Altered integrity of the glycosaminoglycan (GAG) layer (protective mucus)
Neurogenic theories: hypersensitivity
Psychosocial theories: a/w anxiety & depression
, Genetic theories
IC: The GAG layer
Glycosaminoglycan (GAG)
Normally coats the epithelium of the bladder & renders it impermeable to solutes (urine,
substances in urine [crystals, irritants])
Bladder mast cells activated: when irritation occurs --> inflammatory response
Also, there is a heparin compound in the GAG layer
IC/BPS: the neuropathic theory
Upregulation of pain sensation
Central sensitization & increased activation of bladder sensory neurons
Increased sensitivity may be from the bladder itself, or due to increased activity/new
pathways in the CNS
IC/BPS: epidemiology
Likely underestimated/under-dx
Pts who dont come in to be dx & pts who are mis-dx
Prevalence: 850/100k F, 60/100k M (F >>M)
Age: typically in 4th decade of life
No nationality/race more than another
IC/BPS: clinical features
Persistent unpleasant sensation attributable to the bladder, MC feature = pain worse
when bladder is full, & relieved w/urination
IC/BPS: evaluation
Primary objective of evaluation (hx, PE, labs) is to rule out other conditions that may
masquerade (diagnosis of exclusion)
• overactive bladder
• infectious cystitis (UTI)
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