Co-morbidities of interstitial cystitis

Abstract

Introduction: This study aimed to estimate the proportion of patients with interstitial cystitis/painful bladder syndrome (IC/BPS) with systemic dysfunction associated co-morbidities such as irritable bowel syndrome (IBS) and fibromyalgia (FM).

Materials and methods: Two groups of subjects with IC/BPS were included: (1) physician diagnosed patients with IC/BPS and (2) subjects meeting NIDDK IC/PBS criteria based on a questionnaire (ODYSA). These groups were compared to healthy controls matched for age and socio-economic status. NIDDK criteria required: pain with bladder filling that improves with emptying, urinary urgency due to discomfort or pain, polyuria >11 times/24 h, and nocturia >2 times/night. The ODYSA instrument evaluates symptoms pertaining to a range of disorders including chronic fatigue, orthostatic intolerance, syncope, IBS, dyspepsia, cyclic vomiting syndrome, headaches and migraines, sleep, Raynaud's syndrome, and chronic aches and pains.

Results: IC/BPS was diagnosed in 26 subjects (mean age 47 ± 16 years, 92% females), 58 had symptoms of IC/BPS by NIDDK criteria (mean age 40 ± 17 years, 79% females) and 48 were healthy controls (mean age 31 ± 14 years, mean age 77%). Co-morbid complaints in the IC/BPS groups included gastrointestinal symptoms suggestive of IBS and dyspepsia, sleep abnormalities with delayed onset of sleep, feeling poorly refreshed in the morning, waking up before needed, snoring, severe chronic fatigue and chronic generalized pain, migraines, and syncope.

Discussion: Patients with IC/BPS had co-morbid central and autonomic nervous system disorders. Our findings mirror those of others in regard to IBS, symptoms suggestive of FM, chronic pain, and migraine. High rates of syncope and functional dyspepsia found in the IC/BPS groups merit further study to determine if IC/BPS is part of a diffuse disorder of central, autonomic, and sensory processing affecting multiple organs outside the bladder.

Keywords: IC/BPS; co-morbidities; functional gastrointestinal disorders; migraine headache; orthostatic intolerance.

Figure 1

Comparison of effects of IC/BPS on sleep function between healthy controls and patients diagnosed by physician or questionnaire. Dx: corresponds to IC/BPS diagnosed by a physician (diagnosed IC); Sx corresponds to subjects who have symptoms of IC/BPS based on NIDDK criteria (symptomatic IC).

Figure 2

This figure summarizes the complaints of fatigue, chronic pains, and Raynaud’s like symptoms. Dx: corresponds to IC/BPS diagnosed by a physician (diagnosed IC); Sx corresponds to subjects who have symptoms of IC/BPS based on NIDDK criteria (symptomatic IC). “Fingers turning white in cold” is purposed for looking at signs of possible Raynaud’s syndrome.

Figure 3

Summary of the gastrointestinal complaints. Dx: corresponds to IC/BPS diagnosed by a physician (diagnosed IC); Sx corresponds to subjects who have symptoms of IC/BPS based on NIDDK criteria (symptomatic IC). CVS, cyclic vomiting syndrome; IBS, irritable bowel syndrome.

Figure 4

Summary of orthostatic symptoms and headaches. Dx: corresponds to IC/BPS diagnosed by a physician (diagnosed IC); Sx corresponds to subjects who have symptoms of IC/BPS based on NIDDK criteria (symptomatic IC).