OAB and IC/BPS: Two Conditions or a Continuum of One?
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Purpose of Review
Overactive bladder (OAB) and interstitial cystitis/bladder pain syndrome (IC/BPS) are defined as syndromes consisting of “urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence” and “an unpleasant sensation perceived to be related to the urinary bladder, associated with lower urinary tract symptoms,” respectively. Distinguishing between the two diagnoses can be challenging and although OAB and IC/BPS are traditionally considered separate conditions, more evidence is emerging to suggest a continuum between the symptoms. This review considers the two conditions existing on a continuum by reviewing relevant definitions, phenotypes, and treatment considerations.
Recent studies have suggested that up to 25% of patients with IC/BPS reported urge incontinence and 35% of patients with OAB described bladder pain. Analysis assessing validated questionnaires revealed that scores could distinguish controls from patients with storage LUTS but were not able to distinguish between those with OAB and IC/BPS. A novel scoring system spanning domain of urgency incontinence and bladder pain was validated and provided 91% diagnostic accuracy.
OAB and IC/BPS symptoms overlap significantly and it remains unclear if patients with IC/BPS and OAB are unique populations or specific phenotypes of the same condition. We propose that “OAB-dry” patients without fear of leakage may represent a variant of IC/BPS. Unbiased phenotyping based on more accurate symptomatic descriptions may help reveal the correlations of variants of lower urinary tract symptoms with both prognosis and treatment responses.
KeywordsOveractive bladder Interstitial cystitis/bladder pain syndrome Urinary urgency Lower urinary tract symptoms
Compliance with Ethical Standards
Conflict of Interest
Dr. Jennifer T. Anger is an expert witness for Boston Scientific. Dr. Kai B. Dallas, Dr. Lenore A. Ackerman, and Dr. Carrie S. Stewart declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
All procedures performed in studies involving human participants performed by the authors were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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- 2.• Lightner DJ, Gomelsky A, Souter L, Vasavada SP. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU Guideline Amendment 2019. J Urol. 2019;202(3):558–63. https://doi.org/10.1097/JU.0000000000000309Updated AUA/SUFU guidelines pertaining to the diagnosis and treatment of AUA and OAB. The current guideline included updates pertaining to relevant literature published through October 2018.PubMedCrossRefGoogle Scholar
- 6.•• Ackerman AL, Lai HH, Parameshwar PS, Eilber KS, Anger JT. Symptomatic overlap in overactive bladder and interstitial cystitis/bladder pain syndrome: development of a new algorithm. BJU Int. 2019;123(4):682–93 In this study, a novel scoring system including urgency incontinence and bladder pain was validated with 91% accuracy in differentiating between OAB and IC/BPS.PubMedCrossRefGoogle Scholar
- 9.Sammarco AG, Kobernik EK, Haefner HK, Till SR, Berger MB. Lower urinary tract symptoms in a chronic pelvic pain population. Female pelvic medicine & reconstructive surgery. 2019.Google Scholar
- 10.Apostolidis A, Averbeck MA, Sahai A, Rahnama’i MS, Anding R, Robinson D, et al. Can we create a valid treatment algorithm for patients with drug resistant overactive bladder (OAB) syndrome or detrusor overactivity (DO)? Results from a think tank (ICI-RS 2015). Neurourol Urodyn. 2017;36(4):882–93.PubMedCrossRefGoogle Scholar
- 22.Krieger JN, Stephens AJ, Landis JR, Clemens JQ, Kreder K, Lai HH, et al. Relationship between chronic nonurological associated somatic syndromes and symptom severity in urological chronic pelvic pain syndromes: baseline evaluation of the MAPP study. J Urol. 2015;193(4):1254–62.PubMedCrossRefGoogle Scholar
- 30.• Kim A, Hoe KO, Shin JH, Choo MS. Evaluation of the incidence and risk factors associated with persistent frequency in interstitial cystitis/bladder pain syndrome and the efficacy of antimuscarinic treatment. Investig Clin Urol. 2017;58(5):353–8 This study reported thatantimuscarinics do not appear to decrease urinary frequency in IC/BPS patients.PubMedPubMedCentralCrossRefGoogle Scholar
- 33.• Di Lena M, Tolls V, Kelly KL, Nickel JC. Mirabegron as adjuvant treatment for patients with interstitial cystitis/bladder pain syndrome. Can Urol Assoc J. 2018;12(3):E100–e4 Mirabegron, a beta-3 adrenergic receptor agonist, may be a useful adjunct to help with urgency, but not necessarily pain, in IC/BPS patients.PubMedCrossRefGoogle Scholar
- 35.• Tutolo M, Ammirati E, Van der Aa F. What is the best treatment option for coexisting pelvic floor dysfunctions? Eur Urol Focus. 2017;3(6):532–4 Sacral neuromodulation (SNM) is used for urinary frequency, urgency, and urgency incontinence in OAB patients. Use in IC/BPS patients is limited (35), but has demonstrated efficacy in helping the frequency/urgency component of IC/BPS.PubMedCrossRefGoogle Scholar
- 37.•• Kuo HC, Jiang YH, Tsai YC, Kuo YC. Intravesical botulinum toxin-A injections reduce bladder pain of interstitial cystitis/bladder pain syndrome refractory to conventional treatment—a prospective, multicenter, randomized, double-blind, placebo-controlled clinical trial. Neurourol Urodyn. 2016;35(5):609–14 This prospective, multicenter, randomized, double-blinded, placebo-controlled clinical trial studied the use of Onabotulinumtoxin-A in IC/BPS patients. Onabotulinumtoxin-A was associated with significantly decreased visual analog scores (VAS) for pain and increased bladder capacity in comparison to controls.PubMedCrossRefGoogle Scholar