Epidemiology and quality of life

Once thought to be a rare condition, PBS/IC is being increasingly recognized as an important cause of CPP. It can exist either as a solitary disorder or in conjunction with other gynecologic or urologic disorders. The true prevalence of PBS/IC is hard to determine because most patients remain undiagnosed, although it is now thought to occur in up to 7.5% of the general female population and in 38-85% of women who present with CPP. Because the bladder has been insufficiently considered as a component of pelvic pain, many patients with PBS/IC may be misdiagnosed and inappropriately treated for years. It is critical for all clinicians, and especially gynecologists, who are often the first physicians from whom a woman with CPP will seek treatment, to consider PBS/IC in their patients who complain of pelvic pain, particularly when it occurs with urinary symptoms. The hallmark features of PBS/IC are irritative voiding and CPP. A minority of patients have classic ulcers and most have glomerulations, although it is not always necessary to establish these features to make the diagnosis. With careful questioning, most patients, in fact, can be identified by symptomatology, a medical history and a physical examination. Cystoscopy may be useful to rule out other conditions or to evaluate microscopic hematuria, which may be found in these patients. PBS/IC should be correctly diagnosed as early in the disease course as possible in order to avoid debilitating detriments to the patients' QOL in multiple domains. When symptoms of PBS/IC are recognized early on, treatment can be initiated when it is most likely to have a successful outcome. Although evidence-based clinical practice guidelines for IC/PBS are not available, partly because there is a lack of consensus on the definition and etiology of IC, clinicians, both primary care providers and specialists, can be reassured that there are diagnostic and treatment options that are simple to administer and have been demonstrated to be safe and effective.