Unit four : Clinical Features
Pain is the most important symptom. The distribution of pain can be
- Lower abdomen
- Anal canal
- Lower back
- Inner thigh
The pain can be sharp pain to burning sensation. Its intensity is usually perceived to be maximum on full bladder with relief after passing urine. This results in frequent visits to washroom as the patients realizes that if they allow the bladder to fill, then pain is more. For the same reason patients wake up from sleep with pain rather than a desire to pass urine. The patients eventually forget what is a full bladder sensation and they actually perceive pain as a signal to pass urine.
The pain is aggravated on travelling on a bumpy road and these patients prefer to travel by train rather than road.
Deep dyspareunia is one of the indicators of IC/BPS. Pelvic pain has to be differentiated from the pain originating from gynecological reasons like endometriosis, PID and ovarian pathology. Pain can also occur due to operative scars in lower abdomen. Chronic inflammatory conditions of bladder like chronic infective cystitis; tuberculosis, radiation and drug induced (cyclophosphamide) cystitis can have similar presentation.
In men pain of similar nature can result from prostatitis. Chronic non-infective prostatitis can have no microbiological evidence of infection on urine examination, but the pain could be similar. The only difference is that pain is perceived as burning sensation in urethra and is maximum while passing urine rather than before passing urine
Pain originating from colorectal pathology, like in IBS could sometimes be difficult to distinguish from IC/BPS. The two conditions can actually co exist also, further causing difficulty in diagnosis
The patients have progressively high frequency of urination. Some people may report 50-60 visits to washroom in 24 hours. They are scared of going out to picnics or shopping. The urgency is primarily because they cant handle pain and have learnt over the period of time that pain is reduced on emptying the bladder. Frequency and urgency can occur in over active bladder (OAB). OAB can be differentiated clinically from IC/BPS as usually the OAB patients have an intense bladder sensation and a desire to pass urine. A simple question can differentiate between these two conditions ‘ if you want to visit the wash room, and there is none available what would it lead to – leakage of urine or pain?’ if the answer is pain, it is IC/BPS and if it is leakage of urine, it is over active bladder (OAB).
Sexual dysfunction in both sexes can occur due to IC/ BPS. it is primarily related to pain and the psychological effects of a condition which remains undiagnosed/ untreated over a period of time. Deep dyspareunia in women and pain on erection in men are the prime symptoms in early stages of IC/BPS.
Associated comorbidities could be
- Irritable bowel syndrome
- Chronic fatigue syndrome
- Sjogrens syndrome
- Anxiety disorder
- Collagen disorder
Most of these patients undergo unnecessary hysterectomies and prostatectomies because of the mistaken diagnosis. These are not only unnecessary but also complicate the clinical picture by distorting the symptoms.
Next we will learn how to Clinically Examine a patient