Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS)

Acute – In the medical terminology, acute refers to diseases, illnesses or symptoms that develop fast and don’t last long. (Acute doesn’t essentially mean severe.)

Amitriptyline – A sort of antidepressant; occasionally used in the therapy of IC/BPS, too. It mitigates the symptoms, but may have side effects if taken at large doses.

Anamnesis – Describing the history and the current status of a patient, including diseases/conditions in the pasts, injuries, operations, but diet and living conditions, too. An accurate anamnesis helps make the proper diagnosis.

Antidepressants – A group of medicine. In spite of the name, they are used not only for treating depression, but also for several other conditions, e.g. chronic pain syndromes. Certain kinds of them – tricyclic antidepressants – are widely used in the oral therapy of IC/BPS.

Antihistamines – The name refers to histamine antagonists. (Histamine is a compound produced by certain cells. It is involved in the immune response of the body and has inflammatory effect.) They generally have anti-inflammatory effect, certain types of them – e.g. hydroxyzine and cimetidine – are used in the oral therapy of IC/BPS. See also: Histamine

Atrophy – Partial or complete wasting away of a tissue, organ or body part.

Autoimmune disease – A general term for diseases in which the immune system – mistakenly – attacks the own cells, tissues and substances of the body. Some theorize IC/BPS is an autoimmune disease or develops on the basis of autoimmune processes. This theory has not been confirmed yet.

Bacterial cystitis – The inflammation of the bladder which is caused by bacteria.

Baking Soda – See Bicarbonates

Bicarbonates – A group of inorganic salts; in IC/BPS terminology it often refers to sodium bicarbonate (a.k.a. baking soda). It is used for urine alkalization (to mitigate the symptoms), as the part of the treatment.

Biopsy – Collecting specimen from a tissue or an organ. In case of IC/BPS, biopsy is not performed unless the cystoscopy reveals areas that might refer to tumorous alterations.

Bladder Pain Syndrome – See IC/BPS.

BPS – see IC/BPS

BPIC/SS Questionnaire – One of the questionnaires used for diagnosing IC/BPS; it surveys the voiding habits, the grade and the frequency of pelvic pain, focusing on the experience of the previous 7 days. It doesn’t seem to be a reliable method of diagnosing this disease.

Capsaicin – An alkaloid which is present e.g. in the paprika and chili (and responsible for the “hot” sensation). In the medical practice they occasionally use it as a local analgesic. It has been tried in the treatment of IC/BPS, but has failed to improve the condition.

Catheter – A thin rubber pipe which is used for delivering solutions into certain organs (or draining solutions from them).

Chemotherapy Cystitis (Chemo-Cystitis) – A form of cystitis may occur as a complication of the chemotherapy of a cancer. See more: Hemorrhagic Cystitis.

Chondroitin (Chondroitin Sulphate; CS) – A polysaccharide compound which is generally used for treating cartilage problems. In the therapy of IC/BPS, chondroitin sulphate is considered to be one of the GAG-layer replenishers.

Cimetidine – See Antihistamines

Citrates, Citric Acid – The term is generally used for the salts of citric acid; despite the name these compounds have alkalizing effect.

Chronic – In the medical terminology it refers to long-lasting diseases, or conditions that persist for a long time.

Classic IC/BPS – An old term for IC/BPS with Hunner lesion.

Coagulation – See Fulguration.

Cocktail – In the therapy of IC/BPS the term refers to solutions instilled into the bladder that contain more components.

Corticosteroids – A group of hormones produced by the body; the term refers to similar synthetic compounds, too. In the medical practice, a group of anti-inflammatory agents is called so, as well. In the oral medication of IC/BPS corticosteroids can be used, too.

Cystectomy – Removing the bladder via a surgical operation. Current guidelines of treating IC/BPS say that cystectomy is recommended only if the patient hasn’t responded to any other therapy.

Cystitis – A general term for bladder inflammation. (Its official plural form is Cystitides.)

Cystoscopy – Examining the inside of the bladder with a small camera (called cystoscope) which is lead into the bladder through the urethra. It was widely used in the past for diagnosing IC/BPS. Currently, it is performed only if it’s strongly suspected that there are alterations on the bladder wall or mucosa.

Cytology – See Urine Cytology

Differential diagnosis – Distinguishing conditions of similar symptoms and all the diagnostic methods of this purpose. This is the first step of diagnosing IC/BPS: the therapist has to rule out other conditions which may cause the symptoms, e.g. bacterial cystitis.

Diverticulum – A pathological condition, a small bulging sac or sacs of a cavernous organ are pushing outward. The sacs may consist of one or more layers of the organ wall.

DMSO – Dimethyl-sulfoxide; one of the compounds used in the local treatment of IC/BPS. It is the only agent approved by FDA (The USA) for this purpose. It mitigates the symptoms, but, in itself, doesn’t regenerate the GAG-layer.

Dorfman (PUF) questionnaire – One of the questionnaires widely used for diagnosing IC/BPS. It surveys the voiding habits, the presence and frequency of bladder pain, and the pain occurring during a sexual intercourse.

Dyspareunia – Painful sexual intercourse. IC/BPS patients may have dyspareunia, too.

Dysuria – Painful urination. IC/BPS patients may have dysuria, too.

Elimination diet – A form of diet. In the first step only the food and drinks are allowed to take that surely cause no problems. In the next step, each food or drink is to be added one by one – if no symptoms occur, it can be consumed in the future.

Elmiron – See PPS

Endometriosis – A condition in which the endometrial tissue appears outside the uterus. It may cause pelvic pain or infertility. Endometriosis can be a comorbidity of IC/BPS.

End-Stage Bladder – An irreversible process during which the bladder wall becomes rigid, callused, and the volume of the bladder becomes abnormally small.

Epidemiology – The discipline of researching the appearance, abundance, spread and dispersion of diseases.

Etiology – The discipline of researching the causes and the development of diseases.

Fibromyalgia – A condition characterized by wide-spread muscular or musculoskeletal pain. Its etiology is unknown. Fibromyalgia may be a comorbidity of IC/BPS.

Fulguration (Coagulation) – Destroying certain tissues or areas with laser or electricity. (Although the word itself refers to the use of diathermy.) In the treatment of (Hunner lesion) IC/BPS the term refers to the process when the damaged parts of the bladder mucosa are being destroyed. Fulguration destroys the majority of the pain nerve endings, too, so it may greatly decrease the level of pain. After this process can the GAG-layer replenishment start. (Coagulation originally means the irreversible destruction of proteins, but in the terminology of IC/BPS the two expressions may be used in an interchangeable way.)

Gabapentin – A sort of medicine used for different conditions. In the oral therapy of IC/BPS, it is applied for lessening the neuropathic pain.

GAG-layer – A mucus (mucosal) layer which covers the inner surface of the bladder, it consists of glycosaminoglycans. The GAG-layer protects the deeper regions of the bladder wall (including the pain receptors) from the irritative substances that are present normally in the urine. In the condition of IC/BPS this GAG-layer gets damaged, which leads to pain and frequent voiding stimulation.

GAG-layer integrity test a.k.a. Two-day voiding diary – A new method of diagnosing IC/BPS. The basic principle is the following: since the damaged bladder gets irritated because of the salts present in the concentrated urine, the more concentrated the urine is, the smaller the urine portions (the total amount of urine of a voiding) are. For the test, the patient makes a two-day voiding diary. On the first day he/she needs to take the less fluid they can, whereas on the second day the most. In case of a healthy bladder, the mean of the urine portions is the same, regardless of the fluid intake. The bigger the difference of the portions is, the more advanced IC/BPS is.

GAG-layer replenisher – A general term for the compounds that supposed to help the replenishment of the GAG-layer. E.g. heparin, hyaluronic acid and chondroitin sulphate belong to this group.

Glycosaminoglycan – A general term for certain polysaccharides containing nitrogen. These compounds are among the main components of the mucus layer covering the inner surface of the bladder. Chondroitin and hyaluronic acid are glycosaminoglycans, too. See also: GAG-layer.

Hematuria – Blood is present in the urine. In case of IC/BPS hematuria rarely occurs; even if so, the amount of blood is so small that it can be detected by certain laboratorial examinations. Hematuria is a typical symptom of hemorrhagic cystitides.

Hemorrhagic Cystitis (HC) – An umbrella term for conditions in which the bladder is inflamed and its mucosa is bleeding. Different authors use HC for different group of conditions. On this page, Hemorrhagic Cystitis is used for complications of oncotherapeutical treatment: chemotherapy cystitis and radiation cystitis.

Heparin – A polysaccharide compound which contains nitrogen and sulfur. It’s widely used in the medical practice as anticoagulant. In the treatment of IC/BPS it’s one of the GAG-layer replenishers.

Histamine – A transmitter molecule naturally present in the human body. It has a key role in inflammatory processes. It dilates the smaller blood vessels whose wall become more permeable for certain chemical compounds. This results in the typical reddish color of the affected area. Histamine also stimulates the nerve endings whose effect is the itchiness. The therapy of IC/BPS is often complemented with antihistamine substances – certain sorts of medicine that antagonize histamine.

Hunner Lesion (Hunner Ulcer) – In case of the 10–30% of the IC/BPS patients, characteristic lesions can be observed on the bladder wall. In the past they used the term as a synonym of IC/BPS, because this form of the disease was discovered earlier (by Guy Hunner, in 1915). In fact, in case of most of the IC/BPS patients there are no Hunner lesions. The term “Hunner Ulcer”, which used to be the old name of the phenomenon, is misleading, because there are no ulcers present at all. (Ulcerative IC used to be a term that referred to this form of IC/BPS.)

Hyaluronic Acid – A polysaccharide molecule. It is regularly used for treating joint problems and skin regeneration. Several cosmetics contain hyaluronic acid, too. In the treatment of IC/BPS it is one of the GAG-layer replenishers.

Hydrodistension – High pressure cystoscopy. During this process the bladder is being filled up with water; while the cystoscopy is performed the water pressure is being lessened gradually so that the alterations of the bladder mucosa can be examined. It is an effective method for identifying certain typical forms of bleeding which are often present in IC/BPS patients. It is performed in anesthesia. Hydrodistension used to be a common therapeutical tool; currently it is mostly used for diagnostic purposes.

Hydroxyzine – See Antihistamines

Hypersensitive Bladder (HSB) – See IC/BPS

IC/BPS, Interstitial Cystitis, Bladder Pain Syndrome – A condition of urinary symptoms and severe pain. Its etiology is not known, diagnosing it is complicated. According to our current knowledge, there is no permanent cure for IC/BPS, but with an effective treatment, patients can be symptom-free for long years. The naming of the disease in the scientific literature is confusing. In Europe, it’s usually called Interstitial Cystitis (IC). In America, it’s mostly known as Bladder Pain Syndrome. In the Far East, the condition is often called Hypersensitive Bladder (HBS), sometimes they refer to certain types of it with the term. In fact, neither the name nor the definition of the disease is standardized, which often leads to confusion. Most articles use the Interstitial Cystitis/Bladder Pain Syndrome (or shortly IC/BPS) expression (even if both names may be used as an “umbrella term”, or one may be considered a sub-type of the other one.)

Incontinence – The lack of control over urination. Most IC/BPS patients don’t suffer from incontinence.

Instillation – Delivering a substance directly into the bladder. It can be performed with or without a catheter, too.

Interstitial Cystitis – See IC/BPS.

Invasive – In the medical practice the term refers to technics or devices that intrude the body or a cavity of it. In a wider context, it refers to the grade of this “introduction”. Using a catheter, for example, is more invasive than oral medication, but less invasive than performing a surgery.

Irritable Bowel Syndrome (IBS) – A disease of the stomach and/or the bowels, its usual symptoms are abdominal pain and defecation disorders. No alteration of the affected organs can be observed. In case of IC/BPS patients the risk of developing IBS is higher.

Lidocaine (Lignocaine) – A local analgesic widely used in the therapy of IC/BPS, too.

Local Therapy – Treating directly the affected organ or area. In the field of IC/BPS, it primarily refers to bladder instillation.

Lovász Questionnaire – One of the questionnaires used for diagnosing IC/BPS. It surveys the level and frequency of bladder pain.

Lupus – In its scientific name Systemic Lupus Erythematosus (SLE); a chronic autoimmune disease; inflammations develop in the effected organs. It may be a comorbidity of IC/BPS.

Malignant – In the term of medicine it refers to tumorous transformations that may lead to a life-threatening condition without a proper treatment.

Malignoma – A general term for malignant transformations of epithelial origin.

Marker – In the field of diagnostics it refers to substances, molecules, cells etc. whose presence is/are a typical sign of a certain disease or condition. IC/BPS has no known marker.

Mast Cell – A common type of cells in the immune system. Its size is relatively big. Mast cells have a key role in inflammatory and allergic processes, they produce several kind of transmitter molecules, including histamine (see there). Large amount of mast cells can be present in the connective tissues, e.g. around the blood vessels. In the condition of IC/BPS an increased amount of mast cells can be observed.

Nocturia – The condition in which the patient has to wake up during the night to void. If nocturia occurs frequently, and two or more times a night, that may be a sign of IC/BPS. In sever cases the patient has to void in every 20–30 minutes.

Non-Steroids (Non-Steroidal Anti-Inflammatory Drugs, NSAID) – Anti-inflammatory agents with a similar effect but a different mechanism of action to Corticosteroids (see there). NSAIDs are widely used in the oral therapy of IC/BPS.

O’Leary–Sant Questionnaire – A questionnaire used for diagnosing IC/BPS. It surveys the voiding habits, the level and the frequency of bladder pain. It consists of two parts: IC Symptom Index (ICSI) and IC Problem Index (ICPI). Sometimes they evaluate these parts separately.

Onabotulinumtoxin A a.k.a. Botox – In the treatment it is injected into the muscles nearby or the mucosa to mitigate the symptoms. It is an experimental method, whose efficiency hasn’t been confirmed.

Oral Therapy – Administrating medicine orally for treating a disease or condition.

Overactive Bladder Syndrome (OAB) – A condition of urinary urgency, in most cases with increased urinary frequency and nocturia; incontinence may occur, too. OAB is not clearly defined in the scientific literature. Some of the symptoms are the same as those of IC/BPS. However, incontinence is a relatively common symptom of OAB but pain rarely occurs, whereas in case of IC/BPS the situation is the opposite.

Parsons-Test – One of the methods of diagnosing IC/BPS. They fill up the bladder with potassium salts; the increasing pain refers to the damaged or deficient status of the bladder mucosa. Currently, it is not a recommended method of diagnosis, because it is painful and not very reliable.

Pentosan Polysulfate Sodium (PPS, Elmiron, SP 54, Comfora, Jelmiron) – One of the agents used in the therapy of IC/BPS. Several products available in different countries (see the brackets) contain this compound; Elmiron is the only medicine in the USA with an FDA-approval for the oral treatment of IC/BPS. Patients usually start to respond to PPS after about 6 months of therapy, and side-effects may occur, too. There have been attempts to use PPS for bladder instillation, as well.

Placebo – A substance (e.g. pill, liquid etc.) which cannot be distinguished from a certain medicine (e.g. it looks like the same), but contains no active agents. In clinical trials one group of the patients usually get the “real” medicine (whose effect is examined), whereas the other group receives placebo. The patients don’t know whether they got the medicine or the placebo. It can be evaluated how the condition of those who got the medicine has changed, compared to those who got the placebo, so that it can be learnt how effective the medicine actually is.

Potassium – A chemical element, in the medical terminology they often refer to its salts with the word. The potassium present in the urine is highly irritative – and causes pain – in case of a damaged GAG-layer.

Potassium Test – See Parsons-test.

Prolapsus Uteri – See Uterine Prolapse

Prostatitis – The inflammation of the prostate gland.

Qualitative Examination – An examination whose goal is to detect the presence of something (e.g. a pathogen or a molecule), but it doesn’t detect its quantity.

Quantitative Examination – An examination whose goal is to detect both the presence and the quantity of something (e.g. a pathogen or a molecule).

Radiation Cystitis (RC) – The inflammation of the bladder caused by the radiation therapy of the bladder. It is a post-cancer condition.

rUTI, Recurring Urinary Tract Information – See Urinary Tract Infection

Sacral Neuromodulation (SNM), a.k.a. Sacral Nerve Stimulation – A treatment in which the sacral nerve (situated between the spinal cord and the bladder) is being stimulated to mitigate the pain and the voiding urgency. The results of the clinical trials regarding sacral neuromodulation are controversial.

Sjögren Syndrome – An autoimmune disease in which the lachrymal and the salivary glands are affected. It may be a comorbidity of IC/BPS.

Sodium Bicarbonate – See Bicarbonates

SP 54 – See Pentosan Polysulfate Sodium

Sterile Inflammation – Any inflammation which develops not because of a pathogen (e.g. a bacterium).

Substance P – One of the neurotransmitters (molecules of a messenger function in the nerveous system). Substance P plays a key role in inflammatory processes, and in increasing the pain in case of IC/BPS patients.

Transcutaneous Electrical Nerve Stimulation (TENS) – A process for pain relief; the pain nerves are being stimulated with electricity to mitigate the pain. It doesn’t affect the condition itself which causes the pain, though.

Two-Day Voiding Diary – See GAG-Layer Integrity Test.

Urethritis – A general term for any form of the inflammation of the urethra. In case of IC/BPS, the urethra is often affected, too.

Urinary Tract Infection (UTI) – An infection caused by any pathogen (bacteria, in most cases) and in which the urethra, the bladder, and – in worst case – the kidneys are affected. The symptoms may be similar to those of IC/BPS, but it can be symptomless, as well. Occasionally, the GAG-layer might become damaged, too, but it is being regenerated after fighting of the infection, normally. The medical practice focuses primarily on prophylaxis; the treatment itself, in most cases, consists of administering agents effective against the pathogen (e.g. antibiotics). Recurrent Urinary Tract Infection (rUTI), is a condition of two or more proven infections in 6 months, or 3 or more infections in 12 months. UTIs are amongst the most common diseases.

Urine Cytology – The examination of the cells present in the urine. Its primary goal is to detect whether the cause of the symptoms is a sort of malignant transformation.

Urine Portion – The amount (volume) of urine produced during a single voiding occasion. Generally said, urine portions are smaller in case of IC/BPS patients than those of healthy people.

Urine Retention – After voiding there is still some urine remaining in the bladder. It may occur in case of IC/BPS patients.

Urodynamics a.k.a. Urodynamic Testing – A complicated process to monitor the pressure in the bladder to evaluate the bladder capacity, the urine flow, the resistance of the urethra and other parameters. It is not applied in the diagnoses of IC/BPS, because it doesn’t provide enough information. On the other hand, it is used for discovering the cause of incontinence.

Urothelium – A special form of epithelium which can be found at the inner surface of the bladder.

Uterine Prolapse (Prolapsus Uteri) – The uterus descends towards or even through the opening of the vagina.

Vaginitis – The inflammation of the vagina.

VAS Scale – Visual Analogue pain Scale; a widely known method for estimating the amount of pain. The patient himself/herself determines the pain they experience and assign a number between 1–10 to the sensation. The drawback of this method is that different people usually have different opinion on the severeness of pain.

Vesicoureteral Reflux – A pathological condition in which the urine flows back from the bladder to the ureters, and to the kidneys, severely damaging the latter organs.

Vulvodynia – Vaginal pain. IC/BPS patients can experience it more often than those who don’t suffer from this condition.