Editing Interstitial cystitis (section)

==Causes==
The cause of IC/BPS is not known.<ref name=PMHT0025484>{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0025484/ |title=Interstitial Cystitis (Painful Bladder Syndrome) |work=PubMed Health Glossary |author1=Pmhdev }}</ref> However, several explanations have been proposed and include the following: autoimmune theory, nerve theory, mast cell theory, leaky lining theory, infection theory, and a theory of production of a toxic substance in the urine.<ref>{{Cite journal|last1=Patnaik|first1=Sourav Sanchit|last2=Laganà|first2=Antonio Simone|last3=Vitale|first3=Salvatore Giovanni|last4=Butticè|first4=Salvatore|last5=Noventa|first5=Marco|last6=Gizzo|first6=Salvatore|last7=Valenti|first7=Gaetano|last8=Rapisarda|first8=Agnese Maria Chiara|last9=La Rosa|first9=Valentina Lucia|date=June 2017|title=Etiology, pathophysiology and biomarkers of interstitial cystitis/painful bladder syndrome|journal=Archives of Gynecology and Obstetrics|volume=295|issue=6|pages=1341–1359|doi=10.1007/s00404-017-4364-2|issn=1432-0711|pmid=28391486|s2cid=19926780}}</ref> Other suggested etiological causes are [[neurologic]], [[allergic]], [[genetics|genetic]], and [[stress (biology)|stress]]-psychological including exposure to [[abuse]] in [[child abuse|childhood]] or adulthood.<ref name="IC section of the NKUDIC">{{cite web |url=http://kidney.niddk.nih.gov/kudiseases/pubs/interstitialcystitis/ |title=Interstitial Cystitis/Painful Bladder Syndrome |author=National Institute of Diabetes and Digestive and Kidney Diseases |year=2012 |publisher=National Institutes of Health |access-date=25 October 2012 |url-status=dead |archive-url=https://web.archive.org/web/20121023223150/http://kidney.niddk.nih.gov/kudiseases/pubs/interstitialcystitis/ |archive-date=23 October 2012}}</ref><ref>{{Cite web|last1=Eric S.|first1=Rovner|first2=Colin Murrah|last2=Goudelocke|title=Interstitial Cystitis: Etiology|url=http://emedicine.medscape.com/article/441831-overview#a0102|publisher=MedScape Reference|access-date=1 April 2011|url-status=live|archive-url=https://web.archive.org/web/20110624050503/http://emedicine.medscape.com/article/441831-overview#a0102|archive-date=24 June 2011}}</ref><ref>{{cite web|url=https://www.mdconversation.com/mdconJrun/en/welcome/pres/v2v7/indextables.html?meetingName=hb_spndrsticp0702|title=Understanding Interstitial Cystitis|publisher=MD Conversation / peer-reviewed|access-date=1 April 2011|url-status=dead|archive-url=https://web.archive.org/web/20130718183258/https://www.mdconversation.com/mdconJrun/en/welcome/pres/v2v7/indextables.html?meetingName=hb_spndrsticp0702|archive-date=18 July 2013}}</ref><ref name="pmid=17631336">{{Cite journal|last1=Peters|first1=Kenneth M.|last2=Kalinowski|first2=Scott E.|last3=Carrico|first3=Donna J.|last4=Ibrahim|first4= Ibrahim A.|last5=Diokno|first5=Ananias C.|date=September 2007|title=Fact or fiction—is abuse prevalent in patients with interstitial cystitis? Results from a community survey and clinic population|journal=Journal of Urology|volume=178|issue=3|pages=891–895|doi=10.1016/j.juro.2007.05.047|pmid=17631336}}</ref> In addition, recent research shows that those with IC may have a substance in the urine that inhibits the growth of cells in the bladder epithelium.<ref name=pmid19230927/> An infection may then predispose those people to develop IC. Evidence from clinical and laboratory studies confirms that [[mast cell]]s play a central role in IC/BPS possibly due to their ability to release histamine and cause pain, swelling, scarring, and interfere with healing.<ref name=pmid20968203/> Research has shown a proliferation of nerve fibers is present in the bladders of people with IC which is absent in the bladders of people who have not been diagnosed with IC.<ref name=pmid19808225/>

Regardless of the origin, most people with IC struggle with a damaged [[urothelium]], or bladder lining.<ref>{{cite web|url=http://www.mayoclinic.com/health/interstitial-cystitis/DS00497/DSECTION=causes|title=Causes|year=2012|publisher=Mayo Clinic|access-date=1 October 2012|url-status=live|archive-url=https://web.archive.org/web/20120918081114/http://www.mayoclinic.com/health/interstitial-cystitis/DS00497/DSECTION=causes|archive-date=18 September 2012}}</ref> When the surface [[glycosaminoglycan]] (GAG) layer is damaged (via a urinary tract infection (UTI), traumatic injury, etc.), urinary chemicals can "leak" into surrounding tissues, causing pain, inflammation, and urinary symptoms. Oral medications like [[pentosan polysulfate]] and medications placed directly into the bladder via a [[catheter]] sometimes work to repair and rebuild this damaged/wounded lining, allowing for a reduction in symptoms.<ref name=pmid16706553>{{cite journal |doi=10.2165/00003495-200666060-00006 |pmid=16706553 |title=Pentosan Polysulfate |journal=Drugs |volume=66 |issue=6 |pages=821–35 |year=2006 |last1=Anderson |first1=Vanessa R |last2=Perry |first2=Caroline M |s2cid=46958245 }}</ref> Most literature supports the belief that IC's symptoms are associated with a defect in the bladder epithelium lining, allowing irritating substances in the urine to penetrate into the bladder—a breakdown of the bladder lining (also known as the adherence theory).<ref>{{cite journal|title=Interstitial cystitis/painful bladder syndrome: Symptom recognition is key to early identification, treatment|journal=Cleveland Clinic Journal of Medicine|date=May 2007|volume=74|series=S54–S62|issue=3|url=http://www.auanet.org/eforms/elearning/core/topics/fpm-ngb-incont/cystitis-pps/assets/CLEVELAND-Interstitial%20cystitis-painful%20bladder%20syndrome.pdf|url-status=dead|archive-url=https://web.archive.org/web/20110719024153/http://www.auanet.org/eforms/elearning/core/topics/fpm-ngb-incont/cystitis-pps/assets/CLEVELAND-Interstitial%20cystitis-painful%20bladder%20syndrome.pdf|archive-date=19 July 2011|access-date=1 April 2011}}</ref> Deficiency in this glycosaminoglycan layer on the surface of the bladder results in increased permeability of the underlying submucosal tissues.<ref name=pmid19808225/>

GP51 has been identified as a possible urinary biomarker for IC with significant variations in GP51 levels in those with IC when compared to individuals without interstitial cystitis.<ref name=pmid16986030>{{cite journal|last1=Teichman|first1=JMH|title=The Role of Pentosan Polysulfate in Treatment Approaches for Interstitial Cystitis |journal=Reviews in Urology|year=2002|volume=4|issue=Supplement 1|pages=S21–S27|pmid=16986030|pmc=1476002}}</ref>

A proposed mechanism for interstitial cystitis is the autoimmune mechanism.<ref>{{cite web|title=Adult Conditions / Bladder / Interstitial Cystitis|url=http://www.urologyhealth.org/adult/index.cfm?cat=03&topic=210|publisher=American Urological Association Foundation|access-date=1 April 2011|url-status=dead|archive-url=https://web.archive.org/web/20110303095621/http://www.urologyhealth.org/adult/index.cfm?cat=03&topic=210|archive-date=3 March 2011}}</ref> Some studies have noted the link between IC, anxiety, stress, hyper-responsiveness, panic, and abuse.<ref name="pmid19230927" /><ref name="pmid=17631336" /> Biopsies on the bladder walls of people with IC may contain larger counts of mast cells than healthy bladder walls.  Mast cells, which contain [[histamine]] granules, respond to allergic stimuli. In this theory, Mast cells are activated in response to antigen detection in the bladder wall. The activation of mast cells triggers the release of histamine, amongst other inflammatory mediators.<ref name="Kavaler">{{cite book |first1=Elizabeth |last1=Kavaler |year=2007 |chapter=Interstitial Cystitis and Pelvic Pain Syndromes |pages=271–310 |chapter-url={{Google books|DewU6bqY7EoC|page=271|plainurl=yes}} |title=A Seat on the Aisle, Please!: The Essential Guide to Urinary Tract Problems in Women |publisher=Springer |isbn=978-0-387-36745-3 }}</ref> Additionally, another proposed mechanism is increased activity of unspecified nerves in the bladder wall. An unknown toxin or stimuli may activate nerves within the bladder wall, causing the release of neuropeptides. These neuropeptides can induce a secondary cascade which stimulates pain in the bladder wall.<ref name=pmid20968203/>

===Genes===
Some genetic subtypes, in some people, have been linked to the disorder.
* An antiproliferative factor is secreted by the bladders of people with IC/BPS which inhibits bladder cell proliferation, thus possibly causing the missing bladder lining.<ref name=pmid19808225/><ref name=pmid19230927/>
* PAND, at gene map locus 13q22–q32, is associated with a constellation of disorders (a "[[pleiotropic]] syndrome") including IC/BPS and other bladder and kidney problems, thyroid diseases, serious headaches/migraines, [[panic disorder]], and [[mitral valve prolapse]].<ref name=pmid19230927/>