Magazine article Clinical Psychiatry News

Interstitial Cystitis a Culprit for Chronic Pelvic Pain. (Overactive Bladder)

Magazine article Clinical Psychiatry News

Interstitial Cystitis a Culprit for Chronic Pelvic Pain. (Overactive Bladder)

Article excerpt

SAN DIEGO -- Interstitial cystitis may be the culprit behind millions of cases of overactive bladder, and chronic pelvic pain should be considered in the differential diagnosis, investigators said at a meeting sponsored by the International Pelvic Pain Society.

Approximately one-third of the 9 million women with chronic pelvic pain (CPP) have negative laparoscopies, and 95%--or 2.5 million--of those patients probably have interstitial cystitis (IC), said Dr. Charles Butrick of the Kansas City Women's Clinic in Overland Park, Kan.

In addition, 4.5 million of the 17 million patients diagnosed with overactive bladder fail treatment with anticholinergic drugs and most likely have IC, he said.

A close comparison of CPP and IC reveals virtually identical overlap between symptoms, said Dr. Edward Stanford of St. Mary's/Good Samaritan Hospital in Centralia, Ill. Both conditions are characterized by dyspareunia, perimenstrual flares, flaring after sex, symptoms upon voiding, and pain in the lower abdomen, vulva, urethra, vagina, medial thighs, and perineum.

Recurrent urinary tract infections (UTI) are another due to possible IC, Dr. Stanford said. In a study he did of patients with recurrent UTI, 81% had sterile urine, which is one of the hallmarks of IC. Also, some patients may report a feeling of pressure rather than pain and make comments like "It feels like there's an elephant sitting on my stomach," Dr. Butrick said.

In a study conducted by Dr. Stanford and his colleagues at three medical centers around the United States, 82% of 134 patients with pelvic pain, vulvodynia, endometriosis, and dyspareunia had a positive potassium sensitivity test, suggesting that their pain had a bladder component. Seventy-five percent of the patients had reported urinary symptoms, but only 2.9% of those women received an initial diagnosis of IC. …

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