Researchers believe that normal repair of the epithelial lining of the bladder does not occur in patients who develop IC (ARHP, 2008). One theory proposes that the bladder epithelium or lining of glycosaminoglycans (GAG) is damaged due to bladder injury and exposes the sensory nerves to irritants and triggers a noxious sensation. The damaged epithelium allows absorption of potassium and urea into the bladder wall (Klutke & Klutke, 2008). The damaged epithelium may lead to mast cell activation and the release of histamine. It is proposed that vasoactive, nociceptive, and proinflammatory molecules released from mast cells create neuronal sensitization and emit neurotransmitters that continue to stimulate the mast cells in the bladder and play an important role in the chronic and painful symptoms of IC (Sant, Kempuraj, Marchand, & Theoharides, 2006). There may be a possibility that heredity may play a part in some forms of IC. In a few cases, IC has affected a mother and a daughter or two sisters, but it is not usually familial (Clemens, Joyce, Wise, & Payne, 2007). Data has also shown that patients with IC have a higher incidence of certain immunological or allergic conditions. These conditions include allergies, irritable bowel syndrome, sensitive skin, vulvodynia, fibromyalgia, and migraine headaches (ARHP, 2008).
Interstitial cystitis is divided into two categories: ulcerative or classic and nonulcerative or Messing-Stamey types. The classic or ulcerative type clinically presents with a diffusely reddened appearance to the bladder surface epithelium associated with one or more ulcerative patches surrounded by mucosal congestion. The ulcers are called Hunner ulcers. Hunner ulcer upon cystoscopic examination is the hallmark of classic interstitial cystitis. In the United States, this type is rare and may be more resistant to therapy. The nonulcerative type of IC is characterized by similar clinical symptoms but the cystoscopic findings are absent (Rovner & Goudelocke, 2010).
Diagnosis and Management
There are no established diagnostic criteria for IC (Homma et al., 2009). Symptoms of IC are similar to those of other disorders of the bladder and all organic causes of the pain must be ruled out before considering a diagnosis of IC (Clemens et al., 2007). The diagnosis of IC is based on the presence of pain related to the bladder, usually accompanied by frequency and urgency of urination, exclusion of other diseases that could cause the symptoms and cytoscopic findings (Homma et al., 2009). Diagnostic tests that help rule out other diseases include urinalysis, urine culture, cystoscopy, biopsy of the bladder wall and urethra, and distention of the bladder under anesthesia (Clemens et al., 2007).
In 1987 the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) published a definition of IC to provide researchers with guidelines for selecting comparable study populations. The NIDDK criteria include 18...