The healthy bladder surface is coated by a thin mucinous substance, termed bladder surface mucin (BSM), which is composed of numerous sulfonated glycosaminoglycans (GAGs) and glycoprotein. This mucus lining prevents urine and its contents from leaking through the urothelium and damaging the underlying nerves and muscles. In IC patients, this layer is defective and the epithelium is abnormally permeable. As a result, potentially toxic substances in urine are permitted to permeate the bladder muscle, depolarizing sensory nerves and causing the symptoms of IC. One of the urine constituents is potassium (K+), which is highly toxic to the bladder muscularis. Therefore, investigators have developed the potassium sensitivity test to support this theory.12,13 Based on this, GAG agents such as heparin and pentosan polysulfate have been used to treat
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