Interstitial Cystitis (IC): Diagnosis

Your doctor will take a history of your symptoms, your diet, past medical and surgical history, and medications used. You may be asked to fill out a voiding diary and a pain questionnaire. You can help by bringing records of prior urine cultures, any imaging studies of the abdomen and pelvis, prior interventions using medications or procedures. The doctor will want to do a pelvic and rectal exam, also a good neurological exam. A urinalysis and urine culture is essential (usually negative with IC/BPS). A urine cytology (cancer screen) may be ordered. Imaging of the abdomen and pelvis using ultrasound, CAT scan or MRI may be needed.

Urodynamics may be helpful. This test involves placing a small catheter in the bladder and then slowly filling the bladder with sterile water. Urodynamics help us to assess the bladder’s capacity and compliance, and also your ability to relax the pelvic floor when voiding.

Cystoscopy (looking through the urethra into the bladder) is useful to check for ulcers (open areas in the bladder lining that can be seen with IC/BPS). A bladder biopsy may be needed to rule out early cancer.

Laparoscopy (looking through an endoscope into the abdomen) is less commonly used to identify pelvic conditions that might explain the symptoms (e.g., endometriosis or scar tissue from a prior surgery).

There is no one single test that can be used to diagnose IC/BPS. We call it a “diagnosis by exclusion” – meaning other, more easily recognizable problems are ruled out first, most commonly:

• Overactive bladder
• Chronic bacterial cystitis
• Bladder or other pelvic cancers
• Gynecologic disorders (e.g., vaginal atrophy, pelvic congestion syndrome, endometriosis, adhesions)
• Chronic prostatitis in men
• Pudendal nerve entrapment
• Symptoms from prior pelvic radiation
• Urinary stones
• Rare bladder diseases (e.g., eosinophilic cystitis, malakoplakia), and more.