Three causes of Interstitial Cystitis (Painful Bladder Syndrome) (IC/PBS)

IC/PBS is a characterized by urinary frequency, urgency, and lower abdominal pain where no identifiable pathology can be found. It can be misdiagnosed as chronic UTI, OAB, or even chronic pelvic pain. Unlike a UTI, pain tends to improve with urination; unlike OAB there is an element of pain. Unlike chronic pelvic pain, one study, found that pain above the pubic bone and pain in the urethra were more common than genital pain among 226 women with IC/PBS.

The cause(s) of IC/PBS are hotly debated. Each presumed cause has a distinctly different treatment modality. Let' summarize the three of the most currently researched causes of IC/PBS.

1. A defect in the layer of mucus that protects the bladder wall from direct contact with urine. A defect in the mucus (also known a GAG layer) layer has been caused from a severe UTI, damage from childbirth, or some other trauma. Consequently, irritants in the urine create inflammation, tissue changes, and increased pain signals to the brain. Treatments include avoidance of caffeine, alcohol, artificial sweeteners, carbonation, and spicy and acidic foods. There are two FDA approved prescriptive treatments. One is a pill (Elmiron that is taken three times/day. The other is DMSO that is instilled in the bladder by a urologist.

2. A neurological disorder in pain processing pathways of the central nervous system. The limbic system in the brain has an increased sensitivity to pain signals from the pelvic organs, which then triggers muscle contractions in the involved area. Treatments not submitted to the FDA for approval but often used include: amitriptyline or noretriptyline pills, or local anesthetics instilled in the bladder by a urologist.

3. The presence of tissue than is transforming one cell type into a more mature cell type in the bladder neck region. Women not receiving relief from medications were treated with a laser to remove metaplasia. Three months after treatment biopsies of the area showed no metaplasia in the 68% of patients that improved, but metaplasia was still present in the 32% who did not improve.