Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) Diagnosis: Current Limitations and a Pragmatic Clinical Diagnostic Definition.

Abstract

Objective: To develop a consensus on diagnostic criteria for interstitial cystitis/bladder pain syndrome (IC/BPS).

Materials and methods: A subcommittee was identified based on expertise in IC/BPS diagnostic criteria. An outline was generated and iteratively modified until it was found to be acceptable by subcommittee members as the basis for manuscript generation. The manuscript was presented and revised in two iterations according to feedback from international key opinion leaders at the Global Consensus on IC/BPS and the AUA Annual Meeting, respectively.

Results: The patient history and physical examination are necessary components in the diagnosis of IC/BPS. Urinalysis and urine culture are necessary laboratory tests to rule out exclusionary conditions including active infection. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) criteria, which were established in 1988 for research purposes, pose several limitations and result in the exclusion of a large proportion of IC/BPS patients when applied clinically. Thus, we put forth a pragmatic and streamlined definition that is aligned with existing clinical guidance and standard diagnostic workup.

Conclusions: The clinical diagnosis of IC/BPS is based on history, physical examination, and urine studies. IC/BPS is clinically defined as an unpleasant sensation (e.g. pain, discomfort, pressure, burning) that worsens with bladder filling and improves with bladder emptying, of 3 or more months duration, in the absence of exclusionary diagnoses that would likely account for the symptomatology. A substantial number of IC/BPS patients have comorbid pelvic disorders (e.g., pelvic floor dysfunction, vulvodynia, endometriosis) which require separate treatment.

Trial registration: This study is not a clinical trial and thus does not warrant registration as such.