Interstitial cystitis/painful bladder syndrome for the primary care physician

Interstitial cystitis also known as painful bladder disorder refers to individuals with chronic bladder inflammation of unknown cause. The presentation of disabling symptoms of urgency, frequency, nocturia, and varying degrees of suprapubic discomfort, is one that the primary care physician will encounter frequently as the prevalence of interstitial cystitis ranges from 10.6 cases per 100,000 to as high as one in 4.5 women, depending upon the criteria used for its diagnosis. Many etiologies are possible. The disorder can be divided clinically into two groups-ulcerative and non-ulcerative-based on cystoscopic findings and response to treatment. In general the diagnosis is made by excluding known treatable causes of bladder irritation. Criteria for the disease are lacking. Management follows an approach of applying the least invasive therapy that affords sufficient relief of symptoms. This monograph attempts to guide the practicing primary care physician from the clinical presentation to a sensible diagnostic work-up and reviews the present management strategies in patients with interstitial cystitis.