Dry eyes and dry mouth are two common symptoms of Sjogren’s syndrome, an immune system disorder that is often found in patients with other such disorders, such as lupus or rheumatoid arthritis. Now, reports are slowly emerging that suggest doctors might need to be on the lookout for bladder symptoms, which might point to a case of interstitial cystitis (IC). In this report, the authors describe one female patient who developed IC about 23 years after first receiving a diagnosis of Sjogren’s syndrome. The treatment post-IC diagnosis was an immunosuppressive therapy: tacrolimus and prednisolone, a treatment similar to what she had received previously for her autoimmune disorder. The treatment helped alleviate IC symptoms, according to the authors. Exactly why Sjogren’s patients might develop IC is unknown, but there are several other observational studies suggesting a potential link between the two syndromes. In any case, they said, physicians should be on the lookout for IC in their patients with Sjogren’s who have unexplained lower urinary tract symptoms–and if they do find it, consider a treatment with an immunosuppressant.

In this study, investigators looked for very closely at bladder tissue from interstitial cystitis (IC) patients to ascertain differences between Hunner IC and non-Hunner IC at the cellular level. Hunner IC is the less common variant of IC, but can be associated with more severe symptoms. To test for differences, the researchers obtained biopsies of the bladder mucous membrane from 14 female IC/BPS patients with Hunner’s lesion and 14 without Hunner’s lesion. As might be expected, the Hunner IC patients had significantly higher pain scores and smaller bladder capacity compared to the non-Hunner IC patients. However, they also found that the Hunner IC bladder specimens more often showed moderate to severe infiltration of eosinophils, a type of white blood cell often associated with inflammation; additionally, the bladder tissue from the Hunner IC patients more often showed denudation, or a loss of protective surface layers. There were also differences noted in expression of a protein called E-cadherin, and notably, expression of enzyme called endothelial nitric oxide synthase (or e-NOS) was significantly higher in the Hunner IC bladder samples. The researchers think that, in particular, this difference in e-NOS expression may be a key underlying factor that may influence whether an individual develops the Hunner or non-Hunner variety of IC.

It is known that stress can exacerbate the symptoms of interstitial cystitis/painful bladder syndrome (IC/BPS). This animal study provides evidence that adverse events early in life might predispose women to developing IC/BPS as adults. The investigators in the study tested the effects of a stressful event on adult female mice who, at birth, had experienced neonatal maternal separation (NMS). Based on past studies, it is known that maternal separation causes a variety of long-lasting emotional and anxiety related behaviors in mice. They found that in these mice who experienced NMS early in life, a stressful event in adulthood caused a significant increase in urination rate and output compared with a group of mice who did not undergo NMS. Moreover, the NMS mice had changes in gene expression related to regulation of the stress response system. Based on these and a variety of other experimental findings, the investigators concluded that early life stress is a potential underlying cause of stress-related bladder symptom onset later in life.

This educational article makes the point that interstitial cystitis/bladder pain syndrome (IC/BPS) is a disorder that is common in men, yet frequently misdiagnosed. Previously, IC/BPS was thought to be rare in men, but by some recent estimates, up to 20% of IC/BPS patients are male. Men may experience the hallmark symptoms of IC/BPS, such as chronic discomfort and irritative voiding symptoms, yet may be told they have another condition, such as prostatitis, epididymitis (inflammation of a tube behind the testicle), or benign prostatic hyperplasia, or BPH. The delay in diagnosis that men experience in these situations means that they aren’t promptly receiving treatments that could ameliorate the symptoms of their IC/BPS. Even when IC/BPS is properly diagnosed, picking a potentially helpful treatment is challenging, since most studies haven’t incorporated many male patients. In clinical practice, there are many men with properly diagnosed IC/BPS who do benefit from IC/BPS specific treatments such as intravesical therapy, cyclosporine, and fulguration of ulcers. The authors recommend customizing treatment choices based on each male patient’s symptoms using the UPOINT system, and call for further research specifically in men with IC/BPS.

In this study, investigators set out to document what symptoms are most frequently reported in early cases of interstitial cystitis (IC) in the hopes that women in the future will be more likely to get a correct diagnosis up front and receive appropriate treatment that will help relieve their symptoms. The study population included 100 female IC patients who filled out a questionnaire. By far, the most common first symptom was frequency (reported as a first symptom by 81% of patients), while urgency and pain were also commonly reported as first symptoms. Interestingly, the researchers found that 81% of the IC patients had bladder symptoms by age 30, and a substantial portion (21%) had symptoms even before age 10. Despite this, an IC diagnosis was often not made until age 40 or later. That suggests that IC was frequently misdiagnosed at first; and in fact, the most frequent early misdiagnosis was urinary tract infection (74% of respondents). While this suggests a significant knowledge gap among doctors, the author of this study said making an IC diagnosis is easy if clinicians realize the disease typically starts with urinary frequency and progresses slowly with intermittent flares that may occur after sexual activity. If clinicians can use this information to make an accurate diagnosis, more women will receive helpful treatment, and health care costs may be reduced.

Pelvic inflammatory disease (PID) is a gynecologic disorder that, much like interstitial cystitis/bladder pain syndrome (IC/BPS), is associated with acute abdominal pain and chronic inflammation. Despite this similarity, there have been no studies looking at potential associations between the two conditions. Accordingly, investigators looked for cases of PID in a database of patients in Taiwan. The sample included 449 patients with IC/BPS, and for comparison, 1796 randomly selected control subjects. The investigators found that the IC/BPS patients were significantly more likely to also have PID; in all, nearly 42% of the IC/BPS patients had PID, versus just about 15% of the control subjects. That finding suggests that the risk of PID is significantly higher in women with IC/BPS, or at least the Asian women in this study. The investigators aren’t sure why women with IC/BPS would have such a high prevalence of PID, so further study may be needed to confirm the findings and look at the underlying causes.

Investigators with the MAPP Research Network have discovered that the presence of certain microorganisms in the lower urinary tract may be associated with flares in women with urologic chronic pelvic pain syndromes (UCPPS). The researchers assessed urine specimens from 233 women with UCPPS, some of whom had reported flares, and some who had not. They found a total of 81 species of microorganisms. Although the total number and type of microorganisms was similar in both the flare and non-flare groups, there was a greater prevalence of specific fungi, Candida and Saccharomyces, in the flare group (15.7%) versus the non-flare group (3.9%). It’s possible that antibiotic use and menstrual phase could account for a high prevalence of fungi, so the researchers adjusted the data for these potentially confounding factors; even after the adjustment, the women with flares were significantly more likely to have fungi present in their urine specimens.

The use of hormonal contraceptives is very popular in the United States and around the world, yet some questions remain regarding its potential influence on sexual symptoms, bladder/bowel issues such as incontinence, and other potential side effects. In this particular study, investigators hoped to determine whether or not these contraceptives affect pelvic floor function, thus increasing the risk of painful bladder and vulvar pain. They conducted a comprehensive and systematic review of published studies and found 13 high-quality studies that they analyzed in greater depth. By pooling the data from these studies, they found significant links between interstitial cystitis and oral contraceptive use, as well as links between vulvar pain and oral contraceptive use. This does suggest that oral contraceptives could have some effect on pelvic floor function; however, these findings are derived from previously published studies; more research in carefully designed, prospective trials would be needed to confirm a link between hormonal contraceptives and interstitial cystitis or vulvar pain.

Polyomaviruses are small, DNA-based viruses that are widespread in nature, and usually don’t cause an illness unless an individual’s immune system is weakened. The aim of this study was to see if such polyomaviruses might contribute to the development of interstitial cystitis. In fact, the authors did identify an association between interstitial cystitis and presence of polyomaviruses in the urine. The study included 50 patients with interstitial cystitis, who were compared with 50 healthy control subjects matched for age. Investigators found that polyomavirus shedding was significantly more frequent among the patients with interstitial cystitis. Moreover, the virus shedding was more likely among patients who had vesical ulceration, which is a marker of interstitial cystitis severity. There was also some indication that treatment with clorpactin (a therapy that’s active against DNA viruses) helped improve interstitial cystitis symptoms in those patients who had virus shedding. While this is just a pilot study, the investigators believe the data are compelling enough to warrant further investigation.

This report is from a group of Chinese investigators who say they have observed an increase in the number of women with interstitial cystitis (IC) who also have cystitis glandularis (CG), a type of small and likely benign lesion commonly found in bladder biopsies. The investigators reviewed nearly 400 patient charts and found that the patients with IC were more likely to have CG compared with women in the general population (i.e. women without IC). Moreover, about 65% of the women with both IC and CG had other obstructive lower urinary tract diseases, compared with only about 44% of women with IC but no CG. Although CG is generally considered benign, some experts say patients with CG should be monitored because there have been some reports of a potential association between CG and bladder cancer.