UroToday.com – Symptoms characteristic of IC have been reported to occur in more than 2% of women. Far more common conditions can result in confounding symptomatology. Dr. Jeffrey Dell and colleagues from Knoxville, Tennessee and New Brunswick, NJ remind us of some of these more common disorders.

Urinary tract infections (UTI) are very common among women. Over half of all women will experience a urinary tract infection during their lifetimes. Many BPS/IC patients are mistakenly diagnosed with recurrent UTI, and the importance of documenting the presence of true infection in patients with dysuria and frequency is self-evident if one does not want to miscategorize and mistreat this group of patients.

Endometriosis, the presence of endometrial glands and stroma outside the uterus, is a common gynecological condition occurring in up to 50% of premenopausal women and in 71-87% of women with chronic pelvic pain. Patients with endometriosis may present with chronic pelvic pain in addition to urinary frequency, dysuria, and hematuria, particularly if the bladder wall is involved. Dyspareunia is another common symptom. The pain of endometriosis is typically cyclical. The diagnosis is based on history, physical examination, laparoscopic examination, and confirmation by histology.

Chronic pelvic pain (CPP) is generally defined as pain that 1) localizes to the anatomic pelvis, the anterior abdominal wall at or below the umbilicus, the lumbosacral back, or the buttocks; 2) is of sufficient severity to lead to medical care or functional impairment; 3) lasts for greater than 6 months. Best estimates are that 15-20% of women aged 18-50 years have suffered from CPP. It is truly difficult to differentiate from other disorders, Vulvodynia is defined as chronic vulvar burning, stinging, or pain in the absence of clear pathology. Limited epidemiologic data suggest a lifetime prevalence of 10-28%. While BPS/IC is often associated with dyspareunia, its association with vulvodynia as defined is somewhat unclear, and the definition of each disorder should clearly help the clinician make the distinction.

Finally, overactive bladder has prevalence up to 10 times that of BPS/IC. It is characterized by urinary urgency with or without urge urinary incontinence and usually with frequency and nocturia in the absence of obvious pathology. The conditions of BPS/IC and overactive bladder may be differentiated by the presence of pain in BPS. Care should be taken to attribute a failure of efficacy of antimuscarinics in suspected overactive bladder to the presence of BPS, as many patients with overactive bladder may not experience significant efficacy with antimuscarinic therapy.

This is a nice article which brings out issues of importance to the clinician involved with the diagnosis of BPS and confounding disorders.

Dell JR, Mokrzycki ML, Jayne CJ
Eur J Obstet Gynecol Reprod Biol. 2009 Jun;144(2):105-9.

Written by UroToday.com Contributing Editor Philip M. Hanno, MD, MPH

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