Interstitial Cystitis: Diagnosis and Treatment in a Pregnant Patient

Interstitial cystitis or painful bladder syndrome is a chronic condition characterized by severe and acyclic pelvic pain lasting for a period of at least six weeks. Although this condition is not accompanied by urinary infection, the patient's daily activities are impeded. The most common symptoms are urinary frequency, dysuria, suprapubic pain, nycturia, and dyspareunia. The etiology of interstitial cystitis is unclear, and its diagnosis is infrequent because of the low number of cases. A definitive diagnosis is based on cystoscopic findings and typical histopathological evidence, such as Hunner's ulcers. Herein, we describe the diagnosis and treatment of a clinical case of interstitial cystitis in a patient who started presenting symptoms during pregnancy. A 42-year-old woman at 27.2 weeks of pregnancy began showing symptoms at 10 weeks of gestation. She presented with dysuria and hypogastric pain with an intensity of 9/10, which hindered her daily activities. Physical examination revealed tenderness to deep and superficial hypogastric palpation. Routine urinalysis and urine culture test yielded negative results. She was started on symptomatic treatment from 10 weeks of gestation, but it did not result in any improvement. Therefore, intraoperative diagnostic cystoscopy was performed to obtain biopsy samples. Histopathological analysis of the samples showed evidence of interstitial cystitis. Accordingly, she was started on intravesical instillation of hyaluronic acid, which improved her condition. On the basis of the case findings, we recommend that interstitial cystitis should be considered a differential diagnosis in patients with pelvic pain and urinary symptoms unrelated to a urinary infection.