title: Temporal ordering of interstitial cystitis/bladder pain syndrome and non-bladder conditions.
abstract: OBJECTIVE
  To examine the prevalence and timing of nonbladder conditions in a community cohort of women with symptoms of interstitial cystitis/bladder pain syndrome (IC/BPS).
  
  
  METHODS
  As part of the Rand Interstitial Cystitis Epidemiology (RICE) study, we identified 3397 community women who met a validated case definition for IC/BPS symptoms. Each completed a survey asking if they had a physician diagnose them as having irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, migraines, panic attacks, or depression. If a positive response was received, subjects were asked to provide the age of symptom onset. All subjects were also asked to provide the date of IC/BPS symptom onset.
  
  
  RESULTS
  A total of 2185 women reported a diagnosis of at least one of the nonbladder conditions. Onset of bladder symptoms was not consistently earlier or later than the onset of nonbladder symptoms. Depression tended to occur earlier (P < .05), whereas fibromyalgia generally occurred later (P < .05). Mean age of onset was lowest for migraine symptoms, depression symptoms, and panic attacks symptoms, and greatest for fibromyalgia and chronic fatigue syndrome symptoms. Mean age of irritable bowel syndrome and IC/BPS symptom onset was between these other conditions.
  
  
  CONCLUSIONS
  These findings confirm the common co-occurrence of IC/BPS with chronic nonbladder conditions. In women with IC/BPS symptoms and coexistent nonbladder conditions, bladder symptoms do not uniformly predate the nonbladder symptoms. These observations suggest that phenotypic progression from isolated bladder symptoms to regional/systemic symptoms is not a predominant pattern in IC/BPS, although such a pattern may occur in a subset of individuals.
authors.affiliation: Department of Urology, University of Michigan Medical Center, Ann Arbor, Michigan 48109-5330, USA. qclemens@umich.edu
authors.forename: J Quentin
authors.initials: JQ
authors.lastname: Clemens
authors.forename: Marc N
authors.initials: MN
authors.lastname: Elliott
authors.forename: Marika
authors.initials: M
authors.lastname: Suttorp
authors.forename: Sandra H
authors.initials: SH
authors.lastname: Berry
mesh_terms: D000328:Adult; D017668:Age of Onset; D015897:Comorbidity; D018856:Cystitis, Interstitial / Q000453:epidemiology*; D003863:Depression / Q000453:epidemiology; D015673:Fatigue Syndrome, Chronic / Q000453:epidemiology; D005260:Female; D005356:Fibromyalgia / Q000453:epidemiology; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000453:epidemiology; D008881:Migraine Disorders / Q000453:epidemiology; D016584:Panic Disorder / Q000453:epidemiology; D015995:Prevalence