Interstitial cystitis is a chronic disease characterized by bladder pain, frequency and urgency. Because of lack of definition and specific diagnostic criteria terminology today changes towards Painful Bladder Syndrome (PBS) reserving the diagnosis Interstitial Cystitis (IC) for a disease with typical cystoscopic and histological features yet to be defined.
Patients with bladder pain, frequency and urgency must have other pathologies like bacterial, radiation or chemical cystitis, pelvic tumors, infravesical obstruction or urethral diverticula excluded by examination of the urine, endoscopy or other relevant investigations. Evaluation by cystoscopy in general anaesthesia with bladder distension and bladder biopsy gives information on presence of Hunner's ulcer, glomerulations, bladder capacity and bladder wall inflammation, which have influence on treatment strategy and prognosis.
An abundance of treatments have been suggested, but very few have been subjected to proper controlled trials. Patient counseling and instructions in self care and dietary initiatives are important. Physical therapy for primary or secondary myofascial tensions in the pelvis might be helpful. Oral treatment with antihistamines and pentosanpolysulphate is well established, while leucotriene receptor antagonists, cyclosporine and many others are still investigational. Bladder irrigation with DMSO, hyaloronic acid and heparin is widely used, while BCG, lidocain, capsaicin and RTX have been reported. Pain treatment spans from mild analgesics over tricyclic antidepressants (amitryptylin) and antiepileptics (gabapentin) to opioids. Surgical intervention includes bladder distension, resection of Hunner's ulcer, bladder augmentation, urinary diversion and cystectomy depending on disease severity and symptomatology.