Temporal Ordering of Interstitial Cystitis/Bladder Pain Syndrome and Non-bladder Conditions

Department of Urology, University of Michigan Medical Center, Ann Arbor, Michigan. Electronic address: .
Urology (Impact Factor: 2.19). 12/2012; 80(6):1227-32. DOI: 10.1016/j.urology.2012.06.059
Source: PubMed


To examine the prevalence and timing of nonbladder conditions in a community cohort of women with symptoms of interstitial cystitis/bladder pain syndrome (IC/BPS).
As part of the Rand Interstitial Cystitis Epidemiology (RICE) study, we identified 3397 community women who met a validated case definition for IC/BPS symptoms. Each completed a survey asking if they had a physician diagnose them as having irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, migraines, panic attacks, or depression. If a positive response was received, subjects were asked to provide the age of symptom onset. All subjects were also asked to provide the date of IC/BPS symptom onset.
A total of 2185 women reported a diagnosis of at least one of the nonbladder conditions. Onset of bladder symptoms was not consistently earlier or later than the onset of nonbladder symptoms. Depression tended to occur earlier (P < .05), whereas fibromyalgia generally occurred later (P < .05). Mean age of onset was lowest for migraine symptoms, depression symptoms, and panic attacks symptoms, and greatest for fibromyalgia and chronic fatigue syndrome symptoms. Mean age of irritable bowel syndrome and IC/BPS symptom onset was between these other conditions.
These findings confirm the common co-occurrence of IC/BPS with chronic nonbladder conditions. In women with IC/BPS symptoms and coexistent nonbladder conditions, bladder symptoms do not uniformly predate the nonbladder symptoms. These observations suggest that phenotypic progression from isolated bladder symptoms to regional/systemic symptoms is not a predominant pattern in IC/BPS, although such a pattern may occur in a subset of individuals.

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    • "Such clinical features might suggest disordered bladder control from a generalized autonomic nervous system (ANS) abnormality. This concept might explain the IC/BPS known comorbid conditions [5] such as irritable bowel syndrome, migraine headache and fibromyalgia, also associated with ANS function changes [2, 6, 10, 13]. We hypothesized that IC/BPS belongs to a larger family of (often co-morbid) disorders that share common autonomic and sensory abnormalities. "
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    ABSTRACT: Interstitial cystitis/bladder pain syndrome (IC/BPS) is characterized by urinary urgency, frequency, nocturia, pain worse as the bladder fills and improved after emptying. These features might suggest abnormal autonomic bladder control mechanisms. We compared the structural integrity of the autonomic nervous system (ANS) in IC/BPS and control subjects. IRB-approved study at University Hospitals Case Medical Center, Cleveland, OH to evaluate the structural integrity of the ANS in adult females. Testing included cardiovascular response to deep breathing, Valsalva maneuver, 30 min head up tilt, and sudomotor test. Differences in ANS integrity for IC/BPS subjects and controls were determined by modified Composite Autonomic Severity Score (CASS) that includes sudomotor, adrenergic and cardiovascular indices. Baseline heart rate (HR) and HRs from each of three 10 min upright segments of a tilt test were compared and trend analyses performed using t tests. Healthy and IC/BPS subjects were demographically similar. The two groups did not differ in modified-CASS scores but elevated average peak heart rate was evident during baseline (supine; p = 0.057) for IC/BPS subjects prior to a tilt test. Difference at baseline was maintained at each interval during the tilt, with nearly identical slopes across intervals. The preliminary nature of this report denotes a small sample size and important differences may not be detected. The findings show no structural ANS abnormalities in IC/BPS subjects. Higher baseline HR supports the concept of functional rather than structural change in the ANS, such as abnormality of sympathetic/parasympathetic balance that will require further evaluation.
    Clinical Autonomic Research 04/2014; 24(4). DOI:10.1007/s10286-014-0243-0 · 1.49 Impact Factor
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    ABSTRACT: Bladder pain syndrome is one of the most challenging urological disorders to diagnose and manage. Symptoms can be highly debilitating for patients. The exact etiology remains unclear although there have been associations with other regional and global functional disorders. The magnitude and duration of symptom response to current therapies can be highly variable amongst patients, and even within an individual patient’s course. A multidisciplinary approach is paramount and optimal therapy may involve multiple simultaneous treatments.
    Current Bladder Dysfunction Reports 03/2014; 9(1). DOI:10.1007/s11884-013-0214-7
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    ABSTRACT: IC/PBS can be a chronic debilitating bladder condition that has eluded a major diagnostic or treatment breakthrough since the first cases were reported nearly 130 years ago. This condition is defined by a constellation of symptoms including urinary urgency, frequency, and bladder pain without identifiable causes. Potential etiologic mechanisms include bladder urothelial dysfunction, immune dysregulation, pelvic floor myalgia, and nervous system dysfunction. The etiology of IC/PBS is likely multifactorial. Our ability to treat this condition effectively is also limited by the heterogeneity of presentation (varying phenotypes). Very few studies of high-level evidence are available to direct treatment strategies. Since there have been many reviews detailing diagnosis and treatment of IC/PBS, rather than be repetitive, we sought to frame this review by exploring six questions: What is the historical context of IC/PBS? Is it a bladder-based disease? What other conditions are associated with IC/PBS? What does “early” IC/PBS look like, and can this stage be diagnosed? With varying phenotypic presentations, what is the best approach to treat IC/PBS? And finally, what is the history and future of IC/PBS research? The fruits of research to date have minimally impacted care of IC/PBS patients. A different approach with increased research funding is needed to find new things under the sun that will advance the art and science of IC/PBS.
    09/2014; 3(3):165-171. DOI:10.1007/s13669-014-0086-7
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