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Objective: To test the hypothesis that more bladder pain syndrome/interstitial cystitis (BPS/IC) cases than controls report pre-onset urinary symptoms., Methods: In a risk factor study, the date of BPS/IC onset (index date) was systematically determined in 312 female incident cases; the mean age at onset was 42.3 years. Frequency-matched controls were compared on pre-index date medical history., Results: Three pre-index date symptoms were more common in BPS/IC cases: pelvic pain with urinary features, frequency, and bladder pain; 178 cases (57%) vs 56 controls (18%) had at least 1 symptom (P <.001). Several perspectives suggested that prodromal symptoms were different from BPS/IC symptoms. In prodromal women, the median age of the earliest urinary symptom "more than other people" was 20 years. Women with the prodrome were significantly more likely than those without to have pre-index date nonbladder syndromes (NBSs). The prodrome predicted not only BPS/IC but also a worse prognosis for it., Conclusion: Before the onset of BPS/IC, pelvic pain with urinary features, frequency, and/or bladder pain were reported by more than half the cases. Prodromal women recalled abnormal urinary symptoms decades before the onset of BPS/IC. The prodrome was associated with prior NBSs and predicted not only BPS/IC but also its poor prognosis. These data generated 2 hypotheses: that (1) prodromal symptoms are different from BPS/IC symptoms and (2) pain amplification links NBSs, the prodrome, the appearance of BPS/IC, and its poor prognosis. Recognition of the prodrome might provide opportunities for prevention of fully developed BPS/IC., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objectives: To determine whether interstitial cystitis/painful bladder syndrome (IC/PBS) in women is associated with antecedent sexual and reproductive characteristics., Methods: By multivariate analyses, 312 incident IC/PBS cases were compared with matched controls for antecedent sexual and reproductive characteristics, adjusted by demographics, previous surgery, and nonbladder syndromes (NBSs), such as chronic pelvic pain, irritable bowel syndrome, and panic disorder., Results: IC/PBS was significantly associated with previous female hormone use, a history of fewer pregnancies (in premenopausal women), and antecedent NBSs, especially when expressed by the number of such syndromes., Conclusions: Three antecedents to IC/PBS were prominent. Female hormone use was consistent with a pharmacologic effect or as a marker of its indications. A history of fewer pregnancies among premenopausal, but not postmenopausal, women with IC/PBS was consistent with pregnancy postponing the occurrence of IC/PBS, a marker for decisions to avoid pregnancy, or a result of recruitment bias. NBSs, especially the total number experienced by the participant, had the strongest correlation with IC/PBS. This finding suggests that knowledge of the pathogeneses of these NBSs, many of which are functional somatic syndromes, might reveal that of IC/PBS., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objectives: To examine the interaction of types and numbers of antecedent nonbladder syndromes (NBSs) to seek clues to the pathogenesis of interstitial cystitis/painful bladder syndrome (IC/PBS). Numerous case series have shown IC/PBS to be associated with several syndromes that do not include bladder symptoms. In a previously reported case-control study, we confirmed these findings and found that such nonbladder syndromes often preceded the onset of IC/PBS., Methods: Incident female IC/PBS cases (n = 312) and matched controls were compared for 11 antecedent NBSs. The odds ratios (ORs) for IC/PBS according to the number of antecedent NBSs per person were calculated. From this model, each NBS was serially removed, and the calculations for the ORs were repeated using the remaining 10 NBSs. We assessed the types of NBSs included in each subgroup formed by the number of NBSs., Results: The ORs for IC/PBS increased with the increasing number of antecedent NBSs. The types of NBSs were interchangeable in calculating these ORs. The distribution of the types of NBSs was skewed, with allergy overrepresented in those with few NBSs, and the classic functional somatic syndromes of fibromyalgia, chronic fatigue syndrome, and irritable bowel syndrome overrepresented in those with many NBSs., Conclusions: Two main hypotheses were generated. One was that the incidence of a NBS initiated a process that contributed to the emergence of other NBSs and IC/PBS. The second was that each NBS and IC/PBS was a manifestation of a common, shared pathogenesis. It is likely that a well-designed prospective study will be necessary to distinguish between these 2 hypotheses., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objectives: Probing for clues to the pathogenesis of interstitial cystitis/painful bladder syndrome (IC/PBS), we sought antecedent nonbladder syndromes that distinguished incident IC/PBS cases from matched controls., Methods: Female incident IC/PBS cases were recruited nationally, and their IC/PBS onset date (index date) was established. The controls were recruited by national random digit dialing and matched to the cases by sex, age, region, and interval between the (assigned) index date and interview. The prevalence of 24 nonbladder syndromes before the index date was assessed, 7 by multiple methods., Results: The cases with IC/PBS had greater antecedent prevalence of 11 syndromes, and 243 of 313 cases (78%) vs 145 of 313 controls (45%) had multiple syndromes (P < .001). Fibromyalgia-chronic widespread pain (FM-CWP), chronic fatigue syndrome, sicca syndrome, and irritable bowel syndrome were associated with each other by pairwise and factor analyses using numerous assumptions. Cases with FM-CWP, chronic fatigue syndrome, sicca syndrome, and/or irritable bowel syndrome (n = 141, 45%) were more likely to have other syndromes (ie, migraine, chronic pelvic pain, depression, and allergy). Three other syndrome clusters were identified; each was associated with this FM-CWP cluster., Conclusions: Eleven antecedent syndromes were more often diagnosed in those with IC/PBS, and most syndromes appeared in clusters. The most prominent cluster comprised FM-CWP, chronic fatigue syndrome, sicca syndrome, and irritable bowel syndrome; most of the other syndromes and identified clusters were associated with it. Among the hypotheses generated was that some patients with IC/PBS have a systemic syndrome and not one confined to the bladder.

Objectives: No diagnostic physical signs, urologic findings, or laboratory tests are available for interstitial cystitis/painful bladder syndrome (IC/PBS). Its diagnosis is determined by symptoms and the exclusion of mimicking diseases. We hypothesized that certain pain characteristics are sensitive criteria for diagnosing IC/PBS., Methods: In women with recent-onset IC/PBS recruited in 2004 to 2006 for the case-control study, "Events Preceding Interstitial Cystitis," we identified the locations of each patient's pain and in a nonleading way asked about the effects of 17 different experiences (criteria) on the pain. We identified a set of criteria that described the largest number of patients in the Events Preceding Interstitial Cystitis study. In a secondary analysis of another cohort recruited by others in 1993 to 1997, the Interstitial Cystitis Database, we determined the proportion of patients captured by these same criteria., Results: In the Events Preceding Interstitial Cystitis study, pain that worsened with a certain food or drink and/or worsened with bladder filling and/or improved with urination was reported by 151 (97%) of 156 patients. These were the only three criteria that applied directly to the bladder. The same three criteria described the pain of 262 (97%) of 270 women in the Interstitial Cystitis Database who "definitely" had IC/PBS., Conclusions: An hypothesis generated in one IC/PBS patient group and tested in another--pain that worsened with certain food or drink and/or worsened with bladder filling and/or improved with urination--was described by 97% of the patients with IC/PBS in each cohort. This triad might describe the pain of IC/PBS and contribute to a sensitive case definition. Estimating specificity awaits comparison with other diseases with similar symptoms.