Flashcards in Interstitial Cystitis Deck (34)
What is interstitial cystitis/bladder pain syndrome (IC/BPS)?
- an unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms of more than 6 weeks duration, in the ABSENCE of infection or other identifiable causes.
*diagnosis of exclusion
Does IC/BPS consist of chronic pelvic pain, often exacerbated by bladder filling?
YES and associated with urinary frequency.
Is there a specific test or marker that is diagnostic for BPS/IC?
- NO :(
What symptoms are associated with IC/BPS?
- voiding symptoms (frequency, urgency)
- pelvic pain
- nocturia (getting up in the middle of the night to pee).
Do more males or females suffer from IC/BPS?
- FEMALES (5:1 female to male ratio)
*** What is associated with 40% of people with interstitial cystitis (IC)?
- multiple ALLERGIES
How do you differentiate overactive bladder from painful bladder syndrome (aka IC or BPS)?
- bladder PAIN
What other conditions can mimmic IC?
- urinary tract infection
- vulvodynia (pain in the vulva)
- chronic pelvic pain
What will you find on physical exam of a patient with IC?
- TENDERNESS of bladder, suprapubic, levator ani, cervical motion, posterior vaginal, and rectal.
**** What causes IC?
- Don't know, but MAST CELL ACTIVATION and histamine release often occur.
What is the best circumstantial evidence for urine abnormality?
- late occurrence of pain and bowel segment contraction after substitution cystoplasty and continent diversion. (aka pts still have pain after removal of bladder).
What do we think happens with IC?
- breakdown of bladder mucosal lining, leading to irritation and subsequent inflammation of the urothelium
How do we diagnosis IC?
- frequency/volume chart
- focused history and physical exam
- urine culture
- cytology and cystoscopy are recommended if clinically indicated.
Does cystometry in conscious IC patients generally demonstrate normal function?
YES, with the exception of decreased bladder capacity, hypersensitivity, and pain with bladder filling.
What is score is considered relevant for IC when using the O'Leary-Sant or PUF screening questionnaires?
- O'Leary-Sant= 6 or higher
- PUF= 10 or higher
Are glomerulations (pin-point hemorrhages) of the bladder wall seen on cystoscopy consistent with IC?
NO, bc they can be seen in many clinical situations.
What is a Hunner's ulcer?
- rare positive finding that can confirm the diagnosis in patients who meet the definition criteria for IC.
- acute= inflamed, firable, denuded area
- chronic= blanched, non-bleeding area
*provides a therapeutic ulcer.
What is a possible marker that may help with diagnosis of PBS/IC?
- antiproliferative factor (APF)
*** What is the first approach to treatment for IC?
- pt education and support groups
- timed voiding
- stress reduction
- biofeedback, pelvic massage
What foods should you avoid with IC?
- foods high in citric acid (tomatoes, oranges...)
*** What are the 2nd line treatments?
- manual physical therapy (OMM)
- pain managment from expert in this area.
- oral medications (amitriptyline, cimetidine, hydroxyzine, or pentosanpolysulfate)
- intravesical medications (DMSO, heparin, lidocaine)
*** What is Amitriptyline?
- central and peripheral anticholinergic actions
- block the active transport system in presynaptic nerve ending that reuptakes amine neurotransmitters (serotonin and noradrenaline).
*** What is Pentosanpolysulfate (sodium pentosan polysulfate)?
- heparin analogue (oral formulation) used based on theory of epithelial permeability barrier that targets the glycosaminoglucan layer of the urothelium in IC patients.
*usually takes at least 3-6 months to see effects.
What is an ADR of Pentosanpolysulfate with a higher does?
- GI side effects (nausea and diarrhea).
**** Are antihistamines (Hydroxizine) used for treating IC?
What analgesics are used for treating IC?
*** What is the 3rd line treatment?
- cystoscopy + 1-2 mins of hydrodistention (under anesthesia)
*** What is the 4th line treatment?
- neurostimulation via permanently implanted electrode at S3 foramen.
*** What are the 5th line treatments?
- cyclosporine A
- intradetrusor BOTOX
*** What is the 6th line treatment?
- SURGERY= cystectomy with urinary diversion
What therapies should be avoided for IC?
- long-term ABX
- long-term steroid administration
What are some new clinical trials being done for IC?
- hyperbaric oxygen treatment
- intranasal oxytocin
- lidocaine ring
Is IC a lifelong, incurable disease?
YES, but symptoms can be managed.