To test the hypothesis that more bladder pain syndrome/interstitial cystitis (BPS/IC) cases than controls report pre–onset urinary symptoms.
In a risk factor study, the date of BPS/IC onset (index date) was systematically determined in 312 female incident cases; the mean age at onset was 42.3 years. Frequency–matched controls were compared on pre–index date medical history.
Three pre–index date symptoms were more common in BPS/IC cases: pelvic pain with urinary features, frequency, and bladder pain; 178 cases (57%) vs 56 controls (18%) had at least 1 symptom (P <.001). Several perspectives suggested that prodromal symptoms were different from BPS/IC symptoms. In prodromal women, the median age of the earliest urinary symptom �more than other people� was 20 years. Women with the prodrome were significantly more likely than those without to have pre–index date nonbladder syndromes (NBSs). The prodrome predicted not only BPS/IC but also a worse prognosis for it.
Before the onset of BPS/IC, pelvic pain with urinary features, frequency, and/or bladder pain were reported by more than half the cases. Prodromal women recalled abnormal urinary symptoms decades before the onset of BPS/IC. The prodrome was associated with prior NBSs and predicted not only BPS/IC but also its poor prognosis. These data generated 2 hypotheses: that (1) prodromal symptoms are different from BPS/IC symptoms and (2) pain amplification links NBSs, the prodrome, the appearance of BPS/IC, and its poor prognosis. Recognition of the prodrome might provide opportunities for prevention of fully developed BPS/IC.