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In Therapeutic Advances in Urology, researchers report on the role of inflammation, acute or chronic, and its effect on bladder function. Although the etiology of painful bladder syndrome/interstitial cystitis (PBS/IC) is still unknown, it is agreed upon that inflammation plays a central role in the bladder dysfunction that accompanies the condition. It has been proposed that the inflammation may come from a chronic or subclinical infection, a genetic susceptibility, or an autoimmune response.

 

Although the naming of the condition has gone through proposed changes (from interstitial cystitis to painful bladder syndrome to bladder pain syndrome) you will see the terms used interchangeably in the literature. A more recent attempt at refining the definition of IC  was completed by the European Society for the Study of Interstitial Cystitis. IC is described as "...chronic pelvic pain, pressure, or discomfort perceived to be related to the urinary bladder and accompanied by at least one other urinary system such as persistent urge to void or urinary frequency." Many physicians have based diagnosis on symptoms primarily, as more recent research has demonstrated that use of stringent diagnostic criteria or laboratory tests often excluded patients from being diagnosed appropriately. 

 

This article is useful in assimilating research about IC/PBS.  The authors briefly list the pharmacology of several different oral medications that have been studied for use with patients with bladder pain. Some of the medications target the mucosal lining of the bladder, act as antihistamines, target the pro-inflammatatory agents found in patients with bladder pain, or help the patient manage the pain (narcotics.) Other medications cited include anticonvulsants, antidepressants, anticholinergics, or hormones modulators. 

 

As for a nonpharmacological treatment approach for IC, physical therapy is recommended and modalities such as manual therapy, bladder training, biofeedback, and pelvic floor rehab are recommended. The authors conclude that in terms of management guidelines, because patients with bladder pain syndrome have such varied clinical presentations, it is necessary to individualize treatment approaches.

 

 

 



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