Patty Greenberg

ObjectivesIn an ongoing national study of women to identify risk factors for interstitial cystitis/painful bladder syndrome (IC/PBS), dysuria was identified at onset of IC/PBS in a small majority and evidence for urinary tract infection (UTI) was evaluated.MethodsIn women with IC/PBS of ≤12 months duration, symptoms and pertinent laboratory tests at onset were assessed by telephone interview and medical record review.ResultsOf 138 cases, 75 (54%) reported that they started to experience burning or pain on urination at onset of IC/PBS. Of those with urines cultured, 12/35 (34%) with dysuria vs. 1/21 (5%) without dysuria yielded a uropathogen (p=.01). Similarly, microscopic WBC and dipstick nitrites and leukocyte esterase were each significantly more common in urines of those with dysuria than those without. Additionally, 7/75 of those with dysuria vs. 1/62 without dysuria reported chills or fever at onset of IC/PBS. Using various definitions, the prevalence of UTI at onset of IC/PBS, at a minimum, was 16 – 33 % of those with dysuria vs. < 2% of those without dysuria (p ≤ .003).ConclusionsA slight majority of women with IC/PBS reported dysuria at onset of their IC/PBS symptoms. Available laboratory data suggest dysuria may be a sensitive indicator of UTI at onset of IC/PBS; its specificity is as yet undetermined.

ABSTRACT Researchers at Battelle Centers for Public Health Research and Evaluation (CPHRE) were contracted by the Centers for Disease and Prevention (CDC) to conduct a random sample survey to serve as one component of the evaluation of the Prevention Marketing ...

To assess how many patients with interstitial cystitis/painful bladder syndrome (IC/PBlS) obtain medical care soon after symptom onset, and to determine how these patients differ from those who have medical care later. In a risk-factor study of IC/PBlS, we recruited women with IC/PBlS symptoms of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or =12 months&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; duration and carefully identified the onset date, first medical encounter and early clinical findings. Of 138 women with IC/PBlS for &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or =12 months, 49% sought medical care within 7 days and another 31% within 4 weeks. These patients had no easier access to medical care but rather experienced symptoms differently, with more evidence for discomfort and inflammation. However, subsequently they did not differ from those with more gradual onset in features indicative of IC/PBlS, i.e. Hunner&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s ulcers, petechial haemorrhages, symptoms, medications, or quality of life. A shorter time to the first medical encounter was not a function of greater access to medical care but instead was associated with more discomfort and evidence of inflammation, as distinct from those with more gradual onset. The 6-month follow-up of both groups indicated that no significant differences in IC/PBlS symptoms persisted. A careful study of rapid-onset IC/PBlS might provide clues to the pathogenesis of this enigmatic disease.

The longitudinal history of interstitial cystitis/painful bladder syndrome has been studied infrequently. In a national sample of incident cases we assessed changes in symptoms during the first several years of interstitial cystitis/painful bladder syndrome. We recruited 312 women with a history of interstitial cystitis/painful bladder syndrome symptoms of 12 months or less and interviewed them by telephone at baseline, and 6, 12, 18, 24, 36 and 48 months later. We queried symptoms in the last week and interval medication use. Individual and composite symptom categories were constructed. The median history of symptoms at study enrollment was 9 months. Median followup was 33 months after onset. The 57 study withdrawals (18%) were not substantively different than those remaining in followup. Many cases of severe and moderate interstitial cystitis/painful bladder syndrome at enrollment improved with time. As followup progressed, increasing proportions reported improvement while decreasing proportions reported symptom worsening. Of the women 27 (9%) reported at least temporary symptom remission. Of 304 women with incident interstitial cystitis/painful bladder syndrome 35% reported improvement from baseline in symptoms at last followup a median of 33 months after onset. However, the disappearance of all symptoms at any followup was uncommon.