Editing Interstitial cystitis

{{Short description|Medical condition of the bladder and pelvic floor}}
{{cs1 config|name-list-style=vanc}}
{{Use dmy dates|date=February 2021}}
{{Infobox medical condition (new)
| name            = Interstitial cystitis
| synonyms        = Bladder pain syndrome (BPS),<ref name=NIH2012/> painful bladder syndrome (PBS), IC/BPS, IC/PBS, [[urologic chronic pelvic pain syndrome|UCPPS]]<ref name="pmid32378039" />
| field           = [[Urology]]
| pronounce       = {{IPAc-en|ˌ|ɪ|n|t|ər|ˈ|s|t|ɪ|ʃ|əl|_|s|ɪ|ˈ|s|t|aɪ|t|ᵻ|s}} {{respell|IN|tər|STISH|əl|_|sist|EYE|tis}}
| image           = JMedLife-03-167-g002.jpg
| caption         = Hunner's lesion seen in some interstitial cystitis patients by [[cystoscopy]]<ref>{{cite journal |last1=Persu |first1=C |last2=Cauni |first2=V |last3=Gutue |first3=S |last4=Blaj |first4=I |last5=Jinga |first5=V |last6=Geavlete |first6=P |title=From interstitial cystitis to chronic pelvic pain. |journal=Journal of Medicine and Life |date=2010 |volume=3 |issue=2 |pages=167–74 |pmid=20968203|pmc=3019050 }}</ref><ref>{{cite book |last1=Stedman |first1=Thomas Lathrop |title=Stedman's Medical Eponyms |date=2005 |publisher=Lippincott Williams & Wilkins |isbn=9780781754439 |page=344 |url=https://books.google.com/books?id=isqcnR6ryz0C&pg=PA344 }}</ref>
| symptoms        = [[Chronic pain]] of the bladder, [[urinary urgency|feeling the need to urinate right away]], [[urinary frequency|needing to urinate often]], [[pain with sex]]<ref name=NIH2012/>
| complications   = [[depression (mood)|Depression]], [[irritable bowel syndrome]], [[fibromyalgia]]<ref name=NIH2012/><ref name=AUA2015/>
| onset           = Middle age<ref name=NIH2012/>
| duration        = Long term<ref name=NIH2012/>
| types           =
| causes          = Unknown<ref name=NIH2012/>
| risks           =
| diagnosis       = Based on the symptoms [[diagnosis of exclusion|after ruling out other conditions]]<ref name=AUA2015/>
| differential    = [[Urinary tract infection]], [[overactive bladder syndrome|overactive bladder]], [[sexually transmitted infection]]s, [[endometriosis]], [[bladder cancer]], [[prostatitis]]<ref name=NIH2012/><ref name=Bog2007/>
| prevention      =
| treatment       = Lifestyle changes, medications, procedures<ref name=NIH2012/><ref name= pmid29777618/>
| medication      = Oral [[paracetamol]] with [[ibuprofen]] and gastric protection, [[amitriptyline]], [[pentosan polysulfate]], histamine<ref name=NIH2012/><ref name= pmid29777618/>
| prognosis       =
| frequency       = 0.5% of people<ref name=NIH2012/><ref name=AUA2015/>
| deaths          =
}}
<!-- Definition and symptoms -->

'''Interstitial cystitis''' ('''IC'''), a type of '''bladder pain syndrome''' ('''BPS'''), is [[chronic pain]] in the [[Urinary bladder|bladder]] and pelvic floor of unknown cause.<ref name="NIH2012" /> Symptoms include [[urinary urgency|feeling the need to urinate right away]], [[urinary frequency|needing to urinate often]], bladder pain (pain in the organ) and [[pain with sex]].<ref name="NIH2012" /> IC/BPS is associated with [[depression (mood)|depression]] and lower [[quality of life]].<ref name="AUA2015">{{cite journal|last1=Hanno|first1=PM|last2=Erickson|first2=D|last3=Moldwin|first3=R|last4=Faraday|first4=MM|last5=American Urological|first5=Association|title=Diagnosis and treatment of interstitial cystitis/bladder pain syndrome: AUA guideline amendment.|journal=The Journal of Urology|date=May 2015|volume=193|issue=5|pages=1545–53|pmid=25623737|url=https://www.auanet.org/education/guidelines/ic-bladder-pain-syndrome.cfm|doi=10.1016/j.juro.2015.01.086|url-status=live|archive-url=https://web.archive.org/web/20140420032338/https://www.auanet.org/education/guidelines/ic-bladder-pain-syndrome.cfm|archive-date=20 April 2014}}</ref> Some of those affected also have [[irritable bowel syndrome]] and [[fibromyalgia]].<ref name="NIH2012">{{cite web|title=Interstitial cystitis/bladder pain syndrome fact sheet|url=https://www.womenshealth.gov/publications/our-publications/fact-sheet/interstitial-cystitis.html|website=OWH|access-date=6 October 2016|date=16 July 2012|url-status=live|archive-url=https://web.archive.org/web/20161005144219/https://www.womenshealth.gov/publications/our-publications/fact-sheet/interstitial-cystitis.html|archive-date=5 October 2016}}</ref>

<!-- Cause and diagnosis -->
The cause of interstitial cystitis is unknown.<ref name=NIH2012/> While it can, it does not typically run in a family.<ref name=NIH2012/> The diagnosis is usually based on the symptoms [[diagnosis of exclusion|after ruling out other conditions]].<ref name=AUA2015/> Typically the [[urine culture]] is negative.<ref name=AUA2015/> [[Ulceration]] or inflammation may be seen on [[cystoscopy]].<ref name=AUA2015/> Other conditions which can produce similar symptoms include [[overactive bladder syndrome|overactive bladder]], [[urinary tract infection]] (UTI), [[sexually transmitted infection]]s, [[prostatitis]], [[endometriosis]] in females, and [[bladder cancer]].<ref name=NIH2012/><ref name=Bog2007>{{cite journal |last1=Bogart|first1=LM |last2=Berry |first2=SH |last3=Clemens |first3=JQ |title=Symptoms of interstitial cystitis, painful bladder syndrome and similar diseases in women: a systematic review |journal=[[The Journal of Urology]] |volume=177 |issue=2 |pages=450–456 |year=2007|pmid=17222607 |doi=10.1016/j.juro.2006.09.032|s2cid=14482415 }}</ref>

<!-- Treatment -->
There is no cure for interstitial cystitis and management of this condition can be challenging.<ref name=NIH2012/> Treatments that may improve symptoms include lifestyle changes, medications, or procedures.<ref name=NIH2012/> Lifestyle changes may include stopping smoking, dietary changes, reducing [[stress (psychological)|stress]], and receiving [[psychotherapy|psychological support]].<ref name=NIH2012/><ref name="pmid=29777618"/> Medications may include [[paracetamol]] with [[ibuprofen]] and gastric protection, [[amitriptyline]], [[pentosan polysulfate]], or histamine<ref name=NIH2012/><ref name= pmid29777618/> Procedures may include bladder distention, [[nerve stimulation]], or surgery.<ref name=NIH2012/> [[Kegel exercises]] and long term [[antibiotic|antibiotics]] are not recommended.<ref name=AUA2015/>

<!-- Epidemiology and history -->
In the United States and Europe, it is estimated that around 0.5% of people are affected.<ref name=NIH2012/><ref name=AUA2015/> Women are affected about five times as often as men.<ref name=NIH2012/> Onset is typically in middle age.<ref name=NIH2012/> The term "interstitial cystitis" first came into use in 1887.<ref name=Bos2014>{{cite book|last1=Bostwick|first1=David G.|last2=Cheng|first2=Liang|title=Urologic Surgical Pathology|date=2014|publisher=Elsevier Health Sciences|isbn=9780323086196|page=208|edition=3|url=https://books.google.com/books?id=wrHQAgAAQBAJ&pg=PA208|url-status=live|archive-url=https://web.archive.org/web/20161009122127/https://books.google.ca/books?id=wrHQAgAAQBAJ&pg=PA208|archive-date=9 October 2016}}</ref>

==Signs and symptoms==
The most common symptoms of IC are [[suprapubic]] pain,<ref name=pmid23276554>{{cite journal |doi=10.1016/j.tjog.2012.10.002 |pmid=23276554 |title=Treatment of interstitial cystitis in women |journal=Taiwanese Journal of Obstetrics and Gynecology |volume=51 |issue=4 |pages=526–32 |year=2012 |last1=Hsieh |first1=Ching-Hung |last2=Chang |first2=Wei-Chun |last3=Huang |first3=Ming-Chao |last4=Su |first4=Tsung-Hsien |last5=Li |first5=Yiu-Tai |last6=Chiang |first6=Han-Sun |doi-access=free }}</ref> urinary frequency, [[dyspareunia|painful sexual intercourse]],<ref name=PMHT0025484/> and [[nocturia|waking up from sleep to urinate]].<ref name=pmid20025032>{{cite journal |doi=10.1002/nau.20817 |pmid=20025032 |pmc=2805190 |title=Cross-talk and sensitization of bladder afferent nerves |journal=Neurourology and Urodynamics |volume=29 |issue=1 |pages=77–81 |year=2010 |last1=Ustinova |first1=Elena E |last2=Fraser |first2=Matthew O |last3=Pezzone |first3=Michael A }}</ref>

In general, symptoms may include [[Dysuria|painful urination]] described as a burning sensation in the [[urethra]] during urination, pelvic pain that is worsened with the consumption of certain foods or drinks, urinary urgency, and pressure in the bladder or pelvis.<ref name=pmid19808225/> Other described symptoms are [[urinary hesitancy]] (needing to wait for the urinary stream to begin, often caused by [[pelvic floor dysfunction]] and tension), and pain and difficulty driving, working, exercising, or traveling. Pelvic pain experienced by those with IC typically worsens with filling of the urinary bladder and may improve with urination.<ref>{{Cite web|last=Harvard Health Publishing|date=25 March 2020|title=Diagnosing and treating interstitial cystitis|url=https://www.health.harvard.edu/diseases-and-conditions/diagnosing-and-treating-interstitial-cystitis|access-date=2021-01-15|website=Harvard Health}}</ref> Other, more severe symptoms include chronic inflammation, ulcuration (Hunner's leasions), fybrotic scar tissue and stiffness of the bladder.  

During [[cystoscopy]], 5–10% of people with IC are found to have [[Hunner's ulcer]]s.<ref name="IC section of the NKUDIC"/> A person with IC may have discomfort only in the urethra, while another might struggle with pain in the entire pelvis. Interstitial cystitis symptoms usually fall into one of two patterns: significant [[Hypogastrium|suprapubic]] pain with little frequency or a lesser amount of suprapubic pain but with increased urinary frequency.<ref>{{cite web|last=Peters|first=Dr. Jill|title="Interstitial Cystitis" Paul Perry, MD, Chairman, Obgyn.Net Editorial Advisory Board, Chronic Pelvic Pain interviews Jill Peters, MD|url=http://www.obgyn.net/avtranscripts/perry_peters.htm|work=OBGYN.net|publisher=Obgyn.Net Conference Coverage from International Pelvic Pain Society—Simsbury Connecticut—April/May, 1999|access-date=10 April 2011|url-status=live|archive-url=https://web.archive.org/web/20120423234154/http://www.obgyn.net/avtranscripts/perry_peters.htm|archive-date=23 April 2012}}</ref>

===Association with other conditions===
Some people with IC/BPS have been diagnosed with other conditions such as [[irritable bowel syndrome]] (IBS), [[fibromyalgia]], [[myalgic encephalomyelitis/chronic fatigue syndrome]] (ME/CFS), [[Allergy|allergies]], [[Sjögren syndrome]], which raises the possibility that interstitial cystitis may be caused by mechanisms that cause these other conditions.<ref name=pmid19230927>{{cite journal |doi=10.1016/j.juro.2008.11.119 |pmid=19230927 |pmc=2692547 |title=Genetics and Phenotyping of Urological Chronic Pelvic Pain Syndrome |journal=The Journal of Urology |volume=181 |issue=4 |pages=1550–7 |year=2009 |last1=Dimitrakov |first1=Jordan |last2=Guthrie |first2=David }}</ref> There is also some evidence of an association between urologic pain syndromes, such as IC/BPS and CP/CPPS, with [[non-celiac gluten sensitivity]] in some people.<ref name=pmid26605537>{{cite journal |doi=10.1159/000440990 |pmid=26605537 |title=Gluten Sensitivity |journal=Annals of Nutrition and Metabolism |volume=67 |issue=2 |pages=16–26 |year=2015 |last1=Catassi |first1=Carlo |doi-access=free }}</ref><ref name=pmid23204003>{{cite journal |doi=10.1136/bmj.e7982 |pmid=23204003 |title=Non-coeliac gluten sensitivity |journal=BMJ |volume=345 |pages=e7982 |year=2012 |last1=Anonymous |last2=Rostami |first2=K |last3=Hogg-Kollars |first3=S |doi-access=free }}</ref><ref>{{cite web |url=http://www.chronicprostatitis.com/gluten-and-chronic-prostatitis-cpps/ |title=Gluten and CP/CPPS |work=Prostatitis Network |access-date=2016-03-16 |url-status=live |archive-url=https://web.archive.org/web/20160327012729/http://www.chronicprostatitis.com/gluten-and-chronic-prostatitis-cpps/ |archive-date=27 March 2016}}</ref>

In addition, men with IC/PBS are frequently diagnosed as having [[chronic nonbacterial prostatitis]], and there is an extensive overlap of symptoms and treatment between the two conditions, leading researchers to posit that the conditions may share the same cause and pathology.<ref>{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001551/ |title=Prostatitis-nonbacterial-chronic |author=PubMed Health |year=2011 |publisher=U.S. National Library of Medicine |access-date=25 October 2012 |url-status=live |archive-url=https://web.archive.org/web/20121025205146/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001551/ |archive-date=25 October 2012}}</ref>

==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/>

==Diagnosis==
A diagnosis of IC is one of exclusion, as well as a review of clinical symptoms.<ref name=pmid23276554/> The American Urological Association Guidelines recommend starting with a careful history of the person, physical examination and laboratory tests to assess and document symptoms of interstitial cytitis,<ref>{{Cite web|url=https://www.auanet.org/guidelines/interstitial-cystitis/bladder-pain-syndrome-(2011-amended-2014)|title=American Urological Association -|website=www.auanet.org|access-date=2018-11-07|archive-date=20 September 2018|archive-url=https://web.archive.org/web/20180920145129/https://www.auanet.org/guidelines/interstitial-cystitis/bladder-pain-syndrome-(2011-amended-2014)|url-status=dead}}</ref> as well as other potential disorders.

The [[potassium chloride|KCl]] test, also known as the ''potassium sensitivity test'', is no longer recommended. The test uses a mild [[potassium]] solution to evaluate the integrity of the bladder wall.<ref name=pmid19808225/> Though the latter is not specific for IC/BPS, it has been determined to be helpful in predicting the use of compounds, such as [[pentosan polysulphate]], which are designed to help repair the GAG layer.<ref>{{Cite book |last1=Reynard |first1=John |url=https://books.google.com/books?id=3rBuAgAAQBAJ&dq=such+as+pentosan+polysulphate%2C+which+are+designed+to+help+repair+the+GAG+layer&pg=PT213 |title=Oxford Handbook of Urology |last2=Brewster |first2=Simon |last3=Biers |first3=Suzanne |date=2013-02-28 |publisher=OUP Oxford |isbn=978-0-19-101592-2 |language=en}}</ref>

For complicated cases, the use of [[hydrodistention]] with cystoscopy may be helpful. Researchers, however, determined that this visual examination of the bladder wall after stretching the bladder was not specific for IC<ref>{{cite journal |last1=MacDiarmid |first1=SA |last2=Sand |first2=PK |title=Diagnosis of Interstitial Cystitis/Painful Bladder Syndrome in Patients With Overactive Bladder Symptoms |journal=Reviews in Urology |volume=9 |issue=1|pages=9–16 |year=2007|pmid=17396167 |pmc=1832106}}</ref> and that the test, itself, can contribute to the development of small [[glomerulation]]s ([[petechia]]l hemorrhages) often found in IC. Thus, a diagnosis of IC is one of exclusion, as well as a review of clinical symptoms.

In 2006, the ESSIC society proposed more rigorous and demanding diagnostic methods with specific classification criteria so that it cannot be confused with other, similar conditions. Specifically, they require that a person must have pain associated with the bladder, accompanied by one other urinary symptom. Thus, a person with just frequency or urgency would be excluded from a diagnosis. Secondly, they strongly encourage the exclusion of confusable diseases through an extensive and expensive series of tests including (A) a [[medical history]] and [[Physical examination|physical exam]], (B) a dipstick [[urinalysis]], various urine cultures, and a serum [[Prostate-specific antigen|PSA]] in men over 40, (C) flowmetry and post-void residual urine volume by [[ultrasound scan]]ning and (D) cystoscopy. A diagnosis of IC would be confirmed with a hydrodistention during cystoscopy with biopsy.<ref>{{Cite journal|last1=van de Merwe|first1=Joop P.|last2=Nordling|first2=Jørgen|last3=Bouchelouche|first3=Pierre|last4=Bouchelouche|first4=Kirsten|last5=Cervigni|first5=Mauro|last6=Daha|first6=L. Kurosch|last7=Elneil|first7=Suzy|last8=Fall|first8=Magnus|last9=Hohlbrugger|first9=Gero|date=January 2008|title=Diagnostic Criteria, Classification, and Nomenclature for Painful Bladder Syndrome/Interstitial Cystitis: An ESSIC Proposal|journal=European Urology|volume=53|issue=1|pages=60–67|doi=10.1016/j.eururo.2007.09.019|pmid=17900797|issn=0302-2838}}</ref>

They also propose a ranking system based upon the physical findings in the bladder.<ref name=pmid19808225/> People would receive a numeric and letter based score based upon the severity of their disease as found during the hydrodistention. A score of 1–3 would relate to the severity of the disease and a rating of A–C represents biopsy findings. Thus, a person with 1A would have very mild symptoms and disease while a person with 3C would have the worst possible symptoms. Widely recognized scoring systems such as the O'Leary Sant symptom and problem score have emerged to evaluate the severity of IC symptoms such as pain and urinary symptoms.<ref name="Tyagi2014">{{cite journal|vauthors=Tyagi P, Kashyap MP, Kawamorita N, Yoshizawa T, Chancellor M, Yoshimura N |title=Intravesical liposome and antisense treatment for detrusor overactivity and interstitial cystitis/painful bladder syndrome|journal=ISRN Pharmacol |volume=2014 |issue=601653|pages= 601653|date=January 2014|pmid= 24527221|pmc=3914518|doi=10.1155/2014/601653|doi-access=free}}</ref>

===Differential diagnosis===
The symptoms of IC/BPS are often misdiagnosed as a [[urinary tract infection]]. However, IC/BPS has not been shown to be caused by a [[bacterial infection]] and [[antibiotics]] are an ineffective treatment.<ref name="Lim ORourke 2022 p. ">{{citation | last1=Lim | first1=Y | last2=O'Rourke | first2=S | title=Interstitial Cystitis | chapter=article-132252 | publisher=StatPearls Publishing | publication-place=Treasure Island (FL) | year=2022 | pmid=34033350 | url=http://www.ncbi.nlm.nih.gov/books/NBK570588/ | access-date=2022-01-26 | page=}}</ref> IC/BPS is commonly misdiagnosed as [[chronic prostatitis/chronic pelvic pain syndrome]] (CP/CPPS) in men,<ref name=pmid26813678>{{cite journal |pmid=26813678 |pmc=4708534 |year=2015 |last1=Arora |first1=Hans C. |title=The enigma of men with interstitial cystitis/bladder pain syndrome |journal=Translational Andrology and Urology |volume=4 |issue=6 |pages=668–76 |last2=Shoskes |first2=Daniel A. |doi=10.3978/j.issn.2223-4683.2015.10.01 }}</ref> and [[endometriosis]] and [[uterine fibroids]] (in women).

==Treatment==
In 2011, the American Urological Association released consensus-based guideline for the diagnosis and treatment of interstitial cystitis.<ref name="auaguidelines">{{cite web |url=http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/main-reports/ic-bps/diagnosis_and_treatment_ic-bps.pdf |title=AUA Guidelines Diagnosis and Treatment of Interstitial Cystitis |year=2011 |publisher=American Urological Association |access-date=18 October 2012 |url-status=dead |archive-url=https://web.archive.org/web/20120916131439/http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/main-reports/ic-bps/diagnosis_and_treatment_ic-bps.pdf |archive-date=16 September 2012}}</ref> Further reviews of multiple studies and guidelines have updated these recommendations.<ref name="pmid=29777618">{{cite journal|last1= Malde|first1=Sachin|last2=Palmisani|first2=Stefano|last3=Al-Kaisy|first3= Adna|last4=Sahai|first4=Arun|title=Guideline of guidelines: bladder pain syndrome|journal=BJU International|volume=122|issue=5|pages=729–743|date=May 2018|pmid=29777618|doi=10.1111/bju.14399}}</ref><ref name=pmid29777618>{{cite journal|last1=Cacciatore|first1=L|last2=Territo|first2=A|last3=Minore|first3=A|last4=Testa|first4=A|last5=Mantica|first5=G|last6=Esperto|first6=F|title=Bladder Pain Syndrome (BPS): A Comprehensive Review of Treatment Strategies and Management Approaches|journal=Research and Reports in Urology|date=October 2024|volume=16|pages=273–282|doi=10.2147/rru.S387749|doi-access=free|pmid=39479186|pmc=11523923}}</ref>

They include treatments ranging from conservative to more invasive:
# First-line treatments – education, dietary modification, exercise, [[physical therapy]], first-line analgesics ([[nonsteroidal anti-inflammatory drug]] with paracetamol and gastric protection), stress management, [[support group|support groups]], and [[psychotherapy]] including [[cognitive behavioral therapy]]
# Second-line treatments – oral medications (amitriptyline, [[cimetidine]]), bladder instillations (DMSO, [[heparin]]or [[lidocaine]])
# Third-line treatments – treatment of Hunner's lesions (laser, [[fulguration]] or [[triamcinolone]] injection), hydrodistention (low pressure, short duration)
# Fourth-line treatments – [[botulinum toxin]] (BTX-A), [[Neuromodulation (medicine)|neuromodulation]] ([[Sacral nerve stimulation|sacral]] or [[pudendal nerve]])
# Fifth-line treatments – [[cyclosporine A]]
# Sixth-line treatments – surgical intervention ([[urinary diversion]], augmentation, [[cystectomy]])

The American Urological Association guidelines also listed several discontinued treatments, including long-term oral antibiotics, intravesical [[bacillus Calmette Guerin]], intravesical [[resiniferatoxin]]), high-pressure and long-duration hydrodistention, and systemic [[glucocorticoid]]s.<ref name="auaguidelines" />

===Bladder distension===
Bladder distension while under [[general anesthesia]], also known as hydrodistention (a procedure which stretches the bladder [[Volume|capacity]]), has shown some success in reducing urinary frequency and giving short-term pain relief to those with IC.<ref name=pmid23276554/><ref name="treatments"/> However, it is unknown exactly how this procedure causes pain relief.<ref name="pmid17222633">{{cite journal |last1=Erickson |first1=D |last2=Kunselman |first2=A |last3=Bentley |first3=C |last4=Peters |first4=K |last5=Rovner |first5=E |last6=Demers |first6=L |last7=Wheeler |first7=M |last8=Keay |first8=S |title=Changes in Urine Markers and Symptoms after Bladder Distention for Interstitial Cystitis |journal=[[The Journal of Urology]] |volume=177 |issue=2 |pages=556–60 |year=2007 |pmid=17222633 |pmc=2373609 |doi=10.1016/j.juro.2006.09.029}}</ref> Recent studies show pressure on pelvic trigger points can relieve symptoms. The relief achieved by bladder distensions is only temporary (weeks or months), so is not viable as a long-term treatment for IC/BPS. The proportion of people with IC/BPS who experience relief from hydrodistention is currently unknown and evidence for this modality is limited by a lack of properly controlled studies.<ref name=pmid23276554/> [[Bladder rupture]] and [[sepsis]] may be associated with prolonged, high-pressure hydrodistention.<ref name=pmid23276554/>

===Bladder instillations===
Bladder instillation of medication is one of the main forms of treatment of interstitial cystitis, but evidence for its effectiveness is currently limited.<ref name=pmid23276554/> Advantages of this treatment approach include direct contact of the medication with the bladder and low systemic side effects due to poor absorption of the medication.<ref name="pmid23276554" /> Single medications or a mixture of medications are commonly used in bladder instillation preparations. [[Dimethyl sulfoxide|Dimethyl sulfoxide (DMSO)]] is the only approved bladder instillation for IC/BPS yet it is much less frequently used in urology clinics.<ref name="treatments">{{cite web |url=http://www.mayoclinic.com/health/interstitial-cystitis/DS00497/DSECTION=treatments-and-drugs |title=Treatments and drugs |year=2011 |publisher=Mayo Clinic |access-date=1 October 2012 |url-status=live |archive-url=https://web.archive.org/web/20121023044819/http://www.mayoclinic.com/health/interstitial-cystitis/DS00497/DSECTION=treatments%2Dand%2Ddrugs |archive-date=23 October 2012}}</ref>

The disadvantages of installations are severe pain in the urethra, caused by the catheter that is used to administer the instillation, bladder pain and the fact that most installations need to be held in the bladder for at least two hours, whereas some patients have to urinate (far) more frequent than once every two hours. This causes severe pain and/or affects the treatment because the instillation did not sit in the bladder long enough.

About DMSO:

50% solution of DMSO had the potential to create irreversible muscle contraction. However, a lesser solution of 25% was found to be reversible. Long-term use of DMSO is questionable, as its mechanism of action is not fully understood though DMSO is thought to inhibit mast cells and may have anti-inflammatory, muscle-relaxing, and analgesic effects.<ref name="pmid23276554" /><ref name="pmid19808225" /> Other agents used for bladder instillations to treat interstitial cystitis include: heparin, lidocaine, chondroitin sulfate, hyaluronic acid, pentosan polysulfate, [[oxybutynin]], and botulinum toxin A. Preliminary evidence suggests these agents are efficacious in reducing symptoms of interstitial cystitis, but further study with larger, randomized, controlled clinical trials is needed.<ref name="pmid23276554" />

===Diet===
Diet modification is often recommended as a first-line method of self-treatment for interstitial cystitis, though rigorous controlled studies examining the impact diet has on interstitial cystitis signs and symptoms are currently lacking.<ref name=pmid23276554/> An increase in fiber intake may alleviate symptoms.<ref>{{cite web |title=How to get more fiber in your diet |url=https://www.health.harvard.edu/staying-healthy/how-to-get-more-fiber-in-your-diet |website=Harvard Health |publisher=Harvard Health Publishing |access-date=5 January 2022 |language=en |date=20 May 2021}}</ref> Individuals with interstitial cystitis often experience an increase in symptoms when they consume certain foods and beverages. Avoidance of these potential trigger foods and beverages such as tomatoes, cranberries, caffeine-containing beverages including coffee, tea, and soda, [[alcoholic beverages]], [[chocolate]], [[citrus fruits]], [[Chili pepper|hot peppers]], and [[artificial sweeteners]] may be helpful in alleviating symptoms.<ref name=PMHT0025484/><ref name=pmid19808225/> Diet triggers vary between individuals with IC;<ref name=pmid23276554/> the best way for a person to discover his or her own triggers is to use an [[elimination diet]]. Sensitivity to trigger foods may be reduced if [[Calcium glycerylphosphate|calcium glycerophosphate]] and/or sodium bicarbonate is consumed.<ref>{{cite journal|last1=Friedlander |first1=JI |last2=Shorter |first2=B|last3=Moldwin|first3=RM |title=Diet and its role in interstitial cystitis /bladder pain syndrome (IC/BPS) and comorbid conditions|journal=BJU International|volume=109 |issue=11 |pages=1584–1591 |year=2012 |pmid=22233286 |doi=10.1111/j.1464-410X.2011.10860.x|s2cid=205546249 }}</ref> The foundation of therapy is a modification of diet to help people avoid those foods which can further irritate the damaged bladder wall.<ref>{{Cite journal |last1=Gordon |first1=Barbara |last2=Shorter |first2=Barbara |last3=Sarcona |first3=Alessandra |last4=Moldwin |first4=Robert M. |date=September 2015 |title=Nutritional Considerations for Patients with Interstitial Cystitis/Bladder Pain Syndrome |url=http://dx.doi.org/10.1016/j.jand.2015.03.021 |journal=Journal of the Academy of Nutrition and Dietetics |volume=115 |issue=9 |pages=1372–1379 |doi=10.1016/j.jand.2015.03.021 |pmid=25934323 |issn=2212-2672}}</ref>

The mechanism by which dietary modification benefits people with IC is unclear. Integration of neural signals from pelvic organs may mediate the effects of diet on symptoms of IC.<ref name="Klumpp-2008">{{cite journal |last1=Klumpp |first1=David J |last2=Rudick |first2=Charles N |title=Summation model of pelvic pain in interstitial cystitis |journal=Nature Clinical Practice Urology |volume=5 |issue=9 |pages=494–500 |year=2008 |pmid=18769376 |doi=10.1038/ncpuro1203|s2cid=22431404 }}</ref>

===Medications===
[[Nonsteroidal anti-inflammatory drug]] and paracetamol and gastric protection combined with other conservative measures can be an effect first-line treatment.<ref name=pmid29777618/>

As a second-line treatment, [[amitriptyline]] has been shown to be effective in reducing symptoms such as chronic pelvic pain and nocturia<ref name=pmid23276554/> in many people with IC/BPS with a median dose of 75&nbsp;mg daily.<ref name=pmid19808225/> Oral [[pentosan polysulfate]]  is believed to repair the protective glycosaminoglycan coating of the bladder, but studies have encountered mixed results when attempting to determine if the effect is statistically significant compared to placebo.<ref name=pmid23276554/><ref name="pmid18582395">{{cite journal |last1=Dimitrakov |first1=J |last2=Kroenke |first2=K |last3=Steers |first3=WD |last4=Berde |first4=C |last5=Zurakowski |first5=D |last6=Freeman |first6=MR |title=Pharmacological Management of Painful Bladder Syndrome/Interstitial Cystitis: A Systematic Review |journal=Archives of Internal Medicine |volume=167 |issue=18 |pages=1922–1929 |year=2007 |pmid=17923590 |doi=10.1001/archinte.167.18.1922 |pmc=2135553}}</ref><ref name=pmid16706553/> The [[antihistamine]] [[hydroxyzine]] failed to demonstrate superiority over placebo in treatment of people with IC in a randomized, controlled, clinical trial.<ref name=pmid23276554/> However, when hydroxyzine is used in combination with pentosan polysulfate sodium it may be more effective than pentosan polysulfate sodium on its own, but large-scale studies are needed.<ref name=pmid29777618/>

As a last-line treatment the [[calcineurin inhibitor]] [[cyclosporine A]] has been studied as a treatment for interstitial cystitis due to its immunosuppressive properties.<ref name=pmid29777618/> A prospective randomized study found cyclosporine A to be more effective at treating IC symptoms than pentosan polysulfate, but also had more adverse effects.<ref name=pmid23276554/>

In one study, the antidepressant [[duloxetine]] was found to be ineffective as a treatment,<ref name="Papandreou-2009">{{cite journal |last1=Papandreou |first1=Christos |last2=Skapinakis |first2=Petros |last3=Giannakis |first3=Dimitrios |last4=Sofikitis |first4=Nikolaos |last5=Mavreas |first5=Venetsanos |title=Antidepressant Drugs for Chronic Urological Pelvic Pain: an Evidence-Based Review |journal=Advances in Urology |volume=2009 |pages=1–9 |year=2009 |doi=10.1155/2009/797031|pmid=20169141 |pmc=2821755|doi-access=free }}</ref> although a patent exists for use of duloxetine in the context of IC, and is known to relieve neuropathic pain.

===Pelvic floor treatments===
Urologic pelvic pain syndromes, such as IC/BPS and CP/CPPS, are characterized by pelvic muscle tenderness, and symptoms may be reduced with pelvic myofascial physical therapy.<ref name="AndersonWise">{{cite journal |last1= Anderson |first1=R|last2=Wise |first2=D|last3=Nathanson |first3=BH|title=Safety and effectiveness of an internal pelvic myofascial trigger point wand for urologic chronic pelvic pain syndrome|journal=Clin J Pain|volume=27 |issue=9 |pages=764–8 |year=2011 |pmid=21613956 |doi=10.1097/ajp.0b013e31821dbd76|s2cid=23867038}}</ref>

This may leave the pelvic area in a sensitized condition, resulting in a loop of muscle tension and heightened neurological feedback ([[Pain wind-up|neural wind-up]]), a form of [[myofascial pain syndrome]]. Current protocols, such as the [[Wise–Anderson Protocol]], largely focus on stretches to release overtensed muscles in the pelvic or anal area (commonly referred to as [[trigger points]]), physical therapy to the area, and progressive relaxation therapy to reduce causative stress.<ref name="Pelvic Floor">{{cite journal |last1=Bharucha |first1=AE |last2=Trabuco |first2=E |title=Functional and Chronic Anorectal and Pelvic Pain Disorders |journal=Gastroenterology Clinics of North America |volume=37 |issue=3 |pages=685–96 |year=2008 |pmid=18794003 | doi = 10.1016/j.gtc.2008.06.002 |pmc=2676775}}</ref>

Pelvic floor dysfunction is a fairly new area of specialty for physical therapists worldwide. The goal of therapy is to relax and lengthen the pelvic floor muscles, rather than to tighten and/or strengthen them as is the goal of therapy for people with urinary incontinence. Thus, traditional exercises such as [[Kegel exercise]]s, which are used to strengthen pelvic muscles, can provoke pain and additional muscle tension. A specially trained physical therapist can provide direct, hands on evaluation of the muscles, both externally and internally.<ref>{{Cite web|title=Physical Therapy|url=https://www.ichelp.org/diagnosis-treatment/treatments/physicaltherapy/|access-date=2022-01-17|website=Interstitial Cystitis Association|date=7 October 2021 |language=en-US}}</ref>

A therapeutic wand can also be used to perform pelvic floor muscle myofascial release to provide relief.<ref>{{Cite journal|last1=Bond|first1=J.|last2=Pape|first2=Hilary|last3=Ayre|first3=Colin A.|date=2017|title=Efficacy of a therapeutic wand in addition to physiotherapy for treating bladder pain syndrome in women: a pilot randomized controlled trial|url=https://bradscholars.brad.ac.uk/handle/10454/12129|language=en}}</ref>

===Surgery===
[[Surgery]] is rarely used for IC/BPS. Surgical intervention is very unpredictable, and is considered a treatment of last resort for severe refractory cases of interstitial cystitis.<ref name="treatments"/> Some people who opt for surgical intervention continue to experience pain after surgery. Typical surgical interventions for refractory cases of IC/BPS include: [[bladder augmentation]], urinary diversion, transurethral fulguration and resection of ulcers, and bladder removal ([[cystectomy]]).<ref name=pmid23276554/><ref name="treatments"/>

Neuromodulation can be successful in treating IC/BPS symptoms, including pain.<ref name=pmid20972541/> One electronic pain-killing option is [[TENS]].<ref name=pmid20972541>{{cite journal |last1=Fariello |doi=10.1007/s00192-010-1281-3 |pmid=20972541 |title=Sacral neuromodulation stimulation for IC/PBS, chronic pelvic pain, and sexual dysfunction |journal=International Urogynecology Journal |volume=21 |issue=12 |pages=1553–8 |year=2010 |s2cid=13040070 }}</ref><ref name=pmid22521096>{{cite journal |doi=10.1111/j.1533-2500.2012.00558.x |pmid=22521096 |title=Neuromodulation of Pelvic Visceral Pain: Review of the Literature and Case Series of Potential Novel Targets for Treatment |journal=Pain Practice |volume=13 |issue=1 |pages=3–17 |year=2013 |last1=Hunter |first1=Corey |last2=Davé |first2=Nimish |last3=Diwan |first3=Sudhir |last4=Deer |first4=Timothy |s2cid=39659746 |doi-access=free }}</ref> [[Percutaneous tibial nerve stimulation]] stimulators have also been used, with varying degrees of success.<ref name=pmid18372023>{{cite journal |last1=Zhao |first1=J |last2=Bai |first2=J |last3=Zhou |first3=Y |last4=Qi |first4=G |last5=Du |first5=L |title=Posterior Tibial Nerve Stimulation Twice a Week in Patients with Interstitial Cystitis |journal=Urology |volume=71 |issue=6 |pages=1080–4 |year=2008 |pmid=18372023 |doi=10.1016/j.urology.2008.01.018 }}</ref> Percutaneous sacral nerve root stimulation was able to produce statistically significant improvements in several parameters, including pain.<ref name="Pelvic Floor"/>

===Alternative medicine===
There is little evidence looking at the effects of alternative medicine though their use is common.<ref>{{cite journal|last1=Verghese|first1=Tina S.|last2=Riordain|first2=Richael Ni|last3=Champaneria|first3=Rita|last4=Latthe|first4=Pallavi M.|title=Complementary therapies for bladder pain syndrome: a systematic review|journal=International Urogynecology Journal|date=7 December 2015|volume=27|issue=8|pages=1127–1136|doi=10.1007/s00192-015-2886-3|pmid=26642800|pmc=4947099}}</ref> There is tentative evidence that [[acupuncture]] may help pain associated with IC/BPS as part of other treatments.<ref name=pmid16986031>{{cite journal |last1=Whitmore |first1=KE |title=Complementary and Alternative Therapies as Treatment Approaches for Interstitial Cystitis |journal=Reviews in Urology |volume=4 |pages=S28–35 |year=2002 |pmid=16986031 |pmc=1476005 |issue=Suppl 1}}</ref> Despite a scarcity of controlled studies on alternative medicine and IC/BPS, "rather good results have been obtained" when acupuncture is combined with other treatments.<ref name="pmid18663671">{{cite journal |last1=Binder |first1=I. |last2=Rossbach |first2=G. |last3=Ophoven |first3=A. van |title=Die Komplexität chronischer Beckenschmerzen am Beispiel der Interstitiellen Zystitis |journal=Aktuelle Urologie |volume=39 |issue=4 |pages=289–97 |year=2008 |pmid=18663671 |doi=10.1055/s-2008-1038199|s2cid=259989342 }}</ref>

[[Biofeedback]], a relaxation technique aimed at helping people control functions of the [[autonomic nervous system]], has shown some benefit in controlling pain associated with IC/BPS as part of a multimodal approach that may also include medication or hydrodistention of the bladder.<ref name="pmid18496634">{{cite journal |last1=Hsieh |first1=Ching-Hung |last2=Chang |first2=Shao-Tung |last3=Hsieh |first3=Chia-Jung |last4=Hsu |first4=Chun-Sen |last5=Kuo |first5=Tsung-Cheng |last6=Chang |first6=Hui-Chin |last7=Lin |first7=Yi-Hui |title=Treatment of interstitial cystitis with hydrodistention and bladder training |journal=International Urogynecology Journal |volume=19 |issue=10 |pages=1379–84 |year=2008 |pmid=18496634 |doi=10.1007/s00192-008-0640-9|s2cid=11606637 }}</ref><ref name="pmid15088863">{{cite journal |last1=Dell |first1=JR |last2=Parsons |first2=CL |title=Multimodal therapy for interstitial cystitis |journal=The Journal of Reproductive Medicine |volume=49 |issue=3 Suppl |pages=243–52 |year=2004 |pmid=15088863}}</ref>

==Prognosis==
IC/BPS has a profound impact on quality of life.<ref name=pmid23276554/><ref name=pmid20968203>{{cite journal |last1=Persu |first1=C |last2=Cauni |first2=V |last3=Gutue |first3=S |last4=Blaj |first4=I |last5=Jinga |first5=V |last6=Geavlete |first6=P |title=From interstitial cystitis to chronic pelvic pain |journal=Journal of Medicine and Life |volume=3 |issue=2 |pages=167–174|pmid=20968203 |year=2010 |pmc=3019050}}</ref> A 2007 Finnish epidemiologic study showed that two-thirds of women at moderate to high risk of having interstitial cystitis reported impairment in their quality of life and 35% of people with IC reported an impact on their sexual life.<ref name=pmid23276554/> A 2012 survey showed that among a group of adult women with symptoms of interstitial cystitis, 11% reported suicidal thoughts in the past two weeks.<ref>{{cite journal|last1=Hepner|first1=Kimberly A.|last2=Watkins|first2=Katherine E.|last3=Elliott|first3=Marc|last4=Clemens|first4=J. Quentin|last5=Hilton|first5=Lara|last6=Berry|first6=Sandra H.|title=Suicidal ideation among patients with bladder pain syndrome/interstitial cystitis|journal=Urology|date=June 2012|volume=80|issue=2|pages=280–285|pmc=3411912|pmid=22658505|doi=10.1016/j.urology.2011.12.053}}</ref> Other research has shown that the impact of IC/BPS on [[Quality of Life|quality of life]] is severe<ref name=pmid19808225/> and may be comparable to the quality of life experienced in [[End-stage renal disease|end-stage kidney disease]] or [[rheumatoid arthritis]].<ref name="AUA">{{cite web|title=American Urological Association Guideline: Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome [January 2011]|url=http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/main-reports/ic-bps/diagnosis_and_treatment_ic-bps.pdf|publisher=American Urological Association|access-date=1 April 2011|url-status=dead|archive-url=https://web.archive.org/web/20110323041336/http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/main-reports/ic-bps/diagnosis_and_treatment_ic-bps.pdf|archive-date=23 March 2011}}</ref><ref>{{cite book |last1=Ho |first1=Ngoc J |last2=Koziol |first2=James A |last3=Parsons |first3=C. Lowell |chapter=Epidemiology of Interstitial Cystitis |editor1-first=Grannum R. |editor1-last=Sant |title=Interstitial Cystitis |location=Philadelphia |publisher=Lippincott-Raven |year=1997 |pages=9–15 |isbn=978-0-397-51695-7 }}</ref>

International recognition of interstitial cystitis has grown and international urology conferences to address the heterogeneity in diagnostic criteria have recently been held.<ref name=pmid16985602>{{cite journal |last1=Nickel |first1=JC |title=Interstitial Cystitis:The Paradigm Shifts |journal=Reviews in Urology |volume=6 |issue=4 |pages=200–202|pmid=16985602 |year=2004 |pmc=1472838}}</ref><ref>{{cite web|author=IC Network|title=Conferences|url=https://www.ic-network.com/professional-resources/conferences|access-date=9 January 2025}}</ref> IC/PBS is now recognized with an official disability code in the United States of America.<ref name=pmid17546832>{{cite journal |doi=10.3949/ccjm.74.Suppl_3.S54 |pmid=17546832 |title=Interstitial cystitis/painful bladder syndrome: Symptom recognition is key to early identification, treatment |journal=Cleveland Clinic Journal of Medicine |volume=74 |pages=S54–62 |year=2007 |last1=Rosenberg |first1=M. T |last2=Newman |first2=D. K |last3=Page |first3=S. A |s2cid=32727097 }}</ref>

==Epidemiology==
Interstitial cystitis affects men and women of all cultures, socioeconomic backgrounds, and ages. Although the disease was previously believed to be a condition of [[menopause|menopausal]] women, growing numbers of men and women are being diagnosed in their twenties and younger. While BPS is not a rare condition<ref name="Moldwin2000">{{cite book|author=Robert M. Moldwin|title=The Interstitial Cystitis Survival Guide: Your Guide to the Latest Treatment Options and Coping Strategies|url=https://archive.org/details/interstitialcyst00mold|url-access=registration|access-date=23 November 2012|date=1 October 2000|publisher=New Harbinger Publications|isbn=978-1-57224-210-4}}</ref>, severe IC is. Early research suggested that the number of BPS cases ranged from 1 in 100,000 to 5.1 in 1,000 of the general population. In recent years, the scientific community has achieved a much deeper understanding of the epidemiology of interstitial cystitis. Recent studies<ref name=pmid17546832/><ref>{{cite journal |last1=Berry |first1=SH |last2=Elliott |first2=MN |last3=Suttorp |first3=M|last4=Bogart|first4=LM|last5=Stoto|first5=MA |title=Prevalence of symptoms of bladder pain syndrome/interstitial cystitis among adult females in the United States |journal=Journal of Urology |volume=186|issue=2 |pages=540–544 |year=2011 |pmid=21683389 |doi=10.1016/j.juro.2011.03.132 |pmc=3513327}}</ref> have revealed that between 2.7 and 6.53 million women in the USA have symptoms of IC and up to 12% of women may have early symptoms of IC/BPS. Further study has estimated that the condition is far more prevalent in men than previously thought ranging from 1.8 to 4.2 million men having symptoms of interstitial cystitis.{{citation needed|date=December 2020}}

The condition is officially recognized as a disability in the [[United States]].<ref name="Harvard Medical School">{{cite web|title=Harvard Medical School Family Health Guide: Treating interstitial cystitis|url=http://www.health.harvard.edu/fhg/updates/update0104d.shtml|publisher=Harvard Medical School|access-date=1 April 2011|url-status=dead|archive-url=https://web.archive.org/web/20110202061932/http://www.health.harvard.edu/fhg/updates/update0104d.shtml|archive-date=2 February 2011}}</ref><ref>{{cite web |url=http://www.socialsecurity.gov/OP_Home/rulings/di/01/SSR2002-02-di-01.html |title=Policy Interpretation Ruling Titles II and XVI: Evaluation of Interstitial Cystitis |publisher=Social Security Administration |access-date=16 October 2012 |url-status=live |archive-url=https://web.archive.org/web/20121031164825/http://www.socialsecurity.gov/OP_Home/rulings/di/01/SSR2002-02-di-01.html |archive-date=31 October 2012}}</ref>

==History==
Philadelphia surgeon Joseph Parrish published the earliest record of interstitial cystitis in 1836 describing three cases of severe lower urinary tract symptoms without the presence of a [[bladder stone]].<ref name=pmid20968203/> The term "interstitial cystitis" was coined by Dr. [[Alexander Skene]] in 1887 to describe the disease.<ref name=pmid19808225>{{cite journal |doi=10.2215/CJN.02000309 |pmid=19808225 |title=Interstitial Cystitis: An Unsolved Enigma |journal=Clinical Journal of the American Society of Nephrology |volume=4 |issue=11 |pages=1844–57 |year=2009 |last1=Moutzouris |first1=D.-A |last2=Falagas |first2=M. E |doi-access=free }}</ref> In 2002, the United States amended the Social Security Act to include interstitial cystitis as a disability. The first guideline for diagnosis and treatment of interstitial cystitis is released by a Japanese research team in 2009.<ref name=pmid19120522>{{cite journal |doi=10.1111/j.1442-2042.2008.02208.x |pmid=19120522 |title=Japanese guideline for diagnosis and treatment of interstitial cystitis |journal=International Journal of Urology |volume=16 |issue=1 |pages=4–16 |year=2009 |last1=Homma |first1=Yukio |last2=Ueda |first2=Tomohiro |last3=Ito |first3=Takaaki |last4=Takei |first4=Mineo |last5=Tomoe |first5=Hikaru |s2cid=23551461 |doi-access= }}</ref> The American Urological Association released the first American [[clinical practice guideline]] for diagnosing and treating IC/BPS in 2011 and has since (in 2014 and 2022) updated the guideline to maintain standard of care as knowledge of IC/BPS evolves.<ref>{{cite web |title=Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome (2022) |url=https://www.auanet.org/guidelines-and-quality/guidelines/diagnosis-and-treatment-interstitial-of-cystitis/bladder-pain-syndrome-(2022) |publisher=American Urological Association |access-date=27 October 2022}}</ref>

===Names===
Originally called ''interstitial cystitis'', this disorder was renamed to ''interstitial cystitis/bladder pain syndrome'' (IC/BPS) in the 2002–2010 timeframe. In 2007, the [[National Institute of Diabetes and Digestive and Kidney Diseases]] (NIDDK) began using the [[umbrella term]] [[urologic chronic pelvic pain syndrome]] (UCPPS) to refer to [[pelvic pain]] syndromes associated with the bladder (e.g., interstitial cystitis/bladder pain syndrome) and with the [[Prostate|prostate gland]] or [[pelvis]] (e.g., chronic prostatitis/chronic pelvic pain syndrome).<ref name="NIDDK UCPPS">{{Cite web|url=http://grants.nih.gov/grants/guide/rfa-files/RFA-DK-07-003.html|title=Multi-disciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network|access-date=11 January 2008|publisher=NIDDK|year=2007|url-status=live|archive-url=https://web.archive.org/web/20071027140854/http://grants.nih.gov/grants/guide/rfa-files/RFA-DK-07-003.html|archive-date=27 October 2007}}</ref><ref name="pmid32378039">{{cite journal |vauthors=Adamian L, Urits I, Orhurhu V, Hoyt D, Driessen R, Freeman JA, Kaye AD, Kaye RJ, Garcia AJ, Cornett EM, Viswanath O |title=A Comprehensive Review of the Diagnosis, Treatment, and Management of Urologic Chronic Pelvic Pain Syndrome |journal=Curr Pain Headache Rep |volume=24 |issue=6 |pages=27 |date=May 2020 |pmid=32378039 |doi=10.1007/s11916-020-00857-9 |s2cid=218513050 |url=}}</ref> 

In 2008, terms currently in use in addition to IC/BPS include ''painful bladder syndrome'', ''bladder pain syndrome'' and ''hypersensitive bladder syndrome'', alone and in a variety of combinations. These different terms are being used in different parts of the world. The term "interstitial cystitis" is the primary term used in [[ICD-10]] and [[Medical Subject Headings|MeSH]]. Grover et al.<ref name=pmid21789096>{{cite journal |doi=10.1177/1756287211398255 |pmid=21789096 |pmc=3126088 |title=Role of inflammation in bladder function and interstitial cystitis |journal=Therapeutic Advances in Urology |volume=3 |issue=1 |pages=19–33 |year=2011 |last1=Grover |first1=Sonal |last2=Srivastava |first2=Abhishek |last3=Lee |first3=Richard |last4=Tewari |first4=Ashutosh K |last5=Te |first5=Alexis E }}</ref> said, "The [[International Continence Society]] named the disease interstitial cystitis/painful bladder syndrome (IC/PBS) in 2002 [Abrams et al. 2002], while the Multinational Interstitial Cystitis Association have labeled it as painful bladder syndrome/interstitial cystitis (PBS/IC) [Hanno et al. 2005]. Recently, the European Society for the study of Interstitial Cystitis (ESSIC) proposed the moniker, 'bladder pain syndrome' (BPS) [van de Merwe et al. 2008]."

==See also==
* [[Urologic chronic pelvic pain syndrome]]
* [[Chronic prostatitis/chronic pelvic pain syndrome]]—women have vestigial prostate glands that may cause IC/BPS-like symptoms. Men with IC/BPS may have prostatitis, and vice versa.
* [[Overactive bladder]]
* [[Trigger point]]—a key to myofascial pain syndrome.

==References==
{{Reflist}}

== External links ==
* [https://www.ic-network.com/ Interstitial Cystitis Network]
* {{cite journal |doi=10.1097/01.ju.0000099890.35040.8d |pmid=14665834 |title=The Historical Origins of Interstitial Cystitis |journal=The Journal of Urology |volume=171 |issue=1 |pages=20–2 |year=2004 |last1=Parsons |first1=J. Kellogg |last2=Parsons |first2=C. Lowell }}
* [http://kidney.niddk.nih.gov/kudiseases/pubs/interstitialcystitis_ez// The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC)] {{Webarchive|url=https://web.archive.org/web/20110524085058/http://www.kidney.niddk.nih.gov/kudiseases/pubs/interstitialcystitis_ez/ |date=24 May 2011 }}
* {{cite journal |doi=10.1111/j.1442-2042.2009.02326.x |pmid=19548999 |title=Clinical guidelines for interstitial cystitis and hypersensitive bladder syndrome |journal=International Journal of Urology |volume=16 |issue=7 |pages=597–615 |year=2009 |last1=Homma |first1=Yukio |last2=Ueda |first2=Tomohiro |last3=Tomoe |first3=Hikaru |last4=Lin |first4=Alex TL |last5=Kuo |first5=Hann-Chorng |last6=Lee |first6=Ming-Huei |last7=Lee |first7=Jeong Gu |last8=Kim |first8=Duk Yoon |last9=Lee |first9=Kyu-Sung |s2cid=20796904 |doi-access= }}
* [http://kidney.niddk.nih.gov/kudiseases/pubs/interstitialcystitis_ez// European Urology] {{Webarchive|url=https://web.archive.org/web/20110524085058/http://www.kidney.niddk.nih.gov/kudiseases/pubs/interstitialcystitis_ez/ |date=24 May 2011 }}

{{Urinary tract disease}}
{{Medical resources
| ICD11           = {{ICD11|GC00.3}}
| ICD10           = {{ICD10|N30.1}}
| ICD9            = {{ICD9|595.1}}
| ICDO            = 
| OMIM            = 
| MedlinePlus     = 000477
| eMedicineSubj   = med
| eMedicineTopic  = 2866
| DiseasesDB      = 30832
| MeshID          = D018856
| Orphanet        = 37202
}}
{{Authority control}}

{{DEFAULTSORT:Interstitial Cystitis}}
[[Category:Ailments of unknown cause]]
[[Category:Urologic pelvic pain syndrome]]
[[Category:Urinary bladder disorders]]
[[Category:Chronic pain syndromes]]
[[Category:Wikipedia medicine articles ready to translate]]