interstitial cystitis (bladder pain syndrome)

Question 1

what is IC? (bladder pain syndrome)
pathogenesis

Answer 1

• chronic bladder pain, debilitation and impacting quality of life

pathogenesis (unknown)
- understood to be an alteration in the GAG layer (glycosaminoglycan) of the bladder
- neurologic: pain fibers are increasingly sensitive in the bladder
- psychosocial and genetic theoires

generally: more painful when full, less painful when empty

GAG: normal epithelium of the bladder which is impermiable to soultes, so things cant diffused cross & contains bladder mast cells

Question 2

symptoms of interstital cystitis

Answer 2

• graudal, or sudden pain
• worse with filling, specific foods, drinks, sex & better - - when empty
• pressure, pain and spasms
• radiate to the abdomen
• varies in intensity
• nocturia seen
• increase urgency
• no incontinence problems

-pts often ahve concurrent chronic pain syndromes like…
IBS, peliv pain, fibromyalgia , sexual discomfort, depression/anxiety

Question 3

Labs for IC (bladder pain syndrome)

Answer 3

work-up ususally done to rule out other disease processes

• urinalysis with microscopy (r/o malignant or infection)
• urine culture (infection)
• can do post void residual via US (cath. too painful – tight peliv floor)
• cytoscopy if hematuria present
• cytoscopy with hydrodistesion
• ** glomerulation & Hunners lesions on the bladder wall (red lesions attached to fibrin) key finding**
• increased mast cells on biopsy

do NOT do
- potassium sensitivity
- lidocaine
- urodynamics

Question 4

Treatment of IC
pharm and non-pharm

Answer 4

• manage co-morbid condtions
• manage psychosocial conditionsn
• lifestyle: avoid trigger foods & offending activities
• educate pt.

1st line medication: amitriptyline for pain and antidepressant (TCA)
- affective at higher doses, watch QTc prolongation and anti-cholenergic effects & avoid CYP450 drug

other meds…
- pentosan polysylfate sodium (heparon-like med): reconsititues the GAG layer (takes 3-6 months, occular side effects (eye color change & expensive)
- anti-histamines & monteleukast = moderate efficacy

Question 5

secondary treaments of IC (besides amytriptyline and heparon-like med)

Answer 5

• treat hunner lesions: injection steroid, electrical cauterization
• intravescial therapy: with a variety of medications
• detruser muscle botox
• neuromodulators
• cyclosporine A
• bypass urine (last resort)

Question 6

Rescue medication for acute pain with IC

Answer 6

phenazopyridine: orange urine!! avoid in eGFR < 50

methenamine: short term use only

intravesciular lidocaine with heparin, sodium bicarb

neuopathic pain (pregabilin)
sildenafil (men only)
cimdetidine (H2 blocker)