This pain drives me crazy:Psychiatric symptoms in women with interstitial cystitis/bladder pain syndrome

BACKGROUND Interstitial cystitis/bladder pain syndrome(IC/BPS)is an at least 6-mo noninfectious bladder inflammation of unknown origin characterized by chronic suprapubic,abdominal,and/or pelvic pain.Although the term cystitis suggests an inflammatory or infectious origin,no definite cause has been identified.It occurs in both sexes,but women are twice as much affected.AIM To systematically review evidence of psychiatric/psychological changes in persons with IC/BPS.METHODS Hypothesizing that particular psychological characteristics could underpin IC/BPS,we investigated in three databases the presence of psychiatric symptoms and/or disorders and/or psychological characteristics in patients with IC/BPS using the following strategy:("interstitial cystitis"OR"bladder pain syndrome")AND("mood disorder"OR depressive OR antidepressant OR depression OR depressed OR hyperthymic OR mania OR manic OR rapid cyclasterisk OR dysthymiasterisk OR dysphoriasterisk).RESULTS On September 27,2023,the PubMed search produced 223 articles,CINAHL 62,and the combined PsycLIT/PsycARTICLES/PsycINFO/Psychology and Behavioral Sciences Collection search 36.Search on ClinicalTrials.gov produced 14 studies,of which none had available data.Eligible were peer-reviewed articles reporting psychiatric/psychological symptoms in patients with IC/BPS,i.e.63 articles spanning from 2000 to October 2023.These studies identified depression and anxiety problems in the IC/BPS population,along with sleep problems and the tendency to catastrophizing.CONCLUSION Psychotherapies targeting catastrophizing and life stress emotional awareness and expression reduced perceived pain in women with IC/BPS.Such concepts should be considered when implementing treatments aimed at reducing IC/BPS-related pain.

Addressing quality of life in the patient with interstitial cystitis/bladder pain syndrome

Interstitial cystitis/bladder pain syndrome(IC/BPS)is a debilitating,chronic condition characterized by chronic pelvic pain,urinary urgency,and frequency and is well-known to be associated with a decrease in work productivity,emotional changes,sleep,sexual dysfunction,and mobility.Many metrics of quality of life(QoL)in this patient population have been developed;however,a unified,standardized approach to QoL in these patients has not been determined.The effects of IC/BPS and co-morbid conditions on QoL are described using current validated metrics.Next,data regarding successful treatment of IC/BPS in terms of QoL improvement are reviewed.While QoL is the single most important clinical measure of success in the treatment of patients suffering from IC/BPS,addressing QoL in this patient population remains a significant challenge,as its effects on QoL are highly variable and unable to be differentiated from the effects of comorbid conditions on QoL,including depression,poor sleep,and inability to work.Future studies will need to address treatment efficacy on the basis of IC/BPS specific QoL metrics,and multi-modal assessment and therapy to address comorbid disease will also play an important role in the future to ensure comprehensive management of these patients.

Intravesical instillation of platelet-rich plasma for treatment of interstitial cystitis/bladder pain syndrome:A pilot study

Objective:The aim of this study was to evaluate the feasibility of intravesical instillation of platelet-rich plasma(PRP)to treat interstitial cystitis/bladder pain syndrome(IC/BPS).Materials and methods:Twenty PRP samples were tested in vitro for stability after exposure to urine samples with different pH.A pilot study involving 21 female patients with IC/BPS was conducted,and 6 weekly doses of autologous PRP(50 mL)were administered.Patients were followed up at the 2nd,4th,8th,and 12th weeks after terminating instillation.The primary endpoint was the visual analog scale(VAS)for pain,and the secondary endpoints included the IC symptom index,IC problem index of the O'Leary-Sant questionnaire and global response assessment,urine culture,and uroflowmetry.Success was defined as a reduction in VAS by 30%or more compared with basal level,and adverse events were recorded.Results:The mean±SD of VAS was significantly reduced compared with basal level(4.4±2.6 vs.8.8±1.1,respectively,p=0.001).Meanwhile,80%of cases were considered successful,with a 50.1%reduction in the mean score compared with the basal level.The mean±SD of IC symptom index and IC problem index significantly improved compared with the basal level.Global response assessment was markedly,moderately,and slightly improved in 2(10%),10(50%),and 5(25%)patients,respectively,and showed no change in 3(15%).Three patients had positive urine cultures at follow-up,but 1 withdrew after 2 sessions because of a lack of efficacy.Conclusions:Repeated intravesical instillation of PRP could be considered an effective and safe approach for treating IC/BPS.

Efficacy of Frankincense and Myrrha in Treatment of Acute Interstitial Cystitis/Painful Bladder Syndrome

Objective:To investigate the efficacy of frankincense and myrrha in the treatment of acute interstitial cystitis/painful bladder syndrome(IC/PBS).Methods:The effects of frankincense and myrrha on the proliferation and migration of primary human urothelial cells(HUCs)were assessed in vitro.In the animal study,48 virgin female rats were randomized into 4 groups(12 in each group):(1)control group(saline-injected control);(2)cyclophosphamide(CYP)group(intraperitoneal injected 150 mg/kg CYP);(3)CYP+pentosan polysulfate sodium group(orally received 50 mg/kg pentosan polysulfate sodium);and(4)CYP+frankincense and myrrha group[orally received frankincense(200 mg/kg)and myrrha(200 mg/kg)].Rats orally received pentosan polysulfate sodium or frankincense and myrrha on day 1,2,and 3.The experiments were performed on day 4.Pain and cystometry assessment behavior test were performed.Voiding interval values were assessed in rats under anesthesia.Finally,immunohistochemistry and Western blot were used to confirm the location and level,respectively,of cell junction-associated protein zonula occludens-2(ZO-2)expression.Results:Low dose frankincense and myrrha increased cell proliferation and migration in HUCs compared with control(P<0.05).Rats with acute IC/PBS rats exhibited lower voiding interval values,pain tolerance,and ZO-2 expression(P<0.05).Voiding interval values and pain tolerance were higher in the frankincense and myrrha group than CYP group(P<0.05).ZO-2 expression in the bladder was increased in the CYP+pentosan polysulfate and frankincense+myrrha groups compared with the CYP-induced acute IC/PBS group(P<0.05).Conclusion:frankincense and myrrha modulate urothelial wound healing,which ameliorates typical features of acute IC/PBS in rats.

Risk factors for interstitial cystitis/painful bladder syndrome in patients with lower urinary tract symptoms： a Chinese multi-center study

Background Despite 100 years of research, the continued absence of well-established risk factors impedes the diagnosis and treatment of interstitial cystitis/painful bladder syndrome （IC/PBS）. We aimed to identify risk factors in patients with lower urinary tract symptoms （LUTS） without urinary tract infection or benign prostate hyperplasia in China.Methods A total of 397 outpatients with LUTS presenting for care to urology clinics in several hospitals throughout China were surveyed using a standardized questionnaire and validated outcome measures. The definitions for painful bladder syndrome based on the O‘Leary-Sant interstitial cystitis symptom and problem indices were used. The prevalence of possible risk factors was analyzed using the Fisher＇s exact test and Pearson chi-square test, and multivariate predictive models were developed using binary Logistic regression methods.Results Of those multi-centre patients surveyed, including 174 women and 223 men, 41% （162/397） met criteria for painful bladder syndrome. There was a significant difference between women and men （55% （95/174） vs. 30% （67/223）,P 〈0.001）. Women with IC/PBS were more likely than those without IC/PBS to report a history of gynecological infections （odds ratio （OR）： 2.85; 95% confidence interval （CI）： 1.32-6.16, P=0.007）, intake of stimulatory foods （OR： 3.52; 95% CI：1.50-8.30; P=0.004）, irritable bowel （OR： 3.46; 95% CI： 1.22-9.80; P=0.014） and/or anorectal disease （OR： 2.68; 95% CI：1.12-6.40, P=0.023）. After adjusting for confounding factors, bladder pain was significantly associated with stimulatory foods （OR： 3.85; 95% CI： 1.58-9.36, P=0.003） and anorectal disease （OR： 2.76; 95% CI： 1.09-7.04, P=0.03） in women.Caffeine beverage intake （OR： 3.54; 95% CI： 1.54-8.12, P=0.003） was identified the only modifiable association noted in multivariate analysis of men.Conclusions We found that stimutatory foods, anorectal disease and caffeine beverages are potential risk factors for IC/PBS. Further studies are necessary to determine their role in the pathogenesis of this disorder.