title: Bladder pain syndrome/interstitial cystitis as a functional somatic syndrome.
abstract: OBJECTIVE
  To determine whether bladder pain syndrome/interstitial cystitis (BPS/IC) has the characteristics of a functional somatic syndrome (FSS).
  
  
  METHODS
  There is no accepted definition of an FSS. Consequently, this paper reviewed the literature for common FSS characteristics and for reports that BPS/IC has these characteristics.
  
  
  RESULTS
  Eleven articles met inclusion and exclusion criteria and yielded 18 FSS characteristics. BPS/IC patients manifest all but two: the exceptions were normal light microscopic anatomy (after hydrodistention under anesthesia, some BPS/IC bladders have Hunner's lesions and most have petechial hemorrhages) and normal laboratory tests (many BPS/IC patients have hematuria). Petechial hemorrhages and hematuria are probably related and may appear during naturally-occurring bladder distention. Without such distention, then, the 90% of BPS/IC patients without a Hunner's lesion have all the characteristics of an FSS. Comparisons in the opposite direction were consistent: several additional features of BPS/IC were found in FSSs.
  
  
  CONCLUSIONS
  This systematic but untested method is consistent with but does not test the hypothesis that BPS/IC in some patients might best be understood as an FSS. Like most conditions, BPS/IC is probably heterogeneous; hence only a proportion of BPS/IC cases are likely to be manifestations of an FSS. This hypothesis has several implications. Explorations of processes that connect the FSSs might contribute to understanding the pathogenesis of BPS/IC. Patients with FSSs are at risk for BPS/IC and may benefit from future preventive strategies. Therapies that are useful in FSSs also may be useful in some cases of BPS/IC.
authors.affiliation: Department of Medicine, University of Maryland School of Medicine, 10 South Pine Street, #900, Baltimore, MD 21201, United States; Department of Epidemiology and Public Health, University of Maryland School of Medicine, United States. Electronic address: jwarren@medicine.umaryland.edu.
authors.forename: John W
authors.initials: JW
authors.lastname: Warren
mesh_terms: D018856:Cystitis, Interstitial / Q000150:complications* / Q000503:physiopathology*; D006801:Humans; D010146:Pain / Q000209:etiology* / Q000503:physiopathology; D013001:Somatoform Disorders / Q000175:diagnosis* / Q000503:physiopathology; D013577:Syndrome; D001743:Urinary Bladder / Q000503:physiopathology*
keywords: Bladder pain syndrome; Chronic fatigue syndrome; Fibromyalgia; Functional somatic syndromes; Interstitial cystitis; Irritable bowel syndrome