Does irritable bowel syndrome increase the risk of interstitial cystitis/bladder pain syndrome? A cohort study of long term follow-up.

INTRODUCTION AND HYPOTHESIS: Interstitial cystitis/bladder pain syndrome (IC/BPS) and irritable bowel syndrome (IBS) often occur concomitantly without an obvious reason. It is important to determine the relationship between these related diseases. We aimed to determine whether IBS increase the risk of IC/BPS. METHODS: We identified newly diagnosed IBS patients between 2002 and 2013 from a nationwide database as the IBS cohort. Subjects diagnosed with IC/BPS before IBS were excluded. Cox's regression analysis with a hazard ratio (HR) of IC/BPS between IBS and the non-IBS cohort was applied to unmatched and matched (16 confounders of propensity scores) models. The time from diagnosis of IBS to IC/BPS was also calculated. RESULTS: In the unmatched group, which included 100,124 IBS (55% female) and 874,048 non-IBS patients, the IC/BPS adjusted HR was 1.292 (95% confidence interval [CI], 1.131-1.476;p < 0.0001) in the IBS cohort compared with the non-IBS cohort. In the matched group, there were 85,359 patients in each cohort, and the IC/BPS HR was 1.599 (95% CI, 1.344-1.903; p < 0.0001). The average numbers of years until the development of IC/BPS in the IBS cohort and non-IBS cohort were 4.60 ± 2.58 (n = 253) and 5.99 ± 3.49 (n = 295) years, respectively. CONCLUSIONS: IBS was shown to increase the risk of IC/BPS in this 12-year cohort study. The time from the diagnosis of IBS to IC/BPS was 5.35 ± 3.18 years. A common pathophysiology of IBS and IC/BPS is possible. Clinicians should be mindful of the association and promote collaborative care of these two elusive diseases.

Comparison of outpatient reimbursement for interstitial cystitis/bladder pain syndrome and rheumatoid arthritis treatment in Taiwan: A nationwide population-based study.

OBJECTIVE: This study compared Taiwanese public health insurance outpatient reimbursements for interstitial cystitis (IC)/bladder pain syndrome (BPS) and rheumatoid arthritis (RA) treatment. METHODS: This observational study used data from the Taiwan Longitudinal Health Insurance Database between 2002 and 2013. Patients with International Classification of Diseases, Ninth Revision, Clinical Modification codes for IC/BPS and RA were selected and matched in a ratio of 1 : 5 based on index year. After adjustment for possible confounders, including age, sex, income, hospital levels of care, and reimbursements for 24 comorbidities, yearly and per-visit pharmacy, non-pharmacy, and total claims were determined. RESULTS: In all, 1438 IC/BPS and 7190 RA patients were identified in the database. IC/BPS patients were significantly younger, and the proportion of females in this group was higher. Income levels were lower in the IC/BPS cohort, but not significantly. There were no significant differences between cohorts in terms of reimbursements for treatment for comorbidities, with the exception of end-stage renal disease, for which reimbursement was higher in the RA cohort. After adjusting for confounders, the regression coefficient for IC/BPS to RA was significantly lower for yearly total pharmacy claims, yearly total claims, per-visit pharmacy claims, and total claims per visit. CONCLUSIONS: Outpatient reimbursement was significantly lower for IC/BPS than for RA treatment, primarily with regard to pharmacy costs. This indicates less medical utilization for IC/BPS, possibly due to poor treatment outcomes and copayment polices. Further advances in the treatment of IC/BPS and health budget reallocation are encouraged.

Health Education and Symptom Flare Management Using a Video-based m-Health System for Caring Women With IC/BPS.

OBJECTIVE: To assess effectiveness of the video-based m-health system providing videos dictated by physicians for health education and symptom self-management for patients with Interstitial cystitis/bladder pain syndrome (IC/BPS). METHODS: An m-health system was designed to provide videos for weekly health education and symptom flare self-management. O'Leary-Sant index and visual analogue scale as well as SF-36 health survey were administrated to evaluate the disease severity and quality of life (QoL), respectively. A total of 60 IC/BPS patients were recruited and randomly assigned to either control group (30 patients) or study group (30 patients) in sequence depending on their orders to visit our urological clinic. Patients in both control and study groups received regular treatments, while those in the study group received additional video-based intervention. Statistical analyses were conducted to compare the outcomes between baseline and postintervention for both groups. The outcomes of video-based intervention were also compared with the text-based intervention conducted in our previous study. RESULTS: After video-based intervention, patients in the study group exhibited significant effect manifested in all disease severity and QoL assessments except the pain visual analogue scale, while no significance was found in the control group. Moreover, the study group exhibited more significant net improvements than the control group in 7 SF-36 constructs, except the mental health. The limitations include short intervention duration (8 weeks) and different study periods between text-based and video-based interventions. CONCLUSION: Video-based intervention is effective in improving the QoL of IC/BPS patients and outperforms the text-based intervention even in a short period of intervention.

Will cesarean section increase the risk of interstitial cystitis/painful bladder syndrome?

AIMS: A high number of patients with interstitial cystitis/painful bladder syndrome (IC/PBS) have a history of pelvic surgeries, and cesarean section is one of the most common pelvic surgeries in women. This study aimed to investigate if cesarean section increases the risk of IC/PBS. METHODS: Women who exclusively gave birth through cesarean section or vaginal delivery were identified from a nationwide database between 2002 and 2013. All were followed up during the study period to detect the event of IC/PBS. The IC/PBS hazard ratio (HR) in the cesarean cohort was compared with the vaginal delivery cohort with and without matching for confounding factors. RESULTS: The unmatched group included 22 158 cesarean deliveries and 40 214 vaginal deliveries. The IC/PBS HR in the cesarean cohort compared with that in the vaginal delivery cohort was 1.370 (95% confidence interval [CI], 0.903-2.079; P = 0.139). In the matched group, 8368 women were matched in each cesarean and vaginal delivery cohort using propensity scores for age and comorbidities. The IC/PBS HR was 0.725 (95%CI, 0.358-1.471; P = 0.373). Both HRs in these two groups were not significantly different. The incidence density of IC/PBS in delivered women, non-delivery women, and the general female population were not significantly different either (0.310, 0.255, and 0.292 per 1000 person-years, respectively; P = 0.549). CONCLUSIONS: The risk of IC/PBS was not different between cesarean and vaginal delivery after controlling the confounding factors in this cohort study. Cesarean section has no causal effect on IC/BPS. Furthermore, delivery was not a risk factor for IC/PBS.

Alexithymia and anesthetic bladder capacity in interstitial cystitis/bladder pain syndrome.

OBJECTIVE: In contrast to the inconsistent results of organic causes, it has been found that psychological risk factors are reliably related to functional somatic syndromes (FSSs), including interstitial cystitis/bladder pain syndrome (IC/BPS). Compared to patients with acute cystitis, a subgroup of IC/BPS patients with a history of childhood relational trauma reported intensified unregulated affective states (i.e., anxiety and depression) and trauma-related psychopathology (i.e., dissociation). Nevertheless, it remains unknown whether psychosocial risk factors can be separated from bladder-centric factors. This study aimed to verify whether psychosocial factors such as alexithymia, which is a key psychological factor of FSSs, are less likely to be linked to a low bladder capacity in patients with IC/BPS. METHODS: Ninety-four female IC/BPS patients were recruited from the outpatient departments of urology, obstetrics, and gynecology. Anxiety, depression, dissociation, childhood relational trauma, and alexithymia were assessed using standardized scales, and anesthetic bladder capacity was examined by cystoscopic hydrodistention. RESULTS: Positive correlations were found between anesthetic bladder capacity and the psychosocial variables, including alexithymia. An increased bladder capacity was associated with anxiety, dissociation, and childhood relational trauma, and a combination of high cognitive and low affective alexithymia mediated the correlations between bladder capacity and the psychosocial variables. CONCLUSIONS: Psychosocial variables that are associated with an aversive childhood relational environment and affect dysregulation may constitute a pathogenic trajectory that differs from bladder-centric defects such as a lower bladder capacity. The findings of this study support the notion that IC/BPS in some patients may be due to an FSS.

Childhood trauma perpetrated by close others, psychiatric dysfunction, and urological symptoms in patients with interstitial cystitis/bladder pain syndrome.

BACKGROUND: A psychosocial phenotype of interstitial cystitis/bladder pain syndrome (IC/BPS), a urogenital condition without known organic causes, was proposed. While psychosocial variables, including interpersonal maltreatment and negative affect, were studied in association with IC/BPS, the specificities of the relationships between childhood trauma by close others, psychiatric dysfunctions (negative affect and post-traumatic psychopathology), and urogenital symptoms have not been established. METHODS: 94 IC/BPS patients were recruited together with 47 patients with acute cystitis who served as clinical controls. Standardized scales were used to assess various potentially traumatizing events in childhood and adulthood as well as psychiatric (dissociation and negative affect) and urogenital symptoms. RESULTS: Among the potentially traumatizing events, those perpetrated by close others during childhood were found to be the most salient features discriminating the IC/BPS group from the control group. When divided into 2 subgroups according to their history of childhood trauma by close others, only IC/BPS patients with childhood trauma by close others had more dissociative and anxiety symptoms compared with the control group. These two subgroups did not differ in urogenital symptom severity. CONCLUSIONS: Childhood trauma by close others, rather than other types of interpersonal trauma, was a differentiating characteristic in IC/BPS patients, and a childhood trauma related psychosocial phenotype with a distinct clinical profile of dissociation and anxiety proneness was identified. Future studies should investigate whether a distinct set of pathogenic factors exists in IC/BPS patients with a history of childhood trauma by close others, even if this subgroup is not readily differentiated by urogenital symptoms.

A cohort study of interstitial cystitis/bladder pain syndrome and hysterectomy.

INTRODUCTION AND HYPOTHESIS: Symptoms of interstitial cystitis/bladder pain syndrome (IC/BPS) are often confused with uterine conditions. Gynecologists may therefore recommend hysterectomy which was inappropriate for these patients. This study investigated whether IC/BPS increases the risk of hysterectomy in a large nationwide retrospective cohort study. METHODS: From the Longitudinal Health Insurance Database 2010 (LHID2010) in Taiwan, we identified women diagnosed with IC/BPS between 2002 and 2013. Those with a history of hysterectomy before IC/BPS diagnosis were excluded. All women were stratified into three subgroups (younger, middle, older age) based on the propensity scores of 15 confounding factors, including age and comorbidities. All were followed until the end of 2013 to detect the event of hysterectomy. The hazard ratio (HR) of hysterectomy in the IC/BPS cohort was compared with the non-IC/BPS cohort among the three subgroups by Cox regression after adjusting for confounding factors. RESULTS: In addition to the representative middle age, subgroup 2 had similar rates of comorbidities as the general population. The study was both externally and internally valid. The risk of hysterectomy in the IC/BPS cohort (n = 536) was significantly higher than in the non-IC/BPS cohort (n = 103846) in subgroup 2 (HR = 1.701, 95 % CI 1.056-2.740). The mean time to hysterectomy after diagnosis of IC/BPS was 2.97 years. CONCLUSIONS: In this nationwide study, we found that IC/BPS has a causal impact on hysterectomy in the middle-age subgroup in LHID 2010. The possibility of a woman having IC/BPS should be evaluated prior to hysterectomy to avoid inappropriate surgery.

Development and evaluation of an E-health system to care for patients with bladder pain syndrome/interstitial cystitis.

OBJECTIVES: Bladder pain syndrome/interstitial cystitis (BPS/IC) is a chronic disease that highly degrades the quality of life for patients. In the present study, Internet intervention was used to care for bladder pain syndrome/interstitial cystitis patients to alleviate their pain and bothering symptoms. METHODS: Healthcare education was carried out through the Internet by asking the patients, who were randomly divided into study (40 patients) and control (40 patients) groups, to check possible sensitive foods, habits, and behaviors weekly to remind and consolidate important rules for promoting quality of life. The symptom flares consultation through short message service with the Internet used to elevate healthcare efficiency was undertaken. Questionnaires, including Short Form 36 health survey, O'Leary-Sant symptom and problem indices, as well as visual analog scales pain and urgency scales, were used to evaluate quality of life and disease severity improvements before and after information and communication technology intervention. The outcome was evaluated at week 8. RESULTS: The quality of life of both the control and study groups was significantly improved. The quality of life and visual analog scales for the patients in the study group with information and communication technology intervention showed a much greater improvement compared with the patients in the control group (P < 0.05). CONCLUSIONS: The E-health system was shown to be effective in improving quality of life of bladder pain syndrome/interstitial cystitis patients through intervention of Internet healthcare education and short message service for the consolidation of healthy behavior and lifestyle in the 8-week follow up.