Interstitial Cystitis Symptom Research Articles

Anxiety Disorder Patients Endure High Rates of Urinary Urgency

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessAnxiety Disorder Patients Endure High Rates of Urinary UrgencyJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:18 Jan 2008https://doi.org/10.1176/pn.43.2.0025Some time ago, an ad appeared on television in which a woman exclaimed “Gotta go!” and rushed from her meeting. Although the purpose of the ad was to sell medication for urinary urgency, the ad suggested a link between urinary urgency and panicking.That link has now been confirmed in a scientific study. Persons with panic disorder were eight times more likely than controls to experience interstitial cystitis—bladder pain and urinary urgency not caused by a urinary-tract infection.The study, which was headed by Ardesheer Talati, Ph.D., of Columbia University and is in press with Biological Psychiatry, included 693 subjects: 219 had a diagnosis of panic disorder and a history of anxiety in at least one first-degree relative, 199 had a diagnosis of social anxiety disorder and a history of anxiety in at least one first-degree relative, 173 had both a diagnosis of panic disorder and social anxiety and a history of anxiety in at least one first-degree relative, and 102 controls had no psychiatric disorders over their lifetime and no history of anxiety in first- or second-degree relatives. The diagnostic assessments were made with the Schedule for Affective Disorders and Schizophrenia-Lifetime Version, modified for the study of anxiety disorders and updated for DSM-IV.A medical history was also obtained during the course of interviews with the subjects, who were asked whether they had ever experienced any of 64 conditions, and if so, the age of onset. The conditions were grouped in the following categories: cancer, cardiovascular, dermatologic, endocrine/glandular, gastrointestinal, genitourinary, hematological, infectious, metabolic, musculoskeletal, neurological/neuromuscular, respiratory, systemic, and a free-response “other” category.The researchers then looked to see whether subjects with panic disorder and/or social anxiety disorder were more prone to having certain medical conditions than the control subjects. The researchers found that after controlling for age and gender, subjects with panic disorder were eight times more likely than controls to have had interstitial cystitis, and those with social anxiety disorder were five times more likely than controls to have had it. Also after controlling for age and gender, researchers found that panic subjects and social anxiety subjects were at least twice as likely as controls to have had mitral valve prolapse, migraines, irritable bowel syndrome, hypercholesterolemia, hypoglycemia, bronchitis, and skin disorders.So why the link between panic disorder or social anxiety disorder and these specific medical conditions? Previous studies have found that panic disorder and social anxiety disorder often run in families. Thus, the researchers proposed, panic disorder and social anxiety disorder might share a common genetic basis, but then serve as independent risk factors for the development of specific medical conditions—say, by activating the autonomic nervous system.Another possibility, Talati and her colleagues pointed out, is that some of the genes that underpin panic disorder and social anxiety may also contribute to the medical conditions with which they've been associated. In fact, other research that they have conducted suggests that the genes may lie on a specific region of chromosome 13.True, none of the genes known to reside in this region has yet been associated with panic disorder or social anxiety disorder per se. However, the region does contain a gene that makes the serotonin 2A receptor, which has been linked with stress-provoked depression as well as the gene that encodes the endothelin B receptor, which is related to vasoconstriction and could help trigger some medical conditions linked with panic disorder and social anxiety disorder.The researchers will now investigate whether specific genes on chromosome 13 might explain the link between panic disorder—or social anxiety disorder—and the various medical conditions in question, senior study investigator Myrna Weissman, M.D., a professor of epidemiology in psychiatry at Columbia University, told Psychiatric News.Meanwhile, the results have some clinical implications, she pointed out.“ Someone ought to see whether the medications used to treat panic disorder can help reduce the symptoms of interstitial cystitis. Also, clinicians treating any one of these disorders might look for the presence of the others.”An abstract of “Panic Disorder, Social Anxiety Disorder, and a Possible Medical Syndrome Previously Linked to Chromosome 13” can be accessed at<www.journals.elsevierhealth.com/periodicals/bps> under “Articles in Press.” ▪ ISSUES NewArchived

Guided Imagery for Women with Interstitial Cystitis: Results of a Prospective, Randomized Controlled Pilot Study

In the United States, more than 1 million women and men are affected with interstitial cystititis (IC), which is a clinical syndrome involving urinary urgency, frequency, and pelvic pain. A review of the literature revealed that there are no studies showing the effect of guided imagery in women with IC. The purpose of this clinical investigation was to explore the effect of guided imagery on pelvic pain and urinary symptoms in women with IC symptoms. Thirty (30) women with diagnosed IC were randomized into 2 equal groups. One group (treatment) listened to a 25-minute guided imagery compact disc (CD), that was created specifically for women with pelvic pain and IC, twice a day for 8 weeks. The control group rested for 25 minutes twice daily for 8 weeks. Because no guided imagery CDs specifically for women with IC were found on the commercial market, the authors created a script and recorded the CD specifically for women with IC and pelvic pain. The focus of this guided imagery CD was on healing the bladder, relaxing the pelvic-floor muscles, and quieting the nerves specifically involved in IC. Baseline and end-of-study assessment questionnaires (Interstitial Cystitis Symptom Index & Problem Index [IC-SIPI], IC Self-Efficacy Scale, a visual analogue [VAS] scale for pain, and a global response assessment [GRA]), 2-day voiding diaries, and 24-hour pain diaries were completed by the subjects and were evaluated using SPSS (Chicago, IL). More than 45% of the treatment group were responders to guided imagery therapy noting a moderate or marked improvement on the GRA. Pain scores and episodes of urgency significantly decreased in the treatment group. Responders had significant reductions in IC-SIPI scores (problem index, p = 0.006; symptom index, p = 0.004). In addition, responders on the GRA had significant (p = 0.039) improvements in mean pain scores from 5.50 to 2.57 at the end of the study in contrast to the nonresponders, whose pain levels remained the same (4.89 to 4.39). This is the first study providing preliminary data supporting the use of guided imagery as a potential therapy for IC. Guided imagery may be a useful tool to offer women with IC for pain and IC symptom management. It is an intervention without negative side-effects, is readily available, and shows a trend toward improvement of IC symptoms.

Time to Initiation of Pentosan Polysulfate Sodium Treatment After Interstitial Cystitis Diagnosis: Effect on Symptom Improvement

Interstitial cystitis (IC) is a chronic, debilitating condition that is often associated with late diagnosis and a delay in initiation of appropriate IC-specific therapy. The purpose of this study was to determine whether the length of time from initial diagnosis to start of treatment impacts subsequent symptom improvement. A retrospective analysis was conducted in 128 patients with IC who had been treated with pentosan polysulfate sodium (PPS) 300 mg/day for 32 weeks in a multicenter, randomized, double-blind, parallel-group clinical trial. Outcome measures included the O'Leary-Sant Interstitial Cystitis Symptom Index (ICSI) and the O'Leary-Sant Interstitial Cystitis Problem Index (ICPI). Early treatment was defined as treatment initiation 6 months or less after IC diagnosis, whereas late treatment was defined as treatment initiation 24 months or more after IC diagnosis. Efficacy data were analyzed by using the intent-to-treat, last-observation-carried-forward population. At the end of the study, mean changes from baseline in total ICSI and ICPI scores (+/- SEM) for early treatment (6 months or less) versus late treatment (24 months or more) were 3.97 +/- 0.59 versus 2.15 +/- 0.70 (P = 0.0472) and 3.94 +/- 0.56 versus 1.77 +/- 0.63 (P = 0.0117), respectively. Similar trends for both measures were observed when examining other times from IC diagnosis (3 months or less versus 24 months or more, 3 months or less versus 36 months or more, and 6 months or less versus 36 months or more). Initiation of PPS treatment within 6 months of establishing the diagnosis of IC may be associated with greater improvement in patient symptoms and symptom bother.

Followup of Patients With Interstitial Cystitis Responsive to Treatment With Intravesical Bacillus Calmette-Guerin or Placebo

We evaluated the longer term response in patients with interstitial cystitis who initially responded to intravesical bacillus Calmette-Guerin or placebo in a randomized clinical trial. Patients with interstitial cystitis who responded positively to treatment with bacillus Calmette-Guerin or placebo after 34 weeks of followup in a double-blind clinical trial were followed for an additional 34 weeks in an observational study to assess response durability. Outcomes at 68 weeks included a patient reported global response assessment, 24-hour voiding diary, and pain, urgency and validated interstitial cystitis symptom indexes. Of responders to bacillus Calmette-Guerin or placebo in the clinical trial 38 continued extended followup in the observational study. A total of 12 (75%) responders who received placebo and 19 (86%) who received bacillus Calmette-Guerin considered themselves to remain moderately or markedly improved at week 68. Improved symptom outcomes were also generally maintained during followup in the 2 groups. Most patients who respond to therapy with intravesical bacillus Calmette-Guerin or placebo maintain improved symptoms for up to 68 weeks after the initiation of therapy. However, initial response rates are low and placebo responders demonstrated essentially the same durability of response as bacillus Calmette-Guerin responders. These results argue against the routine use of bacillus Calmette-Guerin in this patient group.

Glomerulation Observed During Transurethral Resection of the Prostate for Patients With Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia is a Common Finding But No Predictor of Clinical Outcome

Although glomerulation in the bladder mucosa when the bladder is overdistended is a finding suggestive of interstitial cystitis (IC), it is sometimes observed at transurethral resection of the prostate (TURP) for patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH). We prospectively investigated the incidence and clinical implications of glomerulation found at TURP. From December 2003 to October 2005, 197 patients aged 50 years or older who were considered to be appropriate candidates to undergo TURP for LUTS/BPH were investigated in this study. Just before beginning resection under spinal anesthesia, the bladder was filled to a water pressure of 80 cm and the capacity was measured. After evacuation of the fluid, careful inspection was conducted for glomerulation during refilling. Before TURP, and 3 and 12 months after TURP, the International Prostate Symptom Score and O'Leary-Sant IC Symptom and Problem Index were determined, and uroflowmetry and measurement of residual urine volume were performed. Glomerulation was observed in 40 of the 197 patients (20.3%). There was no difference in bladder capacity between the glomerulation and nonglomerulation groups, although the glomerulation group was younger with lighter resected weight and a higher baseline IC problem index than the nonglomerulation group. There were no differences in other parameters before, 3, and 12 months after TURP between the 2 groups. Although glomerulation at TURP is a common finding, the clinical implications related to IC are unknown. Glomerulation itself may not be a predictor of the clinical outcome of TURP. Glomerulation observed during transurethral resection of the prostate for patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia is a common finding but no predictor of clinical outcome.

Panic Disorder, Social Anxiety Disorder, and a Possible Medical Syndrome Previously Linked to Chromosome 13

Several studies have identified increased medical problems among individuals with panic disorder (PD). We previously found that specific conditions--interstitial cystitis (IC), mitral valve prolapse (MVP), migraines, and thyroid disorders--aggregated non-randomly among panic families (we called this the "PD syndrome") and that families with and without the syndrome were genetically distinguishable on chromosome 13. We present data from a new case-control study that replicates and extends the syndrome phenotype clinically. Probands with a definite diagnosis and family history of PD (n=219), social anxiety disorder (SAD; n=199), or both (n=173) and 102 control subjects with no personal/family history of anxiety were interviewed with the SADS-LA diagnostic instrument. Medical history was obtained via medical checklist and the family history screen; IC symptoms were assessed with criteria developed by the National Institute for Diabetes and Digestive and Kidney Diseases. Subjects and interviewers were unaware of the syndrome hypothesis; final best-estimate diagnoses were blind to syndrome data. Probands with PD or SAD, as compared with control subjects, were five or more times as likely to report IC symptoms and twice as likely to report MVP and migraines (other genitourinary and cardiovascular problems were not elevated). First-degree relatives of probands with PD or SAD were also at increased risk for IC, MVP, thyroid problems, and headaches, regardless of whether the proband reported the same condition. These findings are consistent with previous data supporting a PD syndrome and further suggest that this syndrome might include other anxiety disorders well.

Small Intestinal Bacterial Overgrowth in Patients with Interstitial Cystitis and Gastrointestinal Symptoms

Interstitial cystitis (IC) often coexists with irritable bowel syndrome (IBS). IBS may be explained by small-intestinal bacterial overgrowth (SIBO), which increases immune activation and visceral hypersensitivity. This prospective pilot study tested hypotheses that IC patients with gastrointestinal (GI) symptoms have SIBO, that nonabsorbable antibiotic use improves symptoms, and that improvement is sustained by prokinetic therapy. Consecutive IC patients with GI symptoms had lactulose breath testing (LBT). Those with abnormal results received rifaximin 1,200-1,800 mg/day for 10 days then tegaserod 3 mg/nightly. Questionnaires addressed IC and GI global improvement. Of 21 patients, 17 (81%) had abnormal LBTs. Of 15 patients treated, GI global improvement was moderate to great in 11 (73%) and sustained in ten (67%). IC global improvement was moderate to great in six (40%) and sustained in seven (47%). A majority of IC patients and GI symptoms had an abnormal LBT suggesting SIBO. Rifaximin improved symptoms, which was sustained by tegaserod.

Short-term results of bilateral S2–S4 sacral neuromodulation for the treatment of refractory interstitial cystitis, painful baldder syndrome, and chronic pelvic pain

We evaluated the efficacy of bilateral caudal epidural sacral neuromodulation for the treatment of refractory chronic pelvic pain (CPP), painful bladder syndrome, and interstitial cystitis (IC). Thirty consecutive patients (21 female, 9 male) with severe refractory symptoms underwent bilateral S2-S4 sacral neuromodulation for CPP/IC. Patients were evaluated with the O'Leary IC symptom and problem index (ICSI, ICPI), the short form of the Urogenital Distress Inventory (UDI-6), and the RAND 36-item health survey (SF-36) preoperatively and 6 months postoperatively. The mean and minimum follow-up were 15 and 6 months, respectively. Of the 30 patients, 23 (77%) had a successful trial stimulation and were permanently implanted. Among these patients, the ICSI and ICPI scores improved by 35 (p = 0.005) and 38% (p = 0.007), respectively. The pain score improved by 40% (p = 0.04) and the UDI-6 score by 26% (p = 0.05). On average, patients reported a 42% improvement in their symptoms. SF-36 scores did not improve significantly. In refractory patients, bilateral caudal epidural sacral neuromodulation is another possible mode of treatment, which appears to improve both pelvic pain and voiding symptoms.

Beneficial effects of suplatast tosilate (IPD‐1151T) in a rat cystitis model induced by intravesical hydrochloric acid

To examine the effects of suplatast tosilate (IPD-1151T), a Th2 cytokine inhibitor recently recognized to improve the symptoms in patients with interstitial cystitis (IC), in a rat model of HCl-induced chronic cystitis, to elucidate the possible mechanisms by which the drug improves the symptoms of IC. Chronic cystitis was induced by intravesical instillation of 0.2 mL of 0.4 m HCl in female adult rats. After a once-daily oral administration of IPD-1151T (0.1-100 mg/kg) or prednisolone (5 mg/kg) for 7 days, cystometry was performed under urethane anaesthesia. The bladder from HCl-induced cystitis rats was also assessed histopathologically. On cystometrography there was frequent voiding in cystitis rats. Administration of IPD-1151T for 7 days after intravesical HCl instillation dose-dependently increased the micturition volume and intercontraction intervals. Treatment with prednisolone had similar therapeutic effects. Histological analyses in the bladder from cystitis rats revealed oedema and infiltration of inflammatory cells such as mast cells and eosinophils in the lamina propria and the transitional epithelial thickening. These histological changes and the number of mast cells and eosinophils were reduced by administration of IPD-1151T or prednisolone. The present results indicate that IPD-1151T improves bladder function and pathological changes in HCl-induced cystitis rats, as previously observed in patients with IC. The rat cystitis model induced by HCl could provide useful information for studying proposed therapies for IC which might involve T cell-dependent inflammatory responses as one of its potential pathophysiologies.

Overlap of Voiding Symptoms, Storage Symptoms and Pain in Men and Women

We quantified the degree of symptomatic overlap in individuals who reported urological symptoms and compared these patterns between men and women. A questionnaire was mailed to a random sample of the Kaiser Permanente Northwest membership with no medical record evidence of pelvic malignancy or neurological disease. The questionnaire included the International Prostate Symptom Scale, Interstitial Cystitis Symptom Index and Problem Index, and National Institutes of Health Chronic Prostatitis Symptom Index. The 701 men and 745 women who reported urological symptoms were selected for analysis. The degree of overlap of storage symptoms, voiding symptoms and pain symptoms was assessed. Multiple logistic regression was used to determine symptom predictors. There was a high degree of overlap among the 3 symptom categories with few observed differences between men and women. Of individuals with storage or voiding symptoms 34% of men and 43% of women also had pain symptoms. Of those with pain 90% of men and 94% of women also had voiding or storage symptoms. Logistic regression results indicated that frequency, urgency and any storage symptoms were statistically more common in women than in men, while a slow stream was more common in men than in women. As previously reported, there are limited differences in the degree and distribution of lower urinary tract symptoms in men and women. To our knowledge the novel finding of this study is that pain symptoms commonly coincide with voiding and storage symptoms in the 2 genders. This suggests that categorizing patients into disease categories, such as lower urinary tract symptoms or bladder conditions, may ignore the pain components of symptoms. A symptom based classification symptom may more accurately identify and address all patient complaints.

Dimethyl sulphoxide relaxes rabbit detrusor muscle by decreasing the Ca2+ sensitivity of the contractile apparatus

The intravesical administration of dimethyl sulphoxide (DMSO) is used to alleviate the symptoms of interstitial cystitis. We investigated the relaxant effect of DMSO and its underlying mechanism in the detrusor muscle. The effects of DMSO on contraction, on Ca2+ sensitivity of myofilaments, and on myosin light chain (MLC) phosphorylation were investigated in both intact and alpha-toxin-permeabilized strips of rabbit detrusor muscle. In fura-PE3-loaded strips, DMSO (>1%) induced a significant relaxation during sustained contractions induced by 60 mM K+-depolarization or 10 microM carbachol, while having no effect on the [Ca2+](i) level. DMSO decreased the level of MLC phosphorylation during the contractions induced by 60 mM K+ and 10 microM carbachol. DMSO also inhibited both the contraction and MLC phosphorylation induced by calyculin-A in intact strips. In the alpha-toxin-permeabilized preparations, DMSO relaxed the Ca2+-induced contraction and also inhibited the tension development induced by a stepwise increment of Ca2+ concentrations. Such a relaxant effect of DMSO was enhanced in the presence of phosphate. DMSO relaxes rabbit detrusor muscle by decreasing the Ca2+ sensitivity of myofilaments. Inhibition of the kinase activities involved in myosin phosphorylation may play a major role in DMSO-induced Ca2+ desensitization. Inhibition of the cross-bridge cycling at the step of phosphate release may also contribute to the relaxant effect of DMSO. Such relaxant effects of DMSO could be linked to the therapeutic effect of DMSO in interstitial cystitis.

Did Patients With Interstitial Cystitis Who Failed to Respond to Initial Treatment With Bacillus Calmette-Guerin or Placebo in a Randomized Clinical Trial Benefit From a Second Course of Open Label Bacillus Calmette-Guerin?

We evaluated safety and efficacy outcomes in a case series of subjects who received open label intravesical bacillus Calmette-Guerin after failing to respond to bacillus Calmette-Guerin or intravesical placebo in a randomized clinical trial. Subjects who met National Institutes of Health-National Institute of Diabetes and Digestive and Kidney Diseases criteria for IC and reported at least moderate pain and frequency were initially randomized to 6 weekly intravesical instillations of bacillus Calmette-Guerin or placebo and followed for a total of 34 weeks. At 34 weeks subjects who reported that they had not responded to treatment were offered treatment with open label bacillus Calmette-Guerin, using the same course of treatment and followup. Outcomes included a patient reported global response assessment, a 24-hour voiding diary, pain, urgency, validated interstitial cystitis symptom indexes and adverse events. A total of 156 subjects elected open label bacillus Calmette-Guerin, of whom 18 (12%) withdrew during the open label series. The response rate based on the global response assessment was 18% and it was identical between those initially randomized to placebo (first course of bacillus Calmette-Guerin in the open label series) and those initially randomized to bacillus Calmette-Guerin (second course). Small improvements were observed for most secondary efficacy outcomes. Most participants reported at least 1 adverse event, primarily pain, genitourinary symptoms and gastrointestinal disturbances. However, there was no difference in adverse events between those who received the first course of bacillus Calmette-Guerin in this series compared to those who received 2 courses. The low response rate for bacillus Calmette-Guerin in this open label case series further argues against the routine use of bacillus Calmette-Guerin as treatment for interstitial cystitis.

Organ cross talk modulates pelvic pain

Interstitial cystitis (IC) is a chronic bladder inflammatory disease of unknown etiology that is often regarded as a neurogenic cystitis. IC is associated with urothelial lesions, voiding dysfunction, and pain in the pelvic/perineal area, and diet can exacerbate IC symptoms. In this study, we used a murine neurogenic cystitis model to investigate the development of pelvic pain behavior. Neurogenic cystitis was induced by the injection of Bartha's strain of pseudorabies virus (PRV) into the abductor caudalis dorsalis tail base muscle of female C57BL/6J mice. Infectious PRV virions were isolated only from the spinal cord, confirming the centrally mediated nature of this neurogenic cystitis model. Pelvic pain was assessed using von Frey filament stimulation to the pelvic region, and mice infected with PRV developed progressive pelvic pain. Pelvic pain was alleviated by 2% lidocaine instillation into either the bladder or the colon but not following lidocaine instillation into the uterus. The bladders of PRV-infected mice showed markers of inflammation and increased vascular permeability compared with controls. In contrast, colon histology was normal and vascular permeability was unchanged, suggesting that development of pelvic pain was due only to bladder inflammation. Bladder-induced pelvic pain was also exacerbated by colonic administration of a subthreshold dose of capsaicin. These data indicate organ cross talk in pelvic pain and modulation of pain responses by visceral inputs distinct from the inflamed site. Furthermore, these data suggest a mechanism by which dietary modification benefits pelvic pain symptoms.

Pharmacological validation of a model of cystitis pain in the mouse

Interstitial cystitis (IC) is a chronic pelvic-perineal pain syndrome of unknown etiology that mainly targets the lower urinary tract. Pain is the most prominent feature of IC and current therapies provide limited relief. Novel treatment options for IC could be identified if more predictive animal models were available. A rat model based on administration of cyclophosphamide (CP) mimics the symptoms of IC and has been well characterized. However, experiments in mice have not consistently reported both the spontaneous and evoked pain behaviors. The current series of studies demonstrate that CP (200-400mg, i.p.) increased both spontaneous and evoked pain behaviors in mice. Additionally, clinically relevant compounds: morphine (1-10mg/kg), ketorolac (1-5.6mg/kg) and duloxetine (3-30mg/kg) all significantly reversed pain behaviors. In contrast, gabapentin (56mg/kg) had no effect. Thus, CP-induced cystitis in mice may be used to evaluate novel therapeutics for the treatment of pain due to interstitial cystitis.

Effect of Comestibles on Symptoms of Interstitial Cystitis

Anecdotal evidence suggests that patients with painful bladder syndrome/interstitial cystitis report symptom exacerbation after consuming particular foods, beverages and/or supplements. We determined the prevalence of the effect of comestibles on painful bladder syndrome/interstitial cystitis symptoms and identified particular comestible items more likely to affect such symptoms. A validated questionnaire designed to detect whether food, beverages and/or supplements have an effect on bladder symptoms was administered to 104 patients meeting National Institute for Diabetes and Digestive and Kidney Diseases criteria for interstitial cystitis. In addition to answering general questions about the effect of comestibles on painful bladder syndrome/interstitial cystitis symptoms, subjects were asked to indicate whether each of 175 individual items worsened, improved or had no effect on symptoms. Each response was numerically scored on a scale of -2 to 2 and mean values were generated for each comestible item. Of the surveyed patients with painful bladder syndrome/interstitial cystitis 90.2% indicated that the consumption of certain foods or beverages caused symptom exacerbation. There was no correlation between allergies and the effect of comestibles on symptoms. Patients who reported that specific foods worsened symptoms tended to have higher O'Leary-Sant interstitial cystitis symptom index and problem index, and/or pelvic pain and urgency/frequency patient symptom scale scores. A total of 35 comestible items had a mean score of lower than -1.0, including caffeinated, carbonated and alcoholic beverages, certain fruits and juices, artificial sweeteners and spicy foods. There is a large cohort of patients with painful bladder syndrome/interstitial cystitis in whom symptoms are exacerbated by the ingestion of specific comestibles. The most frequently reported and most bothersome comestibles were coffee, tea, soda, alcoholic beverages, citrus fruits and juices, artificial sweeteners and hot pepper.

The Fibromyalgia Bladder Index

The aim of this study was to determine whether an existing outcome measure, the Interstitial Cystitis Symptom and Problem Index (ICSI/ICPI), is a valid, reliable, and clinically relevant instrument to assess the sensory urinary symptoms in women with fibromyalgia syndrome (FM). Ninety women with American College of Rheumatology 90 FM and who had at least two sensory bladder symptoms participated in the study. All underwent urological screening to exclude lower urinary tract pathology. All participants completed the following: ICSI/ICPI, Fibromyalgia Impact Questionnaire (FIQ), Medical Outcome Study Short Form 36, King's Health Questionnaire (KHQ), and Vulval Symptom Assessment Scale. Assessment was made for internal consistency reliability, test-retest reliability, and concurrent validity. Factor analysis was used to assess the internal structure of the scale. Factor analysis displayed two separate components of symptom and problem combinations as distinct from the original ICSI/ICPI developed for the interstitial cystitis population. The eight items of the index configured differently and formed two subscales of a newly developed Fibromyalgia Bladder Index. The two subscales of this index include the Bladder Urgency and Pain Subscale and the Bladder Frequency and Nocturia Subscale. This index has high internal consistency reliability (Cronbach's alpha coefficient of 0.81), test-retest reliability showing intraclass correlation of 0.85, and high concurrent validity through correlations between the Fibromyalgia Bladder Index and the KHQ (0.735, p = 0.000) and the FIQ (0.433, p = 0.000). This more specific configuration of the ICSI/ICPI better reflects FM bladder symptomatology. The Fibromyalgia Bladder Index is a validated FM-specific instrument that captures information about the sensory bladder symptoms and their impact in this fibromyalgia population. This instrument should allow for better understanding and management of this important fibromyalgia-associated problem.

Sexual Function is a Determinant of Poor Quality of Life for Women With Treatment Refractory Interstitial Cystitis

Interstitial cystitis significantly negatively impacts quality of life. The demographic and clinical factors associated with decreased quality of life in these patients have not been well studied. Women with moderate/severe interstitial cystitis enrolled in a clinical trial of intravesical bacillus Calmette-Guerin were studied. Demographic data and responses to questionnaires were evaluated at baseline, including the O'Leary-Sant Interstitial Cystitis Symptom Index and Problem Index, University of Wisconsin Interstitial Cystitis Inventory, Medical Outcomes Study sexual functioning scale, and the physical composite and mental composite scales of the Medical Outcomes Study Short Form Health Status Survey. Three composite indexes were constructed (from the O'Leary-Sant Interstitial Cystitis Symptom Index, O'Leary-Sant Interstitial Cystitis Problem Index, pain/urgency Likert scales and 24-hour voiding diary) to document the severity, frequency and bother of pain, urinary urgency and frequency (frequency composite index). Linear and multivariate regression models were used to examine predictors of the physical composite and mental composite scales of the Medical Outcomes Study Short Form Health Status Survey. Medical Outcomes Study sexual functioning scale data were available for 163 of the 217 women in the trial. Physical composite scale (median 36) and mental composite scale (median 42) were lower than the standard population value of 50. Multivariate models showed that employment, pain composite index and Medical Outcomes Study sexual functioning scale (all p<0.001) predicted physical composite scale, while only Medical Outcomes Study sexual functioning scale (p<0.001) remained a strong predictor of mental composite scale. Sexual functioning, employment and pain issues predict mental and physical quality of life. In particular, this study identifies sexual functioning as a primary predictor of mental quality of life in women with long-standing interstitial cystitis. It is suggested that sexual functioning may be a salient therapeutic target in the multifaceted treatment of patients with interstitial cystitis.

Rational Approaches to the Treatment of Patients With Interstitial Cystitis

Symptoms of interstitial cystitis can usually be successfully managed with heparinoid therapy to theoretically alter bladder urothelial abnormalities, and with oral medications to inhibit neural upregulation or to control mast cell dysfunction. Other forms of care ranging from intravesical therapy to endoscopic, percutaneous, or open surgery are options that may be used singly or in combination to optimize symptom reduction.

135: Effect of Therapeutic Solution on Dyspareunia and Voiding Symptoms in Interstitial Cystitis

135: Effect of Therapeutic Solution on Dyspareunia and Voiding Symptoms in Interstitial Cystitis

Current Diagnosis of Interstitial Cystitis: An Evolving Paradigm

Our approaches to the diagnosis of interstitial cystitis (IC) are evolving as a result of recent advances in our knowledge of the disease. With increasing awareness of IC prevalence and presentation, clinicians are identifying cases of IC earlier in the disease process. A diagnosis of IC can now be established without applying each step of the traditional diagnostic paradigm, which was designed to identify "classic" cases of IC. In this article, we present an updated paradigm for the diagnosis of IC based on recent clinical data and consensus discussions conducted at the International Consultation on Interstitial Cystitis in Japan (ICICJ) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)/Interstitial Cystitis Association (ICA) research symposium in 2003. The diagnosis is established on the basis of a thorough physical examination and the patient's history of urgency/frequency and/or pain in the absence of bacterial infection or malignancy. Use of a symptom questionnaire to capture and record the presence of all IC symptoms is helpful in establishing the diagnosis. In this evolving paradigm, all other diagnostic measures are optional. Evidence-based medicine does not require the use of either cystoscopy or urodynamics in a workup for IC.