What are interstitial cystitis symptoms and signs?
The symptoms of IC/PBS vary greatly from one person to another but have some similarities to those of a urinary tract infection. They include
- decreased bladder capacity resulting in frequent urination of smaller amounts of urine day and night, referred to as urinary frequency;
- a strong, urgent need to urinate when the need to urinate arises, referred to as urinary urgency;
- bladder pain, bladder pressure, and feelings of pressure, pain, and tenderness around the bladder, pelvis, and perineum (the area between the anus and vagina or anus and scrotum) which may increase as the bladder fills and decrease as it empties;
- painful sexual intercourse (dyspareunia); and
- discomfort or pain in the penis and scrotum.
In most women, symptoms usually worsen around the time of their periods. As with many other illnesses, stress also may intensify the symptoms, but it does not cause them. The symptoms usually have a slow onset, and urinary frequency is the most common early symptom. As IC/PBS progresses over a few years, cycles of pain (flare-ups or flares) and remissions occur. Pain may be mild or so severe as to be debilitating. Symptoms can vary from day to day.
How do health care professionals diagnose interstitial cystitis?
Because the symptoms of IC/PBS are similar to those of other disorders of the urinary system and because there is no definitive test to identify IC/PBS, doctors must exclude other conditions before making a diagnosis of IC/PBS. Among the disorders to be excluded are urinary tract or vaginal infections, bladder cancer, bladder inflammation or infection caused by radiation to the abdomen, eosinophilic and tuberculous cystitis, kidney stones, endometriosis, neurological disorders, sexually transmitted diseases, urinary tract infection with small numbers of bacteria, and, in men, chronic bacterial and nonbacterial prostatitis.
Medical tests that help identify other conditions include a urinalysis, urine culture, cystoscopy, and biopsy of the bladder wall and, in men, laboratory examination of prostatic secretions.
Physical examination of an individual with IC/PBS may reveal tenderness of the bladder either when pushing on the abdomen over the bladder (just above the pubic bone) or during the pelvic examination in women. No specific physical findings are associated with IC/PBS.
Urinalysis and urine culture: These tests can detect and identify the most common bacteria in the urine that may be causing symptoms. A health care professional obtains a urine sample either by catheterization or by the "clean catch" method. For a clean catch, the patient washes the genital area before collecting a sample of urine "midstream" in a sterile container. White and red blood cells and bacteria in the urine suggest an infection of the urinary tract that physicians can treat with antibiotics. If urine is sterile for weeks or months while symptoms persist, a doctor may consider a diagnosis of IC/PBS.
Culture of prostatic secretions: In men, the doctor can obtain a sample of prostatic fluid. This fluid is examined under the microscope for signs of an infection such as red and white blood cells and can be cultured for bacteria. Antibiotics treat prostatic infections.
Potassium sensitivity test: Doctors use a test known as the intravesical potassium sensitivity test (PST) in the evaluation of IC/PBS. In the PST test, health care professionals instill two different solutions (sterile water and a solution of potassium) separately into the bladder. The patient rates the severity of pain and/or urgency that occur when a health care professional instills each solution. People with normal bladder linings cannot tell the difference between the two solutions, while those with IBC/PBS and other conditions that affect the leakiness of the bladder wall will experience more pain when a health care provider injects the potassium solution into the bladder.
Cystoscopy under anesthesia with bladder distension: During cystoscopy, the doctor uses a cystoscope -- an instrument made of a hollow tube about the diameter of a drinking straw with several lenses and a source of light - to look inside the bladder and urethra. The doctor will also distend or stretch the bladder to its capacity by filling it with a liquid or gas. Because bladder distension is painful in IC/PBS patients, before the doctor inserts the cystoscope through the urethra into the bladder, the patient must be given either regional or general anesthesia. Cystoscopy with distension of the bladder with fluid can detect inflammation (visually or with biopsies), a thick and stiff bladder wall, and Hunner's ulcers. After a health care professional drains fluid from the bladder, small red spots, called glomerulations, that represent enlarged blood vessels and pinpoint areas of bleeding can be seen in the bladder's lining.
The doctor also may determine a patient's bladder capacity -- the maximum amount of liquid or gas the bladder can hold under anesthesia. (Without anesthesia, either pain or a severe urge to urinate limits capacity.) Most people without IC/PBS have normal or large maximum bladder capacities under anesthesia. A small bladder capacity (due to scarring) under anesthesia helps to support the diagnosis of IC/PBS.
Cystoscopy has its limitations. Ulcers generally do not appear in mild or early cases of IC/PBS, and glomerulations have been observed in normal individuals without symptoms of IC/PBS. Due to these limitations, physicians recommend cystoscopy only to exclude other possible causes of symptoms and not as the definitive diagnostic test for IC/PBS.
It is important to note that the distension often performed with cystoscopy may lead to relief of symptoms in some patients with IC/PBS, which generally lasts from several weeks to months following the procedure.
Biopsy: A biopsy is a microscopic examination of a small sample of tissue. A physician may remove samples of the bladder and urethra during cystoscopy and examine them with a microscope later. A biopsy helps to exclude bladder cancer. It also may confirm the presence of mast cells or inflammation of the bladder wall that are consistent with a diagnosis of IC/PBS. Nevertheless, there is nothing on the biopsy that can make an absolute diagnosis of IC/PBS.