Interstitial Cystitis (IC) is a disease characterized by chronic bladder pain and voiding dysfunction. While some may associate the name with neurological disorders, 'interstitial' here refers to the structure between the bladder mucosa and the submucosal layer.
According to Health Insurance Review and Assessment service standards, it mainly appears in women in their 40s to 60s, and about 90% of all patients are known to be female. In the case of male patients, it is not uncommon for it to be misdiagnosed because symptoms overlap with prostatitis.
The most prominent symptom is a pattern in which pain intensifies when the bladder is full and decreases after urination. The pain-relief cycle repeated several times a day significantly lowers the patient's quality of life. According to research, while the average voiding volume of a normal adult is 250mL or more per time, it is reported that interstitial cystitis patients average around 75mL.
The diagnostic process is not a single test but is carried out in a way that excludes various diseases (diagnosis of exclusion). First, the location of pain, voiding patterns, and voiding volume are identified through anamnesis, and then the presence of bacteriuria, pyuria, and hematuria is checked with urine tests and bacterial culture tests.
If there are no abnormalities here, the possibility of infectious diseases decreases, and additional causes such as urethritis and prostatitis that require differentiation are checked through urine PCR tests.
A crucial subsequent step is a cystoscopy. In the endoscopy of interstitial cystitis patients, glomerulations caused by microvascular rupture under the mucosa are occasionally seen, and Hunner's ulcers, which are reddish-brown spots on the mucosa, are observed. Hunner's ulcers are recognized as a representative finding for confirming interstitial cystitis in international guidelines (EAU Guidelines, 2023). If necessary, a biopsy is performed concurrently to finally exclude similar diseases.
However, since these lesions are not visible in all patients, the surgeon's experience plays a very important role in diagnostic accuracy. This is because pain patterns, voiding records, endoscopic findings, and exclusion test results must be comprehensively interpreted.
Director Choi Ho-cheul of Goldman Urology Clinic Dongtan Branch explained, "Because interstitial cystitis shows a characteristic where symptoms rise and fall like waves, it is difficult to judge by a single fragmentary test. The core of the diagnosis is to closely observe the timing of pain onset, whether it is relieved after urination, and changes in voiding volume."
He added, "In particular, chronic bladder discomfort that does not improve even after long-term antibiotic treatment is highly likely not to be simple cystitis. If persistent frequent urination, pelvic pain, and pain during urination recur for several months or more, close consultation with a urology specialist is necessary rather than quickly concluding it as simple cystitis or overactive bladder."