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Case History

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Image not available. A 34-year-old woman comes into your consulting room. She says she is fed up with the entire medical profession as her life has been ruined by urinary frequency and urgency. She cannot go out, unless she knows where all the public conveniences are, and makes excuses to the few friends she still has when they invite her somewhere. She has broken up with her boyfriend as sex seemed painful and made her symptoms worse. She has not had a decent night's sleep for three years because of nocturia. She has consulted countless other doctors who 'cannot find anything wrong' and suggested she seeks psychiatric help. She admits she is now suicidal, but only because she feels she has no quality of life and no prospects of getting better (at this point of the consultation she is crying so hard she can no longer talk).

What are relevant questions?

What are relevant tests?

What treatments are available?

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Background

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Image not available. Chronic interstitial cystitis (IC) is one of those tricky fields of medicine where there is no consensus of symptoms to make a diagnosis, no easy standard test to confirm that diagnosis and, as the aetiology is unknown, all the treatments are empirical and have varying success rates from 'modest' to 'poor'. It is not surprising that the group of people that end up with this diagnosis are disgruntled, if not suicidal. There are also areas of overlap with other diseases that cause pelvic pain, and some women may have more than one issue going on in their pelvis, or one problem that may cause multi-organ symptoms. What one must realise is that these people need understanding and as much explanation as we can offer them on the current knowledge about IC, and that research is ongoing.

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What are relevant questions?

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IC symptoms are bladder/pelvic pain, urgency, frequency and nocturia, in the absence of a positive bacterial culture and cytology. IC and painful bladder syndrome share the same cluster of symptoms. Chronic urethral syndrome is an outdated term.1 Pain distin guishes IC from overactive bladder, and vulval pain may distinguish vulvodynia from IC. Dysmenorrhoea distinguishes endometriosis from IC, although many women have endometriosis plus IC. Some women also have an overlap to irritable bowel syndrome. The Interstitial Cystitis Database Study concluded that the National Institutes of Health– National Institute of Diabetes and Digestive and Kidney Diseases (NIH-NIDDK) clinical and cystoscopic diagnostic criteria for research studies of IC were too restrictive for clinical use, because more than 60% of patients regarded by experienced clinicians as suffering from IC fail to meet the criteria.2,3 Conversely, 90% of patients who meet the NIH-NIDDK criteria for diagnosis (glomerulations and/or ulcers) were believed by clinicians to have IC. The NIH-NIDDK criteria, though excellent for research studies, are not suitable for routine clinical diagnosis, and many clinicians are comfortable with a clinical diagnosis, ...

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