Chronic pelvic pain of bladder origin: a focus on interstitial cystitis

Chronic pelvic pain afflicts some 9,000,000 women in the United States. Of these, perhaps 10%-although the true number of those affected is actually much greater-are found to have interstitial cystitis (IC), that is, pain of bladder origin. The etiology is multifactorial, but a fairly good marker is dysfunction of the glycosaminoglycan/mucus/mucin layer of the bladder as detected by a potassium (KCl) sensitivity test. A cascade starting with Substance P seems to be involved in generating inflammation, and even ulceration, which is the focus of pain. This article describes means of diagnosis, including the KCl test and cystoscopy, and both U.S. FDA-approved and extended-use medical treatment options which are always to be attempted before the final step of surgery.