Chronic cystitis with bladder disorders



The symptoms related with glycosaminoglycans (GAGs) layer loss in the bladder wall are predominately those described in bladder irritation.

The direct contact of the urine irritants, cytotoxic drugs and bacterial adherence with the subepithelial layers in the bladder can activate fibres responsible for neuronal hypersensitivity that leads to:7

  • Pain, irritation, pressure, discomfort or other unpleasant sensation related to the urinary bladder
  • a frequent need to urinate (frequency)
  • an urgent, overwhelming need to urinate (urgency)

BPS/IC diagnosis

Diagnosis of BPS/IC is essentially based on symptoms and exclusion of other painful bladder conditions that resemble BPS/IC but have a different identifiable cause (confusable diseases)4

According to European Society for the Study of Interstitial Cystitis (ESSIC) Consensus, BPS/IC would be diagnosed on the basis of:8

  • Chronic (> 6 weeks) 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 frequency

Frequently unrecognized and misdiagnosed, BPS/IC is truly a diagnosis of exclusion2,8

How can I differentiate bacterial cystitis from BPS/IC?

The main differences between interstitial cystitis and bacterial infection of the urinary tract are:2

  • Symptoms peak during attacks
  • Cloudy, aromatic urine
  • Bacteria in urine
  • Burning sensation when urinating
  • Symptoms relieved by antibiotics
  • Symptoms unrelated to bladder filling
  • Symptoms last only a few days
  • Long term frequency
  • Clear urine
  • No bacteria in urine
  • Temporary relief when urinating
  • Antibiotics usually provide no relief
  • Pain/discomfort when bladder fills
  • Symptoms are continuous

Adapted from the COB Foundation. Cystitis Handbook: The Cystitis & Overactive Bladder Foundation 2012.3

The main issue is to rule out bacterial cystitis3

Haemorrhagic cystitis diagnosis

The haemorrhagic cystitis has a spectrum of manifestations that range from microscopic haematuria to gross - or visible - haematuria with clots and has a reported incidence from less than 10 % up to 35 %5

According to Guidelines for the diagnosis, prevention and management of chemical - and radiation - induced cystitis published by the British Association of Urological Surgeons:

  • Diagnosis of haemorrhagic cystitis should be based on symptoms and exclusion of other conditions (e.g. bladder neoplasms), and bacterial or fungal urinary tract infections.5