Interstitial cystitis (IC) is a painful, sterile, disorder of the urinary bladder
characterised by urgency, frequency, nocturia and pain. IC occurs primarily
in women but also in men with recent findings indicating that chronic,
abacterial prostatitis may be a variant of this condition. The prevalence of IC
has ranged from about 8 – 60 cases/100,000 female patients depending on
the population evaluated. About 10% of patients have severe symptoms that
are associated with Hunner’s ulcers on bladder biopsy; the rest could be
grouped in those with or without bladder inflammation. Symptoms of IC
are exacerbated by stress, certain foods and ovulatory hormones. Many
patients also experience allergies, irritable bowel syndrome (IBS) and
migraines. There have been various reports indicating dysfunction of the
bladder glycosaminoglycan (GAG) protective layer and many publications
showing a high number of activated bladder mast cells. Increasing evidence
suggests that neurogenic inflammation and/or neuropathic pain is a major
component of IC pathophysiology. Approved treatments so far include
intravesical administration of dimethylsulphoxide (DMSO) or oral
pentosanpolysulphate (PPS). New treatments focus on the combined use of
drugs that modulate bladder sensory nerve stimulation (neurolytic agents),
inhibit neurogenic activation of mast cells, or provide urothelial cytoprotection, together with new drugs with anti-inflammatory activity.
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