Diagnostic approach for suspected interstitial cystitis/bladder pain syndrome in adults

The diagnosis of IC/BPS is made in patients with an unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms of more than 6 weeks duration, in the absence of infection or other identifiable causes.

IC/BPS: interstitial cystitis/bladder pain syndrome; STI: sexually transmitted infection; UTI: urinary tract infection.

* Structural disease includes urethral diverticula, urogenital prolapse, uterine/cervical mass, inguinal hernia, prostate mass, or eroded/exposed vaginal mesh. Exquisite tenderness may make it impossible to perform an adequate pelvic or rectal examination. In this situation, for patients who meet diagnostic criteria for IC/BPS, clinicians may choose to begin empiric treatment and to defer full examination until symptoms have improved to the point where examination is possible.

¶ Urine tests include urinalysis and culture if indicated, as well as testing for chlamydia and gonorrhea in sexually active patients. Postvoid residual urine volume should be measured either by using a catheter (usually avoided due to associated pain) or by ultrasound.

Δ Other tests may include urine cytology and upper tract imaging.

◊ Cystoscopy may reveal Hunner lesions, which are consistent with IC/BPS.

Graphic 121778 Version 2.0

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Diagnostic approach for suspected interstitial cystitis/bladder pain syndrome in adults