic pain
Pathophysiology
- Poorly understood, potential theories include mast cell activation, upregulation of sensory nerves, altered bladder wall permeability
Diagnostic Workup/Studies
- Rule out UTI & other causes of chronic pelvic pain
- Bladder diary may show frequent small voids
- Cystourethroscopy w/ hydrodistention ± bx
- Bladder filled to near capacity, emptied, & then inspected for petechial hemorrhages, Hunner ulcers (diagnostic), glomerulations (not diagnostic)
- Potassium sens test – instillation of nml saline into bladder followed by KCl solution, positive if pain present w/ KCl instillation (low spec)
Treatment
- Avoidance of spicy foods, coffee, tea, carbonated beverages, tomatoes
- Hydrodistention can improve sx by 20–30%
- DMSO bladder instillation – anti-inflammatory, bladder anesthetic, decreases mast cell activation, relaxes muscle
- Pentosan polysulfate sodium – heparin analog, 100 mg PO TID, only FDA approved oral drug for IC
- Tricyclic antidepressants – inhibit pain fiber activation, amitriptyline 10–75 mg nightly has shown improv in 2/3 of women