SAN FRANCISCO — In a large majority of women presenting with chronic pelvic pain, the bladder is the pain-generating organ, Edward J. Stanford, M.D., said at the annual meeting of the American Association of Gynecologic Laparoscopists.
In three studies involving almost 300 women with chronic pelvic pain, the prevalence of interstitial cystitis ranged from 70% to 82%, said Dr. Stanford of St. Mary's Good Samaritan Medical Center, Centralia, Ill.
In the most recent and thorough of these studies, Dr. Stanford followed 64 women with chronic pelvic pain for a year. Each completed the Pelvic Pain and Urgency/Frequency questionnaire and underwent a vulvar touch test, a potassium sensitivity test, cystoscopy with hydrodissection, and laparoscopy. During the laparoscopy, the investigators biopsied suspicious lesions and removed all adhesions.
Although 64% of the women had adhesions, the pain could not be attributed to that, Dr. Stanford said. In 70%, the bladder was the pain-generating organ, 28% had biopsy-proven endometriosis, and 20% had vulvar pain.
Therefore, in the differential diagnosis of chronic pelvic pain, interstitial cystitis must be ranked first, with irritable bowel syndrome, endometriosis, and vulvodynia a distant second, third, and fourth, respectively. Recurrent urinary tract infection was cited in 7% of the cases.