the filling portion of hydrodistension, one can see white fibrous bundles as the bladder is stretched. When stretched, blood flow is interrupted in these fibrous bundles. After this stretching phase, the emptying phase allows blood flow to resume. This is where one can see bleeding from capillaries. In relation to interstitial cystitis, when noxious stimuli are present, it causes injury to the bladder mucosa resulting in recruitment of inflammatory cells. Disruption of glycosaminoglycan (GAG) layer along with the increased presence of mast cells, T cells, and B cells causes the bladder epithelium to become more permeable. Injury to the GAG layer may lead to increased release of adhesion factors that bind to angiogenic molecules, which generally have little presence under normal conditions, to promote wound healing. Ultimately, increased adhesion factors and overproduction of angiogenic factors from mast cells and disruption of the GAG layer results in tissue fibrosis. As mentioned above, the technique of hydrodistention is one method used to diagnose interstitial cystitis, in which the atrophic bladder is filled and emptied and thus, the stretch of the bladder wall is one possible mechanism of glomerulations. Risk factors Diagnosis of chronic pelvic pain or discomfort, accompanied with urinary symptoms, seems to be the most likely risk factor for glomerulation. Research has shown that up to 7.5% of the adult female population is associated with chronic pelvic pain (CPP), in which irritative voiding is commonly seen. Bladder tissue damage is a component that could lead to CPP. These symptoms are also seen in IC which may have led to the pathogenesis of glomerulation through hydrodistention. It is speculated that chronic underfilling of the bladder contributes to glomerulations. For example, glomerulations can be seen after radiation therapy, in individuals undergoing dialysis, and after urinary diversion. Relation to interstitial cystitis The identification of glomerulations as diagnostic criteria for interstitial cystitis/ bladder pain syndrome is unclear. Interstitial cystitis (IC)/ bladder pain syndrome (BPS) is associated with chronic pelvic pain, pressure and discomfort within the urinary system. In 1987, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) developed diagnostic criteria for IC which included the presence of glomerulations or petechial hemorrhages. The purpose of the NIDDK diagnostic criteria was to facilitate comparable groups for research. It was not intended to set strict criteria for the diagnosis of IC. Interstitial cystitis may also induce angiogenic factors including VEGF (vascular endothelial growth factor) and