Interstitial cystitis ( IC ), also known as bladder pain syndrome ( BPS ), is a type of chronic pain affect the bladder. Symptoms include feeling the need to urinate immediately, need frequent urination, and pain with sex. IC/BPS is associated with lower depression and quality of life. Many of those affected also have irritable bowel syndrome and fibromyalgia.
The cause of IC/CPM is unknown. Although it can be, it is not usually run in families. Diagnosis is usually based on symptoms after exclusion of other conditions. Normally urine culture is negative. Ulceration or inflammation can be seen in cystoscopy. Other conditions that can produce similar symptoms include urinary tract infection (UTI), overactive bladder, sexually transmitted infections, endometriosis, bladder cancer, and prostatitis.
There is no cure for interstitial cystitis. Treatments that can improve symptoms include lifestyle changes, medications, or procedures. Lifestyle changes may include quitting smoking and reducing stress. Medications may include ibuprofen, pentosan polysulfate, or amitriptyline. Procedures may include bladder distension, nerve stimulation, or surgery. Pelvic floor exercises and long-term antibiotics are not recommended.
In the United States and Europe it is estimated that about 0.5% of people are affected. Women are affected about five times more often than men. Onset usually occurs in middle age. The term "interstitial cystitis" was first used in 1887.
Video Interstitial cystitis
Signs and symptoms
The most common symptoms of IC/BPS are suprapubic pain, urinary frequency, painful sexual intercourse, and wake up from sleep to urinate.
In general, symptoms may include painful urination that is described as a burning sensation in the urethra during urination, pelvic pain worsened by consumption of certain foods or beverages, urinary urgency, and pressure in the bladder or pelvis. Other symptoms that are often described are urinary hesitancy (need to wait for the flow of urine to start, often due to pelvic floor dysfunction and tension), and discomfort and difficulty driving, working, exercising, or traveling. The pelvic pain experienced by those with IC usually worsens with bladder filling and may improve with urination.
During cystoscopy, 5-10% of people with IC were found to have Hunner ulcers. A person with an IC may have discomfort only in the urethra, while others may struggle with pain throughout the pelvis. The symptoms of interstitial cystitis usually fall into one of two patterns: significant suprapubic pain with fewer frequencies or fewer amounts of suprapubic pain but with increased urinary frequency.
Associations with other conditions
Some people with IC/BPS have been diagnosed with other conditions such as irritable bowel syndrome (IBS), fibromyalgia, chronic fatigue syndrome, allergies, Sjogren's syndrome, which increases the likelihood that interstitial cystitis may be caused by a mechanism that causes this other condition. There is also some evidence of an association between urological pain syndromes, such as IC/BPS and CP/CPPS, with non-celiac gluten sensitivity in some patients.
In addition, men with IC/PBS are often diagnosed with chronic nonbacterial prostatitis, and there is a wide overlap of symptoms and treatment between two conditions, leading researchers to assume that conditions may share the same etiology and pathology.
Maps Interstitial cystitis
Cause
The current cause of IC/BPS is unknown. However, several explanations have been put forward and include the following: autoimmune theory, neural theory, mast cell theory, leak coating theory, infectious theory, and the production theory of toxic substances in urine. Other suggested etiologic causes are neurological, allergic, genetic, and psychological-stress. In addition, recent studies have shown that those with IC may have substances in urine that inhibit the growth of cells in the bladder epithelium. Infection can then affect people to develop IC. Current evidence from clinical and laboratory studies confirms that mast cells play a central role in IC/BPS may be due to their ability to release histamine and cause pain, swelling, scarring, and interfere with healing. Research has shown the proliferation of nerve fibers present in the bladder of people with ICs that are not in the bladder of people who have not been diagnosed with IC.
Regardless of its origin, most people with IC/BPS struggle with damaged urothelium, or bladder lining. When the glycosaminoglycan (GAG) layer of the surface is damaged (through urinary tract infection (UTI), excessive consumption of coffee or soda, traumatic injury, etc.), urine chemicals can "leak" to the surrounding tissues, causing pain, inflammation, and urinary symptoms. Oral medications such as pentosan polysulfate and drugs placed directly into the bladder through the catheter sometimes serve to repair and rebuild this damaged/wounded layer, allowing for symptom reduction. Much of the literature supports the belief that IC symptoms are associated with defects in the bladder epithelial lining, allowing irritating substances in urine to penetrate into the bladder - essentially, bladder breakdown (also known as compliance theory). Deficiency in the glycosaminoglycan layer on the bladder surface results in increased permeability of the underlying submucosal tissue.
GP51 have been identified as possible urinary biomarkers for ICs with significant variation in GP51 levels in those with IC when compared with individuals without interstitial cystitis.
A number of studies have noted the relationship between IC, anxiety, stress, hyper responses, and panic. Another aetiology proposed for interstitial cystitis is that the immune system attacks the bladder. Biopsy on the bladder wall of people with IC usually contains mast cells. Mast cells that contain histamine packs converge when an allergic reaction occurs. The body identifies the bladder wall as an alien agent, and the histamine package bursts and strikes. The body attacks itself, which is the basis of autoimmune disorders. In addition, ICs can be triggered by unknown toxins or stimuli that cause the nerves in the bladder wall to burn out of control. When they shoot, they release a substance called neuropeptide that triggers a reaction that causes pain in the bladder wall.
Gen
Some genetic subtypes, in some people, have been linked to the disorder.
- Antiproliferative factors are secreted by the bladder of people with IC/BPS that inhibit bladder cell proliferation, which may cause the bladder lining to disappear.
- PAND, located in the 13q22-q32 gene locus, is associated with a distinguishing constellation ("pleiotropic syndrome") including IC/BPS and other bladder and kidney problems, thyroid disease, severe headaches/migraines, panic disorders, and prolapse mitral valve.
Diagnosis
IC/CPM diagnosis is one of the exceptions, as well as a review of clinical symptoms. The AUA guidelines recommend starting with a careful patient history, physical examination and laboratory tests to assess and document IC symptoms, as well as other potential disorders.
The KCl test, also known as the potassium sensitivity test , is no longer recommended. This test uses a mild potassium solution to evaluate the integrity of the bladder wall. Although the latter is not specific to IC/BPS, it has been determined to assist in predicting the use of compounds, such as the pentosan polisulfate, designed to help improve the GAG ​​layer.
For complicated cases, the use of hydrodistention with cystoscopy may be helpful. The researchers, however, determined that visual examination of the bladder wall after bladder stretching was not specific to IC/BPS and that the test itself, could contribute to the development of petechial hemorrhages commonly found in IC/BPS. Thus, the diagnosis of IC/BPS is one of the exceptions, as well as the review of clinical symptoms.
In 2006, the ESSIC community proposed a more rigorous and demanding diagnostic method with specific classification criteria that can not be equated with other similar conditions. In particular, they require that the patient should have pain associated with the bladder, accompanied by one other urinary symptoms. Thus, patients with frequency or urgency alone will be excluded from the diagnosis. Second, they strongly encourage the exclusion of diseases that can be complained through extensive and expensive tests including (A) medical history and physical examination, (B) dipped urine, urine culture, and serum PSA in men over 40, (C) flowmetry and residual post-void urine volume with ultrasound scanning and (D) cystoscopy. Diagnosis of IC/BPS will be confirmed by hydrodistence during cystoscopy with biopsy.
They also proposed a ranking system based on physical findings in the bladder. Patients will receive scores based on numerical and letters based on the severity of their illness as found during hydrodistence. A score of 1-3 will be related to the severity of the disease and the A-C rating is a biopsy finding. Thus, patients with 1A will have very mild symptoms and illness while patients with 3C will have the worst symptoms that may occur. A widely recognized scoring system such as Sant O'Leary's symptoms and problem scores has appeared to evaluate the severity of IC symptoms such as pain and urinary symptoms.
Differential diagnosis
The symptoms of IC/BPS are often misdiagnosed as urinary tract infections. However, IC/BPS has not been proven to be caused by bacterial infection and antibiotics are ineffective treatment. IC/BPS is often misdiagnosed as chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in men, and endometriosis and uterine fibroids (in women).
Treatment
In 2011, the American Urological Association released a consensus-based guideline for the diagnosis and treatment of ICs.
They include treatments ranging from conservative to more invasive:
- First-line treatment - patient education, self-care (diet modification), stress management
- Second-line treatment - physical therapy, oral medications (amitriptyline, cimetidine or hydroxyzine, pentosan polysulfate), bladder instilation (DMSO, heparin, or lidocaine)
- Third-line treatment - Hunner ulcer treatment (laser, fulguration or triamcinolone injection), hydrodistention (low pressure, short duration)
- Fourth-line treatment - neuromodulation (sacral or pudendal nerves)
- Fifth line treatment - cyclosporine A, botulinum toxin (BTX-A)
- Treatment of the sixth line - surgical intervention (urine transfer, augmentation, cystectomy)
The AUA Guidelines also note some discontinued treatments, including long-term oral antibiotics, Calmette Guerin's intravenous bacillus, intravesical resiniferatoxin), high-pressure hydrodistence and long duration, and systemic glucocorticoids.
Bladder distension
The distention of the bladder under general anesthesia, also known as hydrodistention, has shown some success in reducing urinary frequency and providing short-term pain relief to those with IC. However, it is not known exactly how this procedure causes pain relief. Recent studies have shown that pressure at the pelvic trigger point may relieve symptoms. Relief achieved by bladder distention is only temporary (weeks or months), so it is not feasible as long-term treatment for IC/BPS. The proportion of IC/BPS patients experiencing relief from hydrodistention is currently unknown and evidence for this modality is limited by the lack of well-controlled studies. Bladder breakage and sepsis may be associated with prolonged high-pressure hydrodistence.
Bladder instillation
Giving bladder medication is one of the main forms of treatment of interstitial cystitis, but evidence of its effectiveness is currently limited. The advantages of this treatment approach include direct contact of the drug with bladder and low systemic side effects due to poor drug absorption. Single drugs or medicinal mixtures are commonly used in the preparation of bladder cultivation. DMSO is the only approved bladder instillation for IC/BPS but much less commonly used in urology clinics.
50% Solution DMSO has the potential to create irreversible muscle contractions. However, a solution lower than 25% is found to be reversible. Long-term use of DMSO can be questioned, as its mechanism of action is not fully understood even though DMSO is considered to inhibit mast cells and may have anti-inflammatory, muscle-relaxing, and analgesic effects. Other agents used for bladder instillation to treat interstitial cystitis include: heparin, lidocaine, chondroitin sulfate, hyaluronic acid, pentosan polysulfate, oxybutynin, and botulinum toxin A. Preliminary evidence suggests this agent is efficacious in reducing interstitial cystitis symptoms, but further studies with larger, randomized, and controlled controlled clinical trials is required.
Diet
Dietary modification is often recommended as a first-line method of self-treatment for interstitial cystitis, although rigorous controlled studies examining the impact of diet on signs and symptoms of interstitial cystitis are currently lacking. Individuals with interstitial cystitis often experience increased symptoms when they consume certain foods and beverages. Avoiding potential trigger foods and drinks such as caffeine-containing beverages including coffee, tea, and soda, alcoholic beverages, chocolate, citrus fruits, chili peppers and artificial sweeteners can help in alleviating symptoms. The dietary triggers vary between individuals with ICs; the best way for someone to find the triggers themselves is to use an elimination diet. Sensitivity to trigger food can be reduced if calcium glycerophosphate and/or sodium bicarbonate are consumed. Basic therapies are dietary modifications to help patients avoid foods that can be more irritating to damaged bladder walls.
The mechanism by which dietary modification benefits people with ICs is unclear. The integration of nerve signals from the pelvic organs may mediate the effects of diet on IC symptoms.
Drugs
Antihistamine hydroxyzine failed to show an advantage over placebo in the treatment of IC patients in randomized controlled clinical trials. Amitriptyline has been shown to be effective in reducing symptoms such as chronic pelvic pain and nocturia in many patients with IC/BPS at a median dose of 75 mg daily. In one study, duloxetine antidepressants were found to be ineffective as a treatment, although patents exist for the use of duloxetine in the IC context, and are known to relieve neuropathic pain. The calcineurin inhibitor cyclosporine A has been studied as a treatment for interstitial cystitis due to its immunosuppressive properties. A prospective randomized study found cyclosporin A to be more effective in treating the symptoms of IC than polisulfate pentosan, but also has more side effects.
Oral pentosan polisulfate is believed to improve the glycosaminoglycan layer of bladder protector, but studies have found mixed results when trying to determine whether the effect was statistically significant compared with placebo.
pelvic floor treatment
Urological pelvic pain syndromes, such as IC/BPS and CP/CPPS, are characterized by pelvic floor pain, and symptoms may be reduced by pelvic myofascial physical therapy.
This can leave the pelvic area in a sensitive condition, resulting in a circle of muscle tension and increased neurological feedback (neural wind-up), a form of myofascial pain syndrome. Current protocols, such as the Wise-Anderson Protocol, mostly focus on stretching to release excessive muscles in the pelvic or rectal area (commonly referred to as the trigger point), physical therapy to the area, and progressive relaxation therapy to reduce the underlying stress.
Pelvic floor dysfunction is a fairly new field of specialization for physical therapists around the world. The goal of therapy is to relax and lengthen pelvic floor muscles, rather than tightening and/or strengthening them as a therapeutic goal for patients with urinary incontinence. Thus, traditional exercises such as Kegel exercises, used to strengthen pelvic muscles, can cause additional muscle tension and pain. Specially trained physical therapists can provide a direct evaluation of the muscles, both externally and internally.
Surgery
Surgery is rarely used for IC/BPS. Surgical intervention is highly unpredictable, and is considered the final treatment of choice for severe cases of interstitial cystitis. Some patients who choose surgical intervention continue to experience pain after surgery. Typical surgical interventions for IC/BPS refractory cases include: bladder augmentation, urine transfer, transurethral fulguration and ulcer resection, and cystectomy removal.
Neuromodulasi can be successful in treating the symptoms of IC/BPS, including pain. One of the electronic painkilling options is TENS. Percutaneous stimulation of percutaneous tibial nerve has also been used, with varying degrees of success. Percutaneous percutaneous nerve root stimulation can result in statistically significant improvements in some parameters, including pain.
Alternative medicine
There is little evidence to observe the effects of alternative medicine despite its general use. There is tentative evidence that acupuncture can help the pain associated with IC/BPS as part of other treatments. Despite the scarcity of controlled studies on alternative treatments and IC/BPS, "better results have been obtained" when acupuncture is combined with other treatments.
Biofeedback, a relaxation technique that aims to help people control the functioning of the autonomic nervous system, has shown some benefits in controlling IC-related/BPS-related pain as part of a multimodal approach that may also include bladder medication or hydrodistence.
Prognosis
IC/BPS has a major impact on quality of life. A 1997 Finland epidemiological study showed that two thirds of moderate to high risk women had interstitial cystitis reported a decline in their quality of life and 35% of IC patients reported an impact on their sexual lives. A 2012 survey showed that among a group of adult women with symptoms of interstitial cystitis, 11% reported suicidal thoughts in the past two weeks. Other studies have shown that the impact of IC/BPS on quality of life is very heavy and may be comparable to the quality of life experienced in end-stage renal disease or rheumatoid arthritis.
International recognition of interstitial cystitis has evolved and international urological conferences to address heterogeneity in recent diagnostic criteria have been held. IC/PBS is now recognized with an official defect code in the United States.
Epidemiology
IC/BPS affects men and women of all cultures, socioeconomic backgrounds, and ages. Although this disease was previously believed to be the condition of menopausal women, more and more men and women are diagnosed in their twenties and younger lives. IC/BPS is not a rare condition. Initial studies have shown that the prevalence of IC/BPS ranges from 1 in 100,000 to 5.1 in 1,000 general populations. In recent years, the scientific community has reached a much deeper understanding of the epidemiology of interstitial cystitis. Recent research has shown that between 2.7 and 6.53 million women in the US have IC symptoms and up to 12% of women may have early symptoms of IC/BPS. Further studies have estimated that this condition is much more common in men than previously thought to range from 1.8 to 2.2 million men who have symptoms of interstitial cystitis.
This condition is officially recognized as a flaw in the United States.
History
The Philadelphia surgeon Joseph Parrish published the earliest records of interstitial cystitis in 1836 describing three cases of severe lower urinary tract symptoms in the absence of bladder stones. The term "interstitial cystitis" was coined by Dr. Alexander Skene in 1887 to describe the disease. In 2002, the United States amended the Social Security Act to include interstitial cystitis as a disability. The first guidelines for the diagnosis and treatment of interstitial cystitis were released by the Japanese research team in 2009. The American Urological Association released the first American clinical practice guidelines for diagnosing and treating IC/BPS in 2011.
Name
Initially called interstitial cystitis, this disorder was renamed to interstitial cystitis (IC/BPS) in the period 2002-2010. In 2007, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) began using the term umbrella of chronic urban pelvic pain syndrome (UCPPS) to refer to pelvic pain syndrome associated with the bladder (eg, interstitial cystitis/bladder pain syndrome) and with the prostate or pelvic gland (eg, chronic prostatitis/chronic pelvic pain syndrome).
In 2008, terms currently used other than IC/BPS include bladder pain syndrome , bladder pain syndrome and hypersensitivity syndrome of the bladder , alone and in various combinations. These different terms are used in different parts of the world. The term "interstitial cystitis" is the main term used in ICD-10 and MeSH. Grover et al. says, "The Society of the Continent International named the disease interstitial cystitis/ICS/PBS in 2002 [Abrams et al. 2002], while the Multinational Interstitial Cystitis Association marked it as a painful interstitial cystitis syndrome (PBS/IC) [Hanno et al., 2005]) Recently, the European Society for Interstitial Cystitis (ESSIC) study proposed a moniker, 'bladder pain syndrome' (BPS) [van de Merwe et al., 2008]. "
See also
- Chronic prostatitis/chronic pelvic pain syndrome - women have a vestigial prostate gland that can cause IC/BPS-like symptoms. Men with IC/BPS may suffer from prostatitis, and vice versa.
- Overactive bladder
- Trigger point - key to myofascial pain syndrome.
References
External links
- Sistitis interstisial di Curlie (berdasarkan DMOZ)
- Parsons, J. Kellogg; Parsons, C. Lowell (2004). "Asal Usul Sejarah Sistitis Interstisial". The Journal of Urology . 171 (1): 20-2. doi: 10.1097/01.ju.0000099890.35040.8d. PMIDÂ 14665834.
- National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC)
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Homma, Yukio; Ueda, Tomohiro; Tomoe, Hikaru; Lin, Alex TL; Kuo, Hann-Chorng; Lee, Ming-Huei; Lee, Jeong Gu; Kim, Duk Yoon; Lee, Kyu-Sung (2009). "Pedoman klinis untuk interstisial cystitis dan sindrom kandung kemih hipersensitif". Jurnal Urologi Internasional . 16 (7): 597-615. doi: 10.1111/j.1442-2042.2009.02326.x. PMID 19548999. < rentang> - Urologi Eropa
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