Chapter 6 – The Bladder and the Pelvic Floor

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Interstitial cystitis

Interstitial cystitis, also known as ‘bladder pain syndrome’, refers to the complaint of suprapubic pressure or discomfort perceived to be related to the urinary bladder and accompanied by other lower urinary tract symptoms of more than six weeks duration in the absence of proven urinary infection or other obvious pathology.(9, 10) Symptoms can include dysuria, frequency, nocturia, urgency, haematuria, dyspareunia and perineal discomfort.

Interstitial cystitis is often misdiagnosed as recurrent UTI (without urine culture evidence). The aetiology is poorly understood and various theories propose chronic inflammation, autoimmune dysregulation or epithelial cell dysfunction as possible causes. Treatment options include:

behavioural therapy, such as dietary restrictions, fluid management, stress management, or pelvic floor relaxation with a trained pelvic floor physiotherapist oral therapy, e.g. low dose amitriptyline (for pain), pentosan polysulfate sodium (Elmiron), antihistamine various intravesical installation therapies surgery such as bladder distension

Rarely cystectomy is considered. Referral is recommended if interstitial cystitis is suspected.

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