February 2006 · Vol. 18, No. 2The generalist’s guide to interstitial cystitis
How to diagnose and treat all but refractory cases of this not-so-uncommon disease
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Fast Track
5 hallmarks of interstitial cystitis:
Urodynamic studies are not necessary to diagnose interstitial cystitis. A voiding diary, the PUF scale, and the O’Leary-Sant Index are helpful
Cystoscopy with hydrodistension under anesthesia
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Surest diagnosis
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Can be therapeutic
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May avert misdirected therapy
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Rules out neoplasm
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Reassures patient that symptoms are “real”
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Has limitations; not always necessary
Counsel patients that interstitial cystitis is a chronic disease and that improvement may take 3 months or longer
Treatment of visible ulcers by resection or laser ablation carries a relapse rate of more than 50%
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Christine
LaSala,
MDAssistant Professor of Obstetrics and Gynecology, University of Connecticut, Director, Urogynecology Division Hartford Hospital, Hartford, Conn
The typical patient voids 16 times a day and 2 or more times at night. In later stages of the disease, she may urinate as often as 60 times a day and every half hour at night, severely eroding her ability to hold a job, travel, or lead a normal life. In fact, her quality of life may be impaired as much as that of a person with end-stage renal disease.1,2 She sees an average of 4 doctors and endures irritative voiding symptoms for 4 years before her disease is identified. The cause is unknown.
Interstitial cystitis produces a wide spectrum of symptom severity, occurring episodically with spontaneous flare-ups and remission, or with continuous, intractable urinary urgency and pain. Until recently, women presenting with urinary urgency, frequency, and pain were presumed to have a urinary tract infection (UTI) or overactive bladder, and were often treated—to no avail—with multiple courses of antibiotics or anticholinergics.
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