Pelvic pain and surgeries in women before interstitial cystitis/painful bladder syndrome

Published:December 21, 2009DOI:


      The objective of the study was to compare subjects with interstitial cystitis/painful bladder syndrome (IC/PBS) with controls on prior surgeries.

      Study Design

      IC/PBS subjects were compared with matched controls on surgeries and possible surgical indications prior to their index dates.


      Adjusted for demographic variables, logistic regression showed subjects exceeded controls in surgeries longer than 12 months and less than 1 month before the index date. However, addition of possible surgical indications showed chronic pelvic pain (CPP) to have a strong association with IC/PBS, whereas associations with surgeries were reduced to nonsignificance.


      Although women with IC/PBS were more likely to have experienced prior surgeries than controls, the apparent indications for surgeries, not the surgeries themselves, were stronger risk factors for IC/PBS. In particular, a prior history of CPP had a strong association with IC/PBS. Several features of study design, including extensive medical record review, suggest that prior CPP was not undiagnosed IC/PBS. Further investigation of CPP may yield insight into the pathogenesis of IC/PBS.

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        • Hand J.R.
        Interstitial cystitis: report of 223 cases (204 women and 19 men).
        J Urol. 1949; 61: 291-310
        • Hall S.A.
        • Link C.L.
        • Pulliam S.J.
        • et al.
        The relationship of common medical conditions and medication use with symptoms of painful bladder syndrome: results from the Boston Area Community Health Survey.
        J Urol. 2008; 180: 593-598
        • Ingber M.S.
        • Peters K.M.
        • Killinger K.A.
        • Carrico D.J.
        • Ibrahim I.A.
        • Diokno A.C.
        Dilemmas in diagnosing pelvic pain: multiple pelvic surgeries common in women with interstitial cystitis.
        Int Urogynecol J. 2008; 19: 341-345
        • Parys B.T.
        • Haylen B.T.
        • Hutton J.L.
        • Parsons K.F.
        The effects of simple hysterectomy on vesicourethral function.
        Br J Urol. 1989; 64: 594-599
        • Warren J.W.
        • Howard F.M.
        • Cross R.K.
        • et al.
        Antecedent nonbladder syndromes in case-control study of interstitial cystitis/painful bladder syndrome.
        Urology. 2009; 73: 52-57
        • Mathias S.D.
        • Kuppermann M.
        • Liberman R.F.
        • Lipschutz R.C.
        • Steege J.F.
        Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates.
        Obstet Gynecol. 1996; 87: 321-327
        • Warren J.W.
        • Langenberg P.
        • Greenberg P.
        • Diggs C.
        • Jacobs S.
        • Wesselmann U.
        Sites of pain from interstitial cystitis/painful bladder syndrome.
        J Urol. 2008; 180: 1373-1377
        • Steege J.F.
        Pelvic pain phenotyping: the key to progress.
        Obstet Gynecol. 2009; 113: 258-259
        • Hammoud A.
        • Gago L.A.
        • Diamond M.P.
        Adhesions in patients with chronic pelvic pain: a role for adhesiolysis?.
        Fertil Steril. 2004; 82: 1483-1491
        • Thornton J.G.
        • Morley S.
        • Lilleyman J.
        • Onwude J.L.
        • Currie I.
        • Crompton A.C.
        The relationship between laparoscopic disease, pelvic pain and infertility; an unbiased assessment.
        Eur J Obstet Gynecol Reprod Biol. 1997; 74: 57-62
        • Jones K.D.
        • Haines P.
        • Sutton C.J.
        Long-term follow-up of a controlled trial of laser laparoscopy for pelvic pain.
        JSLS. 2001; 5: 111-115
        • Peters A.A.
        • Trimbos-Kemper G.C.
        • Admiraal C.
        • Trimbos J.B.
        • Hermans J.
        A randomized clinical trial on the benefit of adhesiolysis in patients with intraperitoneal adhesions and chronic pelvic pain.
        Br J Obstet Gynaecol. 1992; 99: 59-62
        • Stratton P.
        • Sinaii N.
        • Segars J.
        • et al.
        Return of chronic pelvic pain from endometriosis after raloxifene treatment: a randomized controlled trial.
        Obstet Gynecol. 2008; 111: 88-96
        • Kjerulff K.H.
        • Langenberg P.W.
        • Rhodes J.C.
        • Harvey L.A.
        • Guzinski G.M.
        • Stolley P.D.
        Effectiveness of hysterectomy.
        Obstet Gynecol. 2000; 95: 319-326
        • Hillis S.D.
        • Marchbanks P.A.
        • Peterson H.B.
        The effectiveness of hysterectomy for chronic pelvic pain.
        Obstet Gynecol. 1995; 86: 941-945
        • Howard F.M.
        • El-Minawi A.M.
        • Sanchez R.A.
        Conscious pain mapping by laparoscopy in women with chronic pelvic pain.
        Obstet Gynecol. 2000; 96: 934-939
        • Palter S.F.
        • Olive D.L.
        Office microlaparoscopy under local anesthesia for chronic pelvic pain.
        J Am Assoc Gynecol Laparosc. 1996; 3: 359-364
        • Wesselmann U.
        • Lai J.
        Mechanisms of referred visceral pain: uterine inflammation in the adult virgin rat results in neurogenic plasma extravasation in the skin.
        Pain. 1997; 73: 309-317
        • Berkley K.J.
        • Rapkin A.J.
        • Papka R.E.
        The pains of endometriosis.
        Science. 2005; 308: 1587-1589
        • Giamberardino M.A.
        • De Laurentis S.
        • Affaitati G.
        • Lerza R.
        • Lapenna D.
        • Vecchiet L.
        Modulation of pain and hyperalgesia from the urinary tract by algogenic conditions of the reproductive organs in women.
        Neurosci Lett. 2001; 304: 61-64
        • Clauw D.J.
        • Chrousos G.P.
        Chronic pain and fatigue syndromes: overlapping clinical and neuroendocrine features and potential pathogenic mechanisms.
        Neuroimmunomodulation. 1997; 4: 134-153
        • Petrou M.
        • Harris R.E.
        • Foerster B.R.
        • et al.
        Proton magnetic resonance spectroscopy in the evaluation of cerebral metabolism in patients with fibromyalgia: comparison with healthy controls and correlation with symptom severity.
        AJNR Am J Neuroradiol. 2008; 29: 913-918
        • Wolfe F.
        • Anderson J.
        • Harkness D.
        • et al.
        A prospective, longitudinal, multicenter study of service utilization and costs in fibromyalgia.
        Arthritis Rheum. 1997; 40: 1560-1570
        • Clauw D.J.
        • Schmidt M.
        • Radulovic D.
        • Singer A.
        • Katz P.
        • Bresette J.
        The relationship between fibromyalgia and interstitial cystitis.
        J Psychiatr Res. 1997; 31: 125-131
        • Ness T.J.
        • Powell-Boone T.
        • Cannon R.
        • Lloyd L.K.
        • Fillingim R.B.
        Psychophysical evidence of hypersensitivity in subjects with interstitial cystitis.
        J Urol. 2005; 173: 1983-1987
        • Fitzgerald M.P.
        • Koch D.
        • Senka J.
        Visceral and cutaneous sensory testing in patients with painful bladder syndrome.
        Neurourol Urodyn. 2005; 24: 627-632
        • Clemens J.Q.
        • Link C.L.
        • Eggers P.W.
        • et al.
        Prevalence of painful bladder symptoms and effect on quality of life in black, Hispanic and white men and women.
        J Urol. 2007; 177: 1390-1394
        • Phipps A.I.
        • Buist D.S.
        Validation of self-reported history of hysterectomy and oophorectomy among women in an integrated group practice setting.
        Menopause. 2009; 16: 576-581