IC may often look like other pelvic or bladder conditions.1,2 Therefore, it is critical to thoroughly examine patients who present with symptoms commonly associated with IC.
IC symptoms can mimic the symptoms of unresolved overactive bladder (OAB)
Consider IC in patients who present with
- Urinary urgency and frequency (≥8 voids/day)
- Urgency associated with bladder pain
- Pelvic pain relieved upon urination
- Pain during sexual intercourse
- Symptoms unresponsive to anticholinergic therapy for presumed OAB
Pain is a characteristic symptom of IC, but not OAB, and may help differentiate between the 2 conditions3
- In patients with OAB, urgency is associated with fear of leakage, whereas in patients with IC, urgency is associated with bladder pain2
Findings suggest a high prevalence of IC in patients with OAB symptoms refractory to anticholinergic therapy4
- A study showed that 25 of 47 patients with detrusor overactivity did not respond to therapy with 1 anticholinergic medication4
- 96% (24 of 25) of those patients were diagnosed with IC*
IC Cast: Interstitial Cystitis or Overactive Bladder?
This informative and entertaining video features leading IC key opinion leaders Dr Robert Evans and Dr Scott MacDiarmid. During the video, they discuss OAB as a mimicking condition and offer tips and advice on how to screen for, diagnose, and treat IC.
With:
Robert J. Evans, MD
Associate Professor of Urology
Wake Forest University Scott A. MacDiarmid, MD
Alliance Urology Specialists
Greensboro, NC
Clinical Faculty, Department of Urology
Wake Forest University
- Contraindications: ELMIRON® is contraindicated in patients with known hypersensitivity to the drug, structurally related compounds, or excipients
- Anticoagulant Activity: ELMIRON® is a weak anticoagulant (blood thinner) which may increase bleeding. Patients undergoing invasive surgery or having signs/symptoms of underlying coagulopathy or other increased risk of bleeding (due to anticoagulant therapy or high doses of anti-inflammatory drugs) should be evaluated for the risk of hemorrhage
- Alopecia: In clinical trials of ELMIRON®, alopecia began within the first 4 weeks of treatment. Ninety-seven percent (97%) of the cases of alopecia reported were alopecia areata, limited to a single area on the scalp
- Use in Pregnancy: ELMIRON® is a Pregnancy Category B drug
- Most Common Adverse Reactions (frequency 1% to 4%): Alopecia (4%), diarrhea (4%), nausea (4%), headache (3%), rash (3%), dyspepsia (2%), abdominal pain (2%), liver function abnormalities (1%), dizziness (1%)
References:
- Hanno PM. Interstitial cystitis and related disorders. In: Walsh PC, ed-in-chief;
Retik AB, Vaughan ED Jr, Wein AJ, eds; Kavoussi LR, Novick AC, Partin AW,
Peters CA, associate eds. Campbell's Urology. Vol 1. 8th ed. Philadelphia, PA: Saunders; 2002:631-670.
- Rosenberg MT, Moldwin RM, Stanford EJ. Early diagnosis and management of interstitial cystitis: what nonspecialists should know. Womens Health Gynecol Edition. 2005;5:108-115.
- Dell JR. Chronic pelvic pain of bladder origin: a focus on interstitial cystitis. Int J Fertil. 2003;48:154-162.
- Minaglia S, Özel B, Bizhang R, Mishell DR Jr. Increased prevalence of interstitial cystitis in women with detrusor overactivity refractory to anticholinergic therapy. Urology. 2005;66:702-706.
IC symptoms can mimic the symptoms of a urinary tract infection (UTI)
Consider IC in patients who present with
- Urinary urgency and frequency (≥8 voids/day)
- Pelvic pain, usually relieved upon urination
- Pain during sexual intercourse
- A negative urine culture
- A history of recurrent UTIs unresponsive to antibiotic therapy
Millions of women seek treatment for UTI symptoms every year3
- A study showed that 60% of patients (18 of 30) with IC were initially diagnosed with a UTI4
- Contraindications: ELMIRON® is contraindicated in patients with known hypersensitivity to the drug, structurally related compounds, or excipients
- Anticoagulant Activity: ELMIRON® is a weak anticoagulant (blood thinner) which may increase bleeding. Patients undergoing invasive surgery or having signs/symptoms of underlying coagulopathy or other increased risk of bleeding (due to anticoagulant therapy or high doses of anti-inflammatory drugs) should be evaluated for the risk of hemorrhage
- Alopecia: In clinical trials of ELMIRON®, alopecia began within the first 4 weeks of treatment. Ninety-seven percent (97%) of the cases of alopecia reported were alopecia areata, limited to a single area on the scalp
- Use in Pregnancy: ELMIRON® is a Pregnancy Category B drug
- Most Common Adverse Reactions (frequency 1% to 4%): Alopecia (4%), diarrhea (4%), nausea (4%), headache (3%), rash (3%), dyspepsia (2%), abdominal pain (2%), liver function abnormalities (1%), dizziness (1%)
References:
- Hanno PM. Interstitial cystitis and related disorders. In: Walsh PC, ed-in-chief;
Retik AB, Vaughan ED Jr, Wein AJ, eds; Kavoussi LR, Novick AC,
Partin AW, Peters CA, associate eds. Campbell's Urology. Vol 1. 8th ed. Philadelphia, PA: Saunders; 2002:631-670.
- Rosenberg MT, Moldwin RM, Stanford EJ. Early diagnosis and management of interstitial cystitis: what nonspecialists should know. Womens Health Gynecol Edition. 2005;5:108-115.
- Childs SJ, Egan RJ. Microbiology and epidemiology in recurrent lower urinary tract infections. Infect Urol. May/June 1998;11:88-92.
- Porru D, Politanò R, Gerardini M, et al. Different clinical presentation of interstitial cystitis syndrome. Int Urogynecol J Pelvic Floor Dysfunct. 2004;15:198-202.
IC symptoms can mimic the symptoms of endometriosis
Consider IC in patients who present with
- Pelvic pain and flares associated with menstruation
- Pain during sexual intercourse
- Symptoms unresponsive to endometriosis therapy
Endometriosis and IC may coexist
- 86% of patients diagnosed with endometriosis at a pelvic pain referral center were also diagnosed with IC (N=134)3
- 96% (n=58) of women with chronic pelvic pain were diagnosed with IC, and 80% (n=48) had biopsy-confirmed active endometriosis4
Consider IC in patients with unresolved endometriosis
- More than half of women treated for endometriosis continued to experience symptoms, including pelvic pain (N=24)5
- Contraindications: ELMIRON® is contraindicated in patients with known hypersensitivity to the drug, structurally related compounds, or excipients
- Anticoagulant Activity: ELMIRON® is a weak anticoagulant (blood thinner) which may increase bleeding. Patients undergoing invasive surgery or having signs/symptoms of underlying coagulopathy or other increased risk of bleeding (due to anticoagulant therapy or high doses of anti-inflammatory drugs) should be evaluated for the risk of hemorrhage
- Alopecia: In clinical trials of ELMIRON®, alopecia began within the first 4 weeks of treatment. Ninety-seven percent (97%) of the cases of alopecia reported were alopecia areata, limited to a single area on the scalp
- Use in Pregnancy: ELMIRON® is a Pregnancy Category B drug
- Most Common Adverse Reactions (frequency 1% to 4%): Alopecia (4%), diarrhea (4%), nausea (4%), headache (3%), rash (3%), dyspepsia (2%), abdominal pain (2%), liver function abnormalities (1%), dizziness (1%)
References:
- Hanno PM. Interstitial cystitis and related disorders. In: Walsh PC, ed-in-chief;
Retik AB, Vaughan ED Jr, Wein AJ, eds; Kavoussi LR, Novick AC,
Partin AW, Peters CA, associate eds. Campbell’s Urology. Vol 1. 8th ed. Philadelphia, PA: Saunders; 2002:631-670.
- Rosenberg MT, Moldwin RM, Stanford EJ. Early diagnosis and management of interstitial cystitis: what nonspecialists should know. Womens Health Gynecol Edition. 2005;5:108-115.
- Chung MK, Chung RP, Gordon D. Interstitial cystitis and endometriosis in patients with chronic pelvic pain: the “Evil Twins” syndrome. JSLS. 2005;9:25-29.
- Chung MK, Chung RP, Gordon D, Jennings C. The evil twins of chronic pelvic pain syndrome: endometriosis and interstitial cystitis. JSLS. 2002;6:311-314.
- Dlugi AM, Miller JD, Knittle J, and the Lupron Study Group. Lupron depot (leuprolide acetate for depot suspension) in the treatment of endometriosis: a randomized, placebo-controlled, double-blind study. Fertil Steril. 1990;54:419-427.
IC symptoms can mimic the symptoms of chronic pelvic pain (CPP)
Consider IC in patients who present with
- Generalized pelvic pain for ≥6 months
- Pain during sexual intercourse
- Pain with bladder filling
- Urinary urgency
Pelvic pain may be an indicator of IC
- 79% of patients at a regional pelvic pain center who suffered from persistent pelvic pain (pre- and post-hysterectomy) were diagnosed with bladder dysfunction consistent with IC (n=88)3
- In a study of 45 women scheduled to undergo laparoscopy for CPP, 38% were diagnosed with IC4
- Contraindications: ELMIRON® is contraindicated in patients with known hypersensitivity to the drug, structurally related compounds, or excipients
- Anticoagulant Activity: ELMIRON® is a weak anticoagulant (blood thinner) which may increase bleeding. Patients undergoing invasive surgery or having signs/symptoms of underlying coagulopathy or other increased risk of bleeding (due to anticoagulant therapy or high doses of anti-inflammatory drugs) should be evaluated for the risk of hemorrhage
- Alopecia: In clinical trials of ELMIRON®, alopecia began within the first 4 weeks of treatment. Ninety-seven percent (97%) of the cases of alopecia reported were alopecia areata, limited to a single area on the scalp
- Use in Pregnancy: ELMIRON® is a Pregnancy Category B drug
- Most Common Adverse Reactions (frequency 1% to 4%): Alopecia (4%), diarrhea (4%), nausea (4%), headache (3%), rash (3%), dyspepsia (2%), abdominal pain (2%), liver function abnormalities (1%), dizziness (1%)
References:
- Hanno PM. Interstitial cystitis and related disorders. In: Walsh PC, ed-in-chief; Retik AB, Vaughan ED Jr, Wein AJ, eds; Kavoussi LR, Novick AC, Partin AW, Peters CA, associate eds. Campbell’s Urology. Vol 1. 8th ed. Philadelphia, PA: Saunders; 2002:631-670.
- Rosenberg MT, Moldwin RM, Stanford EJ. Early diagnosis and management of interstitial cystitis: what nonspecialists should know. Womens Health Gynecol Edition. 2005;5:108-115.
- Chung MK. Interstitial cystitis in persistent posthysterectomy chronic pelvic pain. JSLS. 2004;8:329-333.
- Clemons JL, Arya LA, Myers DL. Diagnosing interstitial cystitis in women with chronic pelvic pain. Obstet Gynecol. 2002;100:337-341.
IC symptoms can mimic the symptoms of vulvodynia
Consider IC in patients who present with
- Chronic pelvic pain
- Pain during and after sexual intercourse
- Vulvar pain
IC and vulvodynia may have overlapping symptoms due to a common etiology1
- Patients presenting with vulvodynia may have underlying IC that is causing or contributing to their pain
- Vulvodynia and IC may occur concomitantly
- In a study of 46 women with IC or symptoms of vulvodynia (focal vulvitis), 24% had both conditions3
- Contraindications: ELMIRON® is contraindicated in patients with known hypersensitivity to the drug, structurally related compounds, or excipients
- Anticoagulant Activity: ELMIRON® is a weak anticoagulant (blood thinner) which may increase bleeding. Patients undergoing invasive surgery or having signs/symptoms of underlying coagulopathy or other increased risk of bleeding (due to anticoagulant therapy or high doses of anti-inflammatory drugs) should be evaluated for the risk of hemorrhage
- Alopecia: In clinical trials of ELMIRON®, alopecia began within the first 4 weeks of treatment. Ninety-seven percent (97%) of the cases of alopecia reported were alopecia areata, limited to a single area on the scalp
- Use in Pregnancy: ELMIRON® is a Pregnancy Category B drug
- Most Common Adverse Reactions (frequency 1% to 4%): Alopecia (4%), diarrhea (4%), nausea (4%), headache (3%), rash (3%), dyspepsia (2%), abdominal pain (2%), liver function abnormalities (1%), dizziness (1%)
References:
- Hanno PM. Interstitial cystitis and related disorders. In: Walsh PC, ed-in-chief; Retik AB, Vaughan ED Jr, Wein AJ, eds; Kavoussi LR, Novick AC, Partin AW, Peters CA, associate eds. Campbell’s Urology. Vol 1. 8th ed. Philadelphia, PA: Saunders; 2002:631-670.
- Rosenberg MT, Moldwin RM, Stanford EJ. Early diagnosis and management of interstitial cystitis: what nonspecialists should know. Womens Health Gynecol Edition. 2005;5:108-115.
- McCormack WM. Two urogenital sinus syndromes: interstitial cystitis and focal vulvitis. J Reprod Med. 1990;35:873-876.
IC symptoms can mimic the symptoms of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)
Consider IC in patients who present with
- Voiding symptoms (urgency, frequency [≥8 voids/day], nocturia)
- Generalized pelvic pain
- Pain during sexual intercourse
- Pain with bladder filling
- Unresolved symptoms after empiric antibiotic therapy
Men presumed to have CP/CPPS who are unresponsive to antibiotic therapy may suffer from IC
- In 3 separate studies, 58% to 90% of men with CP/CPPS had cystoscopic findings consistent with IC*3-5
*58%, N=60; 60%, N=20; 90%, N=30.
- Contraindications: ELMIRON® is contraindicated in patients with known hypersensitivity to the drug, structurally related compounds, or excipients
- Anticoagulant Activity: ELMIRON® is a weak anticoagulant (blood thinner) which may increase bleeding. Patients undergoing invasive surgery or having signs/symptoms of underlying coagulopathy or other increased risk of bleeding (due to anticoagulant therapy or high doses of anti-inflammatory drugs) should be evaluated for the risk of hemorrhage
- Alopecia: In clinical trials of ELMIRON®, alopecia began within the first 4 weeks of treatment. Ninety-seven percent (97%) of the cases of alopecia reported were alopecia areata, limited to a single area on the scalp
- Use in Pregnancy: ELMIRON® is a Pregnancy Category B drug
- Most Common Adverse Reactions (frequency 1% to 4%): Alopecia (4%), diarrhea (4%), nausea (4%), headache (3%), rash (3%), dyspepsia (2%), abdominal pain (2%), liver function abnormalities (1%), dizziness (1%)
References:
- Hanno PM. Interstitial cystitis and related disorders. In: Walsh PC, ed-in-chief;
Retik AB, Vaughan ED Jr, Wein AJ, eds; Kavoussi LR, Novick AC, Partin AW,
Peters CA, associate eds. Campbell’s Urology. Vol 1. 8th ed. Philadelphia, PA: Saunders; 2002:631-670.
- Rosenberg MT, Moldwin RM, Stanford EJ. Early diagnosis and management of interstitial cystitis: what nonspecialists should know. Womens Health Gynecol Edition. 2005;5:108-115.
- Berger RE, Miller JE, Rothman I, Krieger JN, Muller CH. Bladder petechiae after cystoscopy and hydrodistension in men diagnosed with prostate pain. J Urol. 1998;159:83-85.
- Miller JL, Rothman I, Bavendam TG, Berger RE. Prostatodynia and interstitial cystitis: one and the same? Urology. 1995;45:587-590.
- Sant GR, Kominski A. Interstitial cystitis in men is frequently misdiagnosed as prostatitis/prostatodynia. Bethesda, MD: National Institutes of Health. 1997 International Research Symposium on Interstitial Cystitis; October 1997.
