Interstitial Cystitis: Enhancing Early Identification in Primary Care Settings

Brittany N. Heck, FNP, MSN

Disclosures

Journal for Nurse Practitioners. 2007;3(8):509-519. 

In This Article

Abstract and Introduction

Abstract

Interstitial cystitis or painful bladder syndrome is a chronic and progressive disease of the lower urinary tract, distinguished by urinary urgency, frequency, and chronic pelvic pain. As a diagnosis of exclusion, interstitial cystitis is commonly misdiagnosed in the clinical setting given its variable symptom presentation, similarity to other gynecologic and urologic diseases, and lack of a definitive diagnostic test. Delay in diagnosis promotes disease progression and can lead to a decreased quality of life. Successful management of interstitial cystitis relies on the clinicians' ability to promptly diagnose the syndrome and initiate effective treatment interventions in the early stages of disease.

Introduction

Interstitial cystitis (IC) or painful bladder syndrome (PBS) is a clinical syndrome of the lower urinary tract distinguished by urinary urgency, frequency, and chronic pelvic pain in the absence of clear pathology. As a chronic and progressive disease, IC presents cyclically; it is commonly characterized by symptom flares and remissions. Currently, IC lacks a clear pathogenesis and a definitive diagnostic test, and it remains a diagnosis of exclusion. Consequently, IC can be difficult to identify in the clinical setting, and often, the diagnosis is missed.

Prevalence rates of IC vary throughout the literature; however, the syndrome is thought to affect approximately 1 million persons in the United States.[1] Although the syndrome occurs in both men and women, 90% of cases affect the female population. Recent findings from Clemens et al[2] found the prevalence of IC in 197 cases per 100,000 women and 41 cases per 100,000 men in a managed care population. Although the prevalence of childhood IC or PBS is rare, increasing evidence shows that the syndrome can occur in the pediatric population.[3] Typically, onset occurs in patients in their mid forties, although in one study, 25% of patients were younger than 30 years.[4]

Difficulty identifying patients with IC or PBS often leads to delayed diagnosis or misdiagnosis. Confirmation of an accurate diagnosis often occurs 5 years after the initial symptoms present.[5] Delay in diagnosis hinders the initiation of effective treatment interventions, promotes further disease progression, and can negatively affect patient quality of life. Patients with IC report increased rates of pain and depression, frequent absence from work, dyspareunia, sexual dysfunction, and an overall decrease in quality of life.[6] Patients with IC have been found to be three to four times more likely to have suicidal thoughts.[7] Furthermore, misdiagnosis in women has lead to the unnecessary surgical procedures such as laparotomies and hysterectomies.[8]

Recognizing that IC is a disease that carries significant physical and emotional consequences, efforts must be directed toward achieving a more timely diagnosis. Primary care providers should be familiar with the pathophysiology, symptom presentation, and treatment strategies of IC and PBS. A working knowledge of available diagnostic tools, in conjunction with an understanding of clinical findings, enhances the likelihood of early identification and diagnosis of IC or PBS.

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