Warren, John W, Howard, Fred M, Cross, Raymond K et al. · Urology · 2009 · DOI
This study compared women with interstitial cystitis/painful bladder syndrome (IC/PBS) to women without the condition to see which other illnesses appeared more often before IC/PBS developed. The researchers found that people with IC/PBS were much more likely to have had multiple other chronic conditions beforehand, particularly fibromyalgia, chronic fatigue syndrome, dry mouth/eyes syndrome, and irritable bowel syndrome. These conditions often clustered together, suggesting that IC/PBS might be part of a broader whole-body syndrome rather than just a bladder problem.
This study is relevant to ME/CFS patients because it documents a strong association between ME/CFS-related syndromes (fibromyalgia, chronic fatigue syndrome, sicca syndrome, IBS) and IC/PBS, suggesting these conditions may share common underlying mechanisms or pathophysiology. The identification of syndrome clusters supports the hypothesis that ME/CFS and related conditions may represent manifestations of a broader systemic disorder, potentially informing future diagnostic and therapeutic approaches for this patient population.
This study does not prove that antecedent syndromes cause IC/PBS or vice versa; it only demonstrates temporal association. The study is retrospective and relies on patient recall of symptom onset, which may be subject to recall bias. The case-control design cannot establish mechanistic relationships between the identified syndrome clusters or determine whether they share a common etiology.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Warren, John W, Howard, Fred M, Cross, Raymond K, Good, Janine L, Weissman, Myrna M, Wesselmann, Ursula, et al. (2009). Antecedent nonbladder syndromes in case-control study of interstitial cystitis/painful bladder syndrome.. Urology. https://doi.org/10.1016/j.urology.2008.06.031
BibTeX
@article{mecfsatlas-warren-2009-antecedent-nonbladder,
author = {Warren, John W and Howard, Fred M and Cross, Raymond K and Good, Janine L and Weissman, Myrna M and Wesselmann, Ursula and Langenberg, Patricia and Greenberg, Patty and Clauw, Daniel J},
title = {Antecedent nonbladder syndromes in case-control study of interstitial cystitis/painful bladder syndrome.},
journal = {Urology},
year = {2009},
doi = {10.1016/j.urology.2008.06.031},
note = {PubMed: 18995888},
url = {https://www.mecfsatlas.com/evidence/warren-2009-antecedent-nonbladder},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-25. https://www.mecfsatlas.com/evidence/warren-2009-antecedent-nonbladder
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