Interstitial Cystitis Bladder Pain Syndrome

Question 1

IC/BPS definition

Answer 1

pressure, pain, or discomfort in the pelvic area + daytime frequency or urgency due to this pain WITHOUT another explanation (high sensitivity diagnosis) AND no improvement with antibiotics or endometriosis hormone treatment (high specificity)

Question 2

Differential that must be excluded prior to IC/BPS

Answer 2

bladder cancer
urethral diverticulum
spinal cord injury
Stroke
Parkinson’s
MS
Spina bifida
cytoxan treatment
Radiation to the bladder
TB of the bladder
Uterine/ovarian/vaginal cancer
Genital herpes
Pregnancy

Question 3

Exam for suspected IC/BPS

Answer 3

Abdominal and pelvic exam to assess for masses, tenderness, hernias, external genital abnormalities

Question 4

Testing for IC/BPS workup

Answer 4

UA and UCx
Voiding diary
Pain via likert scale
Cysto and UDS are optional (but cysto if hunner lesions suspected)

Question 5

IC/BPS treatment

Answer 5

Nonsurgical first (unless Hunner)
Multimodal pain management
Consider PT, pain medications
Amitriptyline, cimetidine, hydroxyzine, pentosan (counsel about macular damage)
Cyclophosphamide
Intravesical DMSO, heparin, lidocaine
Cysto with hydrodistension
Fulgurate Hunners with triamcinolone injection
Botox
neuromodulation
Cx/diversion
do NOT offer long-term abx, BCG, high pressure hydrodistension, long-term steroids