Diagnosis

The symptoms of interstitial cystitis (IC) /painful bladder syndrome closely resemble those of other conditions of the bladder that are treatable. Therefore, the first step in IC/PBS diagnosis in both sexes is ruling out other disease conditions such as bladder cancer and urinary tract infection. In women endometriosis, which involves pelvic pain, must also be ruled out while in men, chronic prostatitis (chronic pelvic pain syndrome) is the disease to look for before focusing on IC/PBS.

Frequency and urgency of urination, pain in pelvic area and absence of other treatable diseases are the pointers that could indicate IC/PBS.

Diagnostic tests for IC/PBS-

a) Urinalysis and Urine Culture

Examining urine under a microscope, and culturing urine samples, can help to rule out urinary tract infections. If the symptoms continue to persist, despite the urine sample being sterile, IC/PBS might be suspected.

A frequency/volume chart for 24 hours may also be worked out.

b) Prostate Secretions

Prostatic fluid might be obtained from men (with no urinary infections) and allowed to be cultured to detect microbes causing prostate infection, which can be easily treated with anti biotics. This is an uncommon test and is not frequently done.

c) Ultrasonography (USG)

USG of kidneys, ureter and bladder with post-void residue may be carried out

d) Urine Cytology

In this test a sample of urine of the patient is centrifuged and the sediments are seen under the microscope. It is a useful test to rule out malignancy of the bladder.

e) Cystoscopy /biopsy

This is an optional investigation in IC. During cytoscopy, a cytoscope, is used to see the bladder clearly and to study its abnormalities, if any.

Sometimes the bladder is distended or stretched in order to better evaluate its inner parts. This can be painful for the patient, therefore the procedure is carried out after administering anesthesia.

To rule out cancer a piece of the bladder tissue is removed (biopsy), during cytoscopy, to be studied under the microscope.

For the first time in 2003 the severity of the different grades of disease was defined in Copenhagen. This depended on ‘Cystoscopic visualisation of the bladder mucosa.’ Severity was defined from no disease or normal to severe disease if it was grade IV.