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267: INTERSTITIAL CYSTITIS

Eric Shamus, PhD, DPT, PT, CSCS; Debra F. Stern, DPT, DBA, MSM, PT; Cynthia E. Neville, DPT, PT, WCS

CONDITION/DISORDER SYNONYM

  • Painful bladder syndrome (PBS)

ICD-9-CM CODES

  • 595.1 Chronic interstitial cystitis

  • Associated physical therapy (PT) diagnoses

    • 315.4 Coordination disorder (clumsiness, dyspraxia and/or specific motor development disorder)

    • 718.45 Contracture of joint, pelvic region, and thigh

    • 719.70 Difficulty in walking

    • 728.2 Muscular wasting and disuse atrophy

    • 728.89 Disorders of muscle, ligament, and fascia

    • 729.9 Other disorders of soft tissue

    • 780.7 Malaise and fatigue

    • 782.3 Edema

    • 786.0 Dyspnea and respiratory abnormalities

ICD-10-CM CODES

  • N30.10 Interstitial cystitis (chronic) without hematuria

  • N30.11 Interstitial cystitis (chronic) with hematuria

PREFERRED PRACTICE PATTERN

  • As of June 2014, the APTA Guide to Physical Therapist Practice does not include practice patterns for organ system pathology. Therefore, the associated or secondary musculoskeletal, cardiovascular/pulmonary, or potential neuromuscular patterns would be indicated.

  • 4C: Impaired Muscle Performance1

PATIENT PRESENTATION

A 45-year-old woman reports that 3 years ago she had a urinary tract infection (UTI) that was treated with antibiotics. She had recurrent symptoms of UTIs every 2 to 3 months for the next 2 years until during the last episode, she was told by the physician that the urinalysis was negative. The burning with urination was painful. In the past year she has developed more symptoms. She has noticed that she has to urinate more frequently, at least 10 times per day. She wakes up at least three times at night to urinate. Pain is temporarily relived by urination.

FIGURE 267-1

Causes and predisposing factors of bladder infections. Most cases are due to ascending infections caused by enteric bacteria such as E coli and Proteus species. (From Chandrasoma P, Taylor CR. Concise Pathology. 3rd ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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KEY FEATURES

Description

  • Chronic inflammation of the bladder wall

  • Frequent, painful urination

  • Severe pain with or without attempts at urination, or no pain at all, especially in elderly and children

Essentials of Diagnosis

  • Unknown etiology

  • Frequent, painful urination

  • Difficulty urinating

  • Pelvic pressure

  • Lower abdomen discomfort

  • Pelvic pain in women

General Considerations

  • Often misdiagnosed as UTI

  • Some urogynecologic (UG) pathologies may be appropriate for PT, though PT does not usually treat UG disorders specifically

  • Diagnosis for occult problems may take time, require intensive diagnostic testing

  • May refer pain to back, pelvic region

  • UG disorders frequently refer pain to other body areas; individuals may be inappropriately referred to PT

  • May mimic colon cancer or tumor, irritable bowel, colitis

  • May mimic gynecologic problems in females: Endometriosis, uterine fibroids, ectopic pregnancy

  • Can have periods of remission

Demographics

  • Women more susceptible than men: Female–male ratio ...

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