INTRODUCTION: Painful Bladder Syndrome/Interstitial Cystitis (PBS/IC)

Abstract

As Urogynecology has moved increasingly away from its initial role as a ‘‘borderline’’ discipline, there has been a gradual increase in the attention given to problems in women which had been neglected by traditional gynecology, since these problems were previously considered to be an inevitable consequence of aging – urinary incontinence and pelvic organ prolapse, for example. Our understanding of sensory disturbances of the lower urinary tract is much less clear. A precise diagnosis is difficult to obtain and this condition has been recently more broadly classified as Painful Bladder Syndrome (PBS). A restricted portion of this syndrome is represented by interstitial cystitis (IC) which, while known to have a nonbacterial etiology, is far from being completely understood. Many different hypotheses attempt to explain the causes of this condition, which involve the entire pelvic floor. However, it seems that the bladder plays a central role even in patients who do not have predominantly urological symptoms. Symptoms of many patients with IC affect all the pelvic organs, superimposing other diagnoses such as irritable bowel syndrome, vulvodynia or endometriosis, but pain is the common element. For this reason, the International Continence Society (ICS) has included IC in the broader category of PBS. In order to emphasize the role of IC in the context of the varied panorama of PBS, some studies have used the double nomenclature of PBS/IC, which we encourage. Numerous definitions of IC can be found in the literature, but from all of the authors a common factor emerges: this is a disease of unknown etiological origin, chronic, as yet without effective pharmacological therapies, often ignored by doctors, and far from being resolved. The difficulty in obtaining a correct diagnosis within a short time, the psychologically traumatic process for the patient, and the lack of information from the scientific community, have brought groups of patients together to form national non-profit organizations in order to raise awareness about IC, provide funds for research, and support people who have an illness which is considered by many family doctors, gynecologists and urologists to be a problem ‘‘all in the head.’’ The scientific community’s interest in IC is increasing along with enthusiasm in the world of research. Due to the necessity for a means of comparison between countries throughout the world, MICA – Multinational Interstitial Cystitis Association – (www.multinationalica.org) was formed, founded by non-profit organizations from the United States, Germany, Austria and Italy. MICA provides a platform for exchange between the doctors who have been working in this field for some time. The goal of the first MICA Meeting was to encourage dialogue about the definition of IC within the international scientific community and to provide the most up-to-date information on all aspects of the disease. The meeting also served to incorporate the experiences of the various patient non-profit organizations, in order not to forget the disabling effect on the daily life of both those who suffer from the disease and their families and friends. The expert opinions of the researchers and representatives of non-profit IC organizations directly involved in this inaugural MICA meeting are brought together in this Supplement in order to stimulate doctors and researchers to resolve this enigma by continuing their efforts to obtain a better understanding of the definition of IC and its possible causes, and to search for more uniformly effective treatments. Int Urogynecol J (2005) 16: S1 DOI 10.1007/s00192-005-1287-4