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Interstitial cystitis

Interstitial cystitis (commonly abbreviated to "IC") is a urinary bladder disease of unknown cause characterised by pelvic and intense bladder pain, urinary frequency (as often as every 10 minutes), pain with sexual intercourse, and often pain with urination. It is not unusual for patients to experience nocturia and pain with sexual intercourse. IC is also known as painful bladder syndrome (PBS), particularly outside of the USA. more...

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IC affects men and women of all cultures, socioeconomics and ages. Previously believed to be a condition of post menopausal women, growing numbers of men and women are being diagnosed in their twenties and younger. IC is not a rare condition. Recent research suggests that IC prevalence ranges from 1 in 100,000 to 5.1 in 1,000 of the general population. New epidemiological data for the United States should be released in 2006.

It is not unusual for patients to have beeen misdiagnosed with a variety of other conditions, including: overactive bladder, urethritis, urethral syndrome, trigonitis, prostatitis and other generic terms used to describe frequency/urgency symptoms in the urinary tract.


The cause of interstitial cystitis is unknown, though several theories have been put forward (these include autoimmune, neurologic, allergic and genetic). Regardless of the origin, it is clear that IC patients struggle with a damaged mucin, aka the GAG layer, aka bladdering lining. When this protective coating is damaged (perhaps via a UTI, excessive consumption of coffees or sodas, traumatic injury, etc.), urinary chemicals can "leak" into surrounding tissues causing pain, inflammation and urinary symptoms. Oral medications like Elmiron and medications which are placed directly into the bladder via a catheter work to repair and hopefully rebuild this damaged/wounded lining, allowing for a reduction in symptoms.

Recent work by the University of Maryland indicates that genetics are a factor in, and may even (in some cases) be the cause of IC. Two genes, FZD8 and PAND, are associated with the syndrome. FZD8, at gene map locus 10p11.2, is assocated with an antiproliferative factor secreted by the bladders of IC patients which "profoundly inhibits bladder cell proliferation," thus causing the missing bladder lining. PAND, at gene map locus 13q22-q32, is associated with a constellation of disorders (a "pleiotropic syndrome") including IC and other bladder and kidney problems, thyroid diseases, serious headaches/migraines, panic disorder, and mitral valve prolapse.


It may well be that the symptoms of interstitial cystitis have multiple causes, and IC is actually several syndromes which will eventually be discerned. For example, patients with Hunner's Ulcers are believed to be the most advanced cases. They have larger "wounds" in the bladder that are much more difficult to treat. It is estimated that only 5 to 10% of patients have these ulcers. Far more patients may experience a very mild form of IC, inwhich they have no visible wounds in their bladder, yet struggle with symptoms of frequency, urgency and/or pain. Still other patients may have discomfort only in their urethra, while others struggle with pain in the entire pelvis. Some patients may experience pelvic floor tightness and dysfunction, while others have normal muscle tone.


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Researchers Report Relief of IC Symptoms with Pentosan Polysulfate - interstitial cystitis
From American Family Physician, 8/15/01 by J. Curtis Nickel

(96th Annual American Urological Association Meeting) The findings of the first study conducted to evaluate the onset of effect and dose-response relationship of pentosan polysulfate sodium (Elmiron) in the treatment of interstitial cystitis (IC) indicate that significant improvement of symptoms occurrs with duration of therapy in relation to differences in dosages. The 32-week, randomized, double-blind, multicenter study enrolled 380 patients with a positive cystoscopic examination or a history of IC symptoms of at least six months' duration. Patients were randomized to receive 100, 200 or 300 mg of pentosan or placebo three times daily. Measurement tools included the Patient's Overall Rating of Symptom Index (PORIS) and the O'Leary-Sant Interstitial Cystitis Symptom Index. Patients who showed 50 percent or more improvement on PORIS were considered responders. Of the 230 patients who completed the study, 23.1 percent who received 300 mg per day, 16.5 percent who received 600 mg per day and 16.9 percent who received 900 mg per day were responders. At 32 weeks, the percentages rose to 67.1, 59.5 and 60.1 percent, respectively, leading investigators to suggest that while no significant measure of efficacy was evident between dosages, improvement in symptoms had not plateaued at 32 weeks, and further improvement may be obtained with long-term therapy. Pentosan polysulfate sodium is the only oral medication approved by the U.S. Food and Drug Administration for the treatment of IC.--J. CURTIS NICKEL, m.d., et al., Kingston General Hospital, Ontario, Canada.

COPYRIGHT 2001 American Academy of Family Physicians
COPYRIGHT 2001 Gale Group

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