Can Interstitial Cystitis Cause Dysuria?
Yes, dysuria is a well-recognized symptom of interstitial cystitis/bladder pain syndrome (IC/BPS) and occurs commonly in affected patients, particularly in younger individuals at the time of diagnosis. 1, 2
Clinical Presentation of Dysuria in IC/BPS
Dysuria manifests as a characteristic symptom in IC/BPS patients, though its prevalence varies by patient demographics:
- Younger patients (<30 years) experience dysuria significantly more frequently than older patients, with dysuria being one of the predominant urinary symptoms in this age group 3
- Dysuria occurs alongside other hallmark IC/BPS symptoms including urinary frequency, urgency, and chronic pelvic/bladder pain 2, 4
- The pain associated with urination in IC/BPS is distinct from infectious cystitis because urine cultures remain negative despite the presence of dysuria 1, 4
Distinguishing IC/BPS Dysuria from Other Conditions
The dysuria in IC/BPS has specific characteristics that help differentiate it from other urological conditions:
- IC/BPS dysuria persists for at least 6 weeks in the absence of documented urinary tract infection, which is a key diagnostic criterion 1
- Unlike bacterial cystitis, patients with IC/BPS may initially present with a single symptom such as dysuria, but subsequent cultures are consistently negative 1
- The dysuria is perceived as pain, pressure, or discomfort related to the urinary bladder, distinguishing it from urethritis which typically presents with urethral discharge 5
Age-Related Symptom Patterns
The prominence of dysuria varies significantly by age at diagnosis:
- Patients diagnosed before age 30 report dysuria at significantly higher rates (P<0.001) compared to middle-aged and older patients 3
- Younger patients also experience more urinary urgency (P=0.033) and frequency (P=0.006) alongside their dysuria 3
- In contrast, older patients (≥60 years) more commonly present with nocturia and urinary incontinence rather than dysuria 3
Clinical Implications
When evaluating a patient presenting with dysuria:
- Always obtain urine culture to document negative results, as this is essential for IC/BPS diagnosis and excludes bacterial infection 1, 4
- Document the duration of symptoms—dysuria must be present for at least 6 weeks to meet diagnostic criteria 1
- Assess for accompanying symptoms including pelvic pain, urinary frequency, urgency, and in women, dyspareunia 1, 3
- Consider IC/BPS particularly in younger patients presenting with persistent dysuria and negative urine cultures 3
Treatment Considerations for Dysuria
Management of dysuria in IC/BPS requires addressing the underlying bladder pain syndrome:
- Behavioral modifications including avoidance of bladder irritants and stress management should be implemented first 1
- Manual physical therapy is indicated for patients with pelvic floor tenderness, which commonly accompanies dysuria in IC/BPS 1, 5
- Oral medications such as amitriptyline, cimetidine, or hydroxyzine may provide relief 1, 5
- Pain management alone is insufficient—treatment must address the underlying bladder-related symptoms causing the dysuria 1
- In severe cases, transvaginal photobiomodulation has shown preliminary evidence for reducing pain with urination (MCID=-2.6, d=1.0) 6