- Nicole Cozean, PT, DPT, WCS
Interstitial Cystitis or Chronic Prostatitis in Men: Is there a (meaningful) difference?
There is a great deal of confusion between chronic prostatitis and interstitial cystitis. They have very similar symptoms, diagnostic criteria, food triggers, and treatments. So are they the same condition, or is there any difference between the two? Just as importantly, are there any practical differences in symptoms, diagnosis, or treatment?
Both interstitial cystitis (IC) and chronic prostatitis (CP) are characterized by chronic pelvic pain and urinary symptoms. Both conditions cause pelvic floor dysfunction, which can refer pain throughout the pelvic region, including the bladder, the suprapubic region (just below the belly button), perineum, testicles, and penis.
When men have urinary symptoms, like urgency and frequency of urination, urologists tend to focus on the prostate. The prostate is a small, walnut-sized organ in the pelvic floor of men, and the urethra run from the bladder through the prostate to exit, so it is a logical place to look. However, the prostate is often innocent, especially when there are other IC symptoms like suprapubic pain. Even after tests for a bacterial infection come back negative, men are often diagnosed with 'chronic nonbacterial prostatitis.'
Because IC is incorrectly thought to be rare in men, doctors often go to great lengths to not consider IC as a diagnosis. They often look for sexually transmitted diseases, drug use, various cancers, or other options instead of identifying interstitial cystitis.
Chronic Prostatitis or Interstitial Cystitis?
The two conditions are remarkably similiar - so much so that many researchers believe them to be the same condition or so closely related that should be under the same umbrella term. Both interstitial cystitis (IC) and chronic prostatitis (CP) are characterized by chronic pelvic pain, urinary symptoms, having to use the bathroom at night, and other pelvic pain.
The similarities don't end there.
Both conditions cause pelvic floor dysfunction, which can refer pain throughout the pelvic region, including the bladder, the suprapubic region (just below the belly button), perineum, testicles, and penis.
Chronic prostatitis and interstitial cystitis are both conditions of exclusion - they can only be diagnosed after other causes are ruled out. Typically, these other possibilities can include urinary tract infections (UTIs), a bacterial infection of the prostate (prostatitis), sexually transmitted diseases, kidney stones, or bladder cancer.
For IC and CP, symptoms mimic a bacterial infection - for IC, the suspect is typically a UTI, while bacterial prostatitis is suspected for CP patients. Once an infection is ruled out as a cause of the symptoms, the conditions can be diagnosed.
Male Pelvic Organs
Note the location of the prostate. It's right next to the bladder, and the urethra runs right through the prostate after leaving the bladder. It's not surprising that pain, dysfunction, or inflammation in one can affect the other, or that either can be causing urinary symptoms.
(Image courtesy of The Interstitial Cystitis Solution, Fair Winds Publishing, 2016)
Among the unique aspects of chronic prostatitis and interstitial cystitis is the sensitivity to certain foods and drinks that patients experience. These foods, known as triggers, can flare or exacerbate symptoms in both conditions.
Researchers found that 77% of patients with chronic prostatitis experienced these food sensitivities, while 95% of IC patients also reported food triggers. As the authors concluded:
"Foods and beverages that were most bothersome to CP/CPPS and IC groups
were identical." - (Herati et al, 2009)
The most common food triggers for both groups were coffee, tea, alcohol, citrus fruits, spicy foods, and tomato products. Experts recommend an elimination diet for both IC and CP patients to determine your individual triggers.
Oral medications can be prescribed for both interstitial cystitis and chronic prostatitis to relieve pain, reduce inflammation, and try to calm the upregulated nervous system. Changes in diet can help eliminate trigger foods, and lifestyle changes like reducing the amount of time spent sitting can be helpful for patients.
Pelvic floor physical therapy is considered the most proven treatment for interstitial cystitis, and researchers have shown it has a very similar benefit for chronic prostatitis as well. After only ten visits of pelvic floor physical therapy, patients with CP reported 40-60% improvement in pain, urinary symptoms, and sexual function.
Recent research has suggested that interstitial cystitis may be far more common in men than chronic prostatitis. In a survey of more than 5,000 households, the RAND study found IC was up to 8 times more likely in patients with pain and urinary symptoms than chronic prostatitis. In the same study, the authors discovered that nearly one in four patients with symptoms could be categorized with either IC or CP (or considered to have both). Only 8% of the men who were surveyed met the Chronic Prostatitis definition but did not meet the IC criteria.
The dramatic similarities between chronic prostatitis and interstitial cystitis have prompted some researchers to postulate that they are in fact the same condition. Others have proposed creating an umbrella term, where IC and CP are two different subtypes of a broader condition.
Regardless, the practical implications are clear. The same treatments are effective for both IC and CP: pelvic floor physical therapy, changes in diet, oral medications to control symptoms, stretching, and self-care are vital for both conditions. Whatever the name, find the most effective holistic treatment plan for you.
Dr. Nicole Cozean is the founder of PelvicSanity physical therapy, Orange County's premier pelvic floor physical therapy clinic. One of only 270 PTs to be board-certified in the pelvic floor, and the first PT to serve on the ICA Board of Directors, Nicole is the author of the acclaimed and best-selling book The Interstitial Cystitis Solution (2016). She is an adjunct professor at her alma mater, Chapman University. The PelvicSanity blog focuses on presenting practical, positive information to help patients beyond the walls of Nicole's clinic.