Interstitial Cystitis and FM:
Separate but Overlapping

Depositphotos_33851191_mMany people with fibromyalgia may also be diagnosed with interstitial cystitis, or vice versa. As in many chronic pain cases, it’s quite common for two or more pain syndromes to overlap.

Interstitial cystitis (IC) is a chronic pelvic pain disorder that affects an estimated 847,000 adults, 94% of whom are women. Symptoms vary from case to case and even in the same individual. They range from mild discomfort, pressure, and tenderness to intense pain in the bladder and pelvic area.

Oftentimes, patients with IC are misdiagnosed with irritable bladder, prostatitis, cystitis, urethral syndrome, or are even sent away without a diagnosis.

A diagnosis of IC is based on the presence of urinary urgency, urinary frequency—people with severe cases may urinate as many as 60 times a day—bladder or pelvic pain, ulcers, and inflammation of the bladder wall. The inflammation can lead to a scarring or stiffening of the bladder, a reduced capacity to hold the bladder, and glomerulations (pinpoint bleeding in the bladder lining caused by recurrent irritation).

Overlapping but Not Equal

One 21-year-old patient, Amanda, saw two separate physicians who both diagnosed her with an “irritable bladder,” and both told her that her fibromyalgia (FM) was the cause of her reoccurring pelvic pain. But a third urologist, who had considerable experience working with pelvic pain conditions, ordered a cystoscopy with hydrodistention, which helped confirm her IC diagnosis.

Dr. Daniel Clauw, Director of the Center for Chronic Pain and Fatigue Research at the University of Michigan Medical Center in Ann Arbor, says,

“IC is more common in FM patients than would otherwise be expected, and many patients with IC have FM.

“It is possible that both conditions could flare each other,” Dr. Clauw notes. “Either can occur, but in reality, if they have the same underlying mechanisms, then it is difficult to say that one exacerbates the other,” says Dr. Clauw, who has conducted research on the overlapping nature of IC and FM. “Instead, the bladder and musculoskeletal symptoms might occur concurrently because the underlying condition is worse.”

Many urologists these days use the cystoscopy with hydrodistention—the “gold standard”—to confirm a diagnosis of IC. This procedure allows the physician to look for causes of bleeding in the urine and other bladder problems. Dr. John W. Weigel, Professor of Surgery in the Department of Urology at the University of Kansas Medical Center in Kansas City, says that although cystoscopy with hydrodistention “is not fool proof, [it] is the best definitive way to diagnose interstitial cystitis. It’s a valuable treatment modality in patients who are getting worse on medical therapy,” says Dr. Weigel, who frequently depends on the procedure to find glomerulations and evaluate the loss of bladder capacity.

When a patient’s diagnosis is confirmed, they can then take action, beginning with a medication and diet regimen to reduce pain and improve their sleep quality.

Dr. Andre Barkhuizen, Associate Professor of Medicine, Arthritis and Rheumatic Diseases at Oregon Health and Science University in Portland, Oregon, sees a number of patients with FM who also have IC. He speculates that similar mechanisms could cause the two conditions.

“FM and IC symptoms are most likely driven from within the nervous system and not from the muscles or bladder,” Dr. Barkhuizen says.

More studies are needed to establish these links, says Karen Berkley, Ph.D., professor and researcher in Florida State University’s Program in Neuroscience in Tallahassee. Dr. Berkley has conducted studies with laboratory rats to learn how inflammation or injury in one organ may affect the activity of an organ nearby. She describes how a single neuron 3d rendered illustration of the female nervous systemin the spinal cord may react to the stimulation of the bladder, uterus and colon—a convergence that helps coordinate activities among the body’s systems. “Organs can function as single entities, or all the information can come in from different systems and converge. We’re a whole body (that) keeps operating in tandem,” Dr. Berkley says. “A lot of information is brought in by the nervous system to keep us from falling apart.”

Researchers are still uncertain of what causes fibromyalgia and interstitial cystitis, and whether IC is a manifestation of FM, or if the two aggravate one another. Rigorous studies by several institutions are ongoing to determine the origins of these pain syndromes. Whether or not they can be traced back to the nervous system, the ultimate goal is the development of a treatment to eliminate the suffering of those living with one or both of these separate but overlapping conditions.

2017-11-28T10:53:19-08:00Tuesday, April 28, 2015|Chronic Pain Conditions, Learning Exchange|