Think interstitial cystitis in cases of chronic pelvic pain

OB/GYN News, March 1, 2005 by Robert Finn

SAN FRANCISCO -- In an overwhelming majority of women presenting with chronic pelvic pain, the bladder is the pain-generating organ, Edward J. Stanford, M.D., said at the annual meeting of the American Association of Gynecologic Laparoscopists.

In three studies of almost 300 women with chronic pelvic pain, the prevalence of interstitial cystitis ranged from 70% to 82%, said Dr. Stanford of St. Mary's Good Samaritan Medical Center, Centralia, Ill.

In the most recent and thorough of these studies, Dr. Stanford followed 64 women with chronic pelvic pain for a year. Each patient completed the Pelvic Pain and Urgency/Frequency questionnaire and underwent a vulvar touch test, a potassium sensitivity test, cystoscopy with hydrodissection, and laparoscopy. During the laparoscopic period, suspicious lesions were biopsied and adhesions removed.

Although 64% did have adhesions, the pain could not be attributed to this cause, Dr. Stanford said. In 70% the bladder was the pain-generating organ, 28% had biopsy-proven endometriosis, and 20% had vulvar pain. Therefore, in the differential diagnosis of chronic pelvic pain, interstitial cystitis must be ranked first, with irritable bowel syndrome, endometriosis, and vulvodynia ranked second, third, and fourth, respectively.