Symptoms of Interstitial Cystitis
Interstitial cystitis/bladder pain syndrome (IC/BPS) presents with bladder/pelvic pain or pressure as the hallmark symptom, accompanied by urinary frequency and a strong urge to urinate, with symptoms persisting for at least six weeks in the absence of infection. 1, 2
Core Symptom Complex
Pain is the defining feature that distinguishes IC/BPS from other bladder conditions:
- Bladder/pelvic pain or pressure is the cardinal symptom, typically perceived in the suprapubic region but may extend throughout the pelvis and to extragenital locations 2
- Many patients describe their discomfort as "pressure" rather than "pain"—this is a critical distinction that clinicians must recognize to avoid missing the diagnosis 2, 3
- Pain characteristically worsens with bladder filling and improves with urination 2
- Pain may be exacerbated by specific foods or drinks 2
Urinary Symptoms
The urinary symptoms in IC/BPS are driven by pain avoidance, not fear of incontinence:
- Urinary frequency occurs in 92% of patients but is not specific to IC/BPS 2
- Urinary urgency is present in 84% of patients, but differs qualitatively from overactive bladder 2
- IC/BPS patients experience a more constant urge to void to avoid or relieve pain, whereas overactive bladder patients have sudden compelling urges to avoid incontinence 2, 4
- Nocturia (nighttime urination) is common 3
Sex-Specific Symptoms
Gender-specific manifestations must be documented:
- In women: dyspareunia (painful intercourse) and relationship of pain to menstruation should be noted 1
- In men: ejaculatory pain and pain at the tip of the penis, perineum, suprapubic region, or testicles 3
- Men with IC/BPS may meet criteria for both IC/BPS and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), as these conditions have overlapping clinical characteristics 2, 4
Documentation Requirements for Diagnosis
The following must be documented for clinical diagnosis:
- Duration: Symptoms must be present for at least six weeks with documented negative urine cultures 1, 2
- Number of voids per day 1
- Sensation of constant urge to void 1
- Location, character, and severity of pain, pressure, or discomfort 1
Critical Pitfall to Avoid
Do not dismiss patients who use the word "pressure" instead of "pain"—this descriptor is extremely common in IC/BPS and failing to recognize it leads to diagnostic delays and misdiagnosis. 2, 3 The American Urological Association emphasizes using broad descriptors when evaluating patients because many do not spontaneously report "pain" as their primary complaint. 2