Role of inflammation in bladder function and interstitial cystitis

Abstract

Cystitis, or inflammation of the bladder, has a direct effect on bladder function. Interstitial cystitis is a syndrome characterized by urinary bladder pain and irritative symptoms of more than 6 months duration. It commonly occurs in young to middle-aged women with no known cause and in fact represents a diagnosis of exclusion. Many factors have been suggested, including chronic or subclinical infection, autoimmunity and genetic susceptibility, which could be responsible for initiating the inflammatory response. However, a central role of inflammation has been confirmed in the pathogenesis of interstitial cystitis. Patients with interstitial cystitis are usually managed with multimodal therapy to break the vicious cycle of chronic inflammation at every step. Patients who develop irreversible pathologies such as fibrosis are managed surgically, which is usually reserved for refractory cases.

Keywords: bladder; inflammation; interstitial cystitis; management; painful bladder syndrome.

Figure 1.

Integrated pathophysiology of interstitial cystitis. (Reproduced with permission from Sant et al. [2007]).

Figure 2.

Algorithm for the management of patients with chronic pelvic pain. GnRH, gonadatrophin-releasing hormone; IBS, irritable bowel syndrome; OC, oral contraceptives.

Figure 3.

The cycle of interstitial cystitis: treatment directed at the urothelial layer, nervous system, and immune system to break the cycle of pain at various steps.