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Query: UMLS:C0030794 (pelvic pain)
 4,056 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Once thought to be a rare condition, PBS/IC is being increasingly recognized as an important cause of CPP. It can exist either as a solitary disorder or in conjunction with other gynecologic or urologic disorders. The true prevalence of PBS/IC is hard to determine because most patients remain undiagnosed, although it is now thought to occur in up to 7.5% of the general female population and in 38-85% of women who present with CPP. Because the bladder has been insufficiently considered as a component of pelvic pain, many patients with PBS/IC may be misdiagnosed and inappropriately treated for years. It is critical for all clinicians, and especially gynecologists, who are often the first physicians from whom a woman with CPP will seek treatment, to consider PBS/IC in their patients who complain of pelvic pain, particularly when it occurs with urinary symptoms. The hallmark features of PBS/IC are irritative voiding and CPP. A minority of patients have classic ulcers and most have glomerulations, although it is not always necessary to establish these features to make the diagnosis. With careful questioning, most patients, in fact, can be identified by symptomatology, a medical history and a physical examination. Cystoscopy may be useful to rule out other conditions or to evaluate microscopic hematuria, which may be found in these patients. PBS/IC should be correctly diagnosed as early in the disease course as possible in order to avoid debilitating detriments to the patients' QOL in multiple domains. When symptoms of PBS/IC are recognized early on, treatment can be initiated when it is most likely to have a successful outcome. Although evidence-based clinical practice guidelines for IC/PBS are not available, partly because there is a lack of consensus on the definition and etiology of IC, clinicians, both primary care providers and specialists, can be reassured that there are diagnostic and treatment options that are simple to administer and have been demonstrated to be safe and effective.
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PMID:Epidemiology and quality of life. 1667 17

The objective of this paper was to establish whether patients with confirmed painful bladder syndrome/interstitial cystitis (PBS/IC) presenting with symptoms of UTI have actual bacteriuria vs a flare of their PBS/IC symptoms. One hundred and six (n = 106) consecutive female patients (mean age 39.8 +/- 14 years) with newly diagnosed IC were identified and followed longitudinally for 24 months. At the initial visit and at all subsequent visits, urinary specimens were obtained by sterile catheterization (Bard 14Fr female) and cultured for bacteria. Eight patients had an initially positive urine culture, and repeat cultures 8 weeks after treatment were all negative. Once sterile urine was established, the diagnosis of PBS/IC was confirmed. A pelvic pain/urgency/frequency (PUF) questionnaire score was obtained from 89 patients. After the diagnosis of PBS/IC, all patients received multimodal treatment. Patients were instructed to present to the office whenever they developed symptoms of UTI, at which time a sterile catheter specimen was obtained and sent for culture. Greater than 10(3) colonies were considered positive. Patients who did not report flares were contacted to establish whether unreported treatments were given. Seventy-two patients (68%) had no UTI episodes or flares. The remaining 34 patients (32%) presented with 54 flares, of which 44 were culture-negative and 10 were culture-positive. A single flare was reported by 21 patients during the 24 months, with three positive cultures (14.3%). Recurrent UTI symptoms (two to four flares) were seen in a small group (n = 13) for a total of 33 flares. Of these, seven had two flares each (12 negative, 2 positive), five had three flares each (12 negative, 3 positive), and one patient had four flares (two negative, two positive). Therefore, within the group with recurrent symptoms, seven positive cultures were obtained for a rate of recurrent bacteriuria of 6.6% (7/106). Nine of the 10 positive bacterial cultures were due to gram-negative bacteria: Escherichia coli (n = 6), Proteus mirabilis (n = 1), Klebsiella pneumonia (n = 1), and Citrobacter sp. (n = 1). One grew Streptococcus sp. There was no difference between the flare group and nonflares in regards to age or PUF scores between groups. This study is the first to report on the low incidence of confirmed UTIs in a large group of PBS/IC patients followed longitudinally. These data suggest that only a small number of PBS/IC patients with UTI symptoms have positive urine cultures (9.4%; 10/106). Although the symptoms of recurrent UTI are prevalent in IC patients, the incidence of confirmed recurrent UTIs is only 6.6%. Because the flares of IC are usually self-limiting, treatment response to antibiotics may be misleading in light of the low incidence of positive urine cultures. These data suggest that the symptom flares of IC are not usually associated with recurrent UTI and, therefore, are likely due to a triggering of the other painful mechanisms involved in IC patients who are culture-negative.
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PMID:There is a low incidence of recurrent bacteriuria in painful bladder syndrome/interstitial cystitis patients followed longitudinally. 1703 70

Interstitial cystitis/painful bladder syndrome (IC/PBS) is characterized by urinary frequency, urgency, and pelvic pain in the absence of any other identifiable pathology. Initial identification of IC/PBS is challenging, as patients may have a range of symptoms that overlap with other disorders, including urinary tract infection (UTI). These patients may be treated empirically with antibiotics; however, many patients with such symptoms are actually culture negative and are later diagnosed with IC/PBS. This review describes the importance of recognizing the symptom overlap between IC/PBS and UTI and focuses on approaches to the diagnosis and management of IC/PBS. Physicians can improve patient care by considering IC/PBS early in the differential diagnosis.
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PMID:Interstitial cystitis/painful bladder syndrome: appropriate diagnosis and management. 1793 71

The aims of this study were to evaluate the efficacy and tolerability of intravesical instillations of high-molecular-weight hyaluronic acid (HA) 1.6% and chondroitin sulfate (CS) 2.0% in patients with refractory painful bladder syndrome/interstitial cystitis (PBS/IC) and to observe their impact on Quality of Life. Twenty-three women were enrolled. They received bladder instillations with HA and CS weekly for 20 weeks and then monthly for 3 months. Mean follow-up after completion of therapy was 5 months. We observed a significant improvement in urinary symptoms on voiding diaries and Visual Analogue Scale for frequency (p = 0.045), urgency (p = 0.005), and pain (p = 0.001). The O'Leary-Sant Interstitial Cystitis Symptom Index and Interstitial Cystitis Problem Index resulted in a significant improvement in both scores (p = 0.004 and 0.01, respectively). The Pelvic Pain and Urgency/Frequency Symptom Scale only showed significant improvement in the symptom score (p = 0.001). This promising experience seems to offer an additional therapeutic option in patients with refractory PBS/IC.
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PMID:A combined intravesical therapy with hyaluronic acid and chondroitin for refractory painful bladder syndrome/interstitial cystitis. 1833 95

Growing clinical and scientific data imply that the condition currently called interstitial cystitis is not just a mere bladder end-organ disease but that the symptoms perceived to be related to the bladder are rather one aspect of a complex pelvic pain syndrome. The term bladder pain syndrome/interstitial cystitis (BPS/IC) suggested by the European Society for the Study of IC/PBS (ESSIC) for this condition is currently the only one strictly consistent with the taxonomy guidelines of the European Association of Urology and the International Association for the Study of Pain. BPS would be diagnosed on the basis of chronic pelvic pain, pressure, or discomfort perceived to be related to the urinary bladder, accompanied by at least one other urinary symptom such as persistent urge to void or urinary frequency. Confusable diseases as the cause of the symptoms must be excluded. Classification of BPS types might be performed according to findings at cystoscopy with hydrodistention and morphologic findings in bladder biopsies. The end-organ condition interstitial cystitis has thus become a chronic pain syndrome with a predominantly neurovisceral pathophysiology. In daily practice, therapeutic approaches aiming at both the peripheral bladder urothelium and central nervous targets should be combined. A multimodal treatment strategy, such as the combination of tricyclic antidepressants with instillation therapy, still appears reasonable and justified.
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PMID:[From end-organ disease to a classifiable bladder pain syndrome: paradigm shift in the understanding of urological pain syndromes exemplified by the condition currently called interstitial cystitis]. 1894 52

Interstitial cystitis/painful bladder syndrome (IC/PBS) is a chronic syndrome characterized by irritative voiding symptoms and pelvic pain or discomfort. IC/PBS represents localized bladder pathophysiologic changes and central nervous system upregulation. Patients exhibit bladder hyperalgesia and allodynia. Childhood sexual abuse occurs in up to 27% of females in the United States. Adults with a prior history of abuse or traumatization demonstrate hypothalamic-pituitary-adrenal (HPA) axis abnormalities, similar to IC/PBS patients. Childhood sexual abuse and physical traumatization are associated with subsequent lifelong risks of chronic pain syndromes. IC/PBS patients have increased rates of sexual abuse or physical traumatization histories compared with controls. IC/PBS patients with abuse histories tend to have greater pain intensity and lesser irritative voiding symptoms compared with nonabused IC/PBS patients. This article reviews the relationship between sexual abuse, HPA axis abnormalities, IC/PBS pathophysiology, and the role of sexual abuse on subsequent IC/PBS.
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PMID:The relationship between sexual abuse and interstitial cystitis/painful bladder syndrome. 1986 55

Urologic chronic pelvic pain syndrome (UCPPS) is a symptom-based umbrella term for interstitial cystitis/painful bladder syndrome (IC/PBS) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in men. Unfortunately, no gold standard for diagnosis or treatment of UCPPS exists. We review several emerging theories on the etiology and pathogenesis of UCPPS with a special emphasis on genomic and proteomic technologies. We also propose a systems-biology approach to elucidating the pathogenetic mechanisms implicated in UCPPS and the discovery and validation of new biomarkers for UCPPS. Using data gleaned from high-throughput genomic and proteomic screens can help develop effective treatments for this enigmatic chronic pelvic pain syndrome.
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PMID:Urologic chronic pelvic pain syndrome--looking back and looking forward. 1995 62

Interstitial cystitis/painful bladder syndrome (IC/PBS) is a chronic bladder disorder characterized by pelvic pain and irritative voiding symptoms. The symptoms of IC/PBS can overlap with such conditions as endometriosis, recurrent urinary tract infection, chronic pelvic pain, overactive bladder, and vulvodynia. The etiology of IC/PBS is likely multifactorial and may involve a defective urothelium, neurogenic upregulation, and mast cell activation. A thorough patient history and physical examination are critical in the differential diagnosis of IC/PBS. Frequent follow-up and patient education are important components of treatment once a condition is diagnosed. A multimodal approach to therapy can provide optimal relief for patients with IC/PBS.
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PMID:Diagnosis and treatment of interstitial cystitis/painful bladder syndrome: a review. 2049 65

Endometriosis affects 6-10% of women in their reproductive years, causing chronic pelvic pain and infertility. Its pathogenesis remains poorly understood and current treatments, based on hormonal therapy or surgery, are often insufficient. The purpose of our study was to investigate the role of the ERK pathway in the development of endometriosis and to test the effects of protein kinase inhibitors on the proliferation of endometriotic cells in vitro and in vivo. We studied ex vivo human endometrial and endometriotic cells in culture. Stromal and epithelial cells were extracted from endometrial and endometriotic biopsies from patients with endometriosis and from patients without endometriosis. The ERK pathway was explored by western blot on cell lysates and by ELISA on total crushed specimens of endometrium. Cells in culture were treated with A771726, PD98059, and U0126. Human endometriotic lesions were implanted in nude mice. Mice were treated with A771726, leflunomide, PD98059, U0126 or PBS during 2 weeks before sacrifice and extraction of the endometriotic implants for histological examination. We found that the ERK pathway was significantly activated in endometriotic cells and in endometrial cells from patients with endometriosis compared to endometrial cells of control patients, both by ELISA and by western blot. This phenomenon was associated with an increased proliferation of endometriotic cells compared to endometrial cells. Treating endometriotic cells with A771726, PD98059 or U0126 abrogated the phosphorylation of ERK and significantly decreased the cellular proliferation in vitro. In vivo, A771726, leflunomide, PD98059, and U0126 controlled the growth of endometriotic implants in the mouse model of endometriosis. Our study shows that protein kinase inhibitors could be new candidates to treat endometriosis. However, further studies are needed to evaluate their effects and tolerability in humans.
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PMID:Protein kinase inhibitors can control the progression of endometriosis in vitro and in vivo. 2082 52

Painful bladder syndrome/interstitial cystitis (PBS/IC) is a condition of chronic pelvic pain associated with irritative voiding symptoms. Management of PBS/IC has been a challenge for generations of physicians, owing to a lack of consensus on its definition, an incompletely understood pathophysiology, and numerous available therapies without high-quality evidence to guide their usage. This article reviews the most current conception of PBS/IC and data on effective treatments to recommend a management strategy.
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PMID:Management strategies for painful bladder syndrome. 2084 81


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