Diagnosis of Interstitial Cystitis

Diagnosing Interstitial Cystitis is not easy for the medical practitioner. For most doctors, it takes time to reach the final diagnosis of IC. As interstitial cystitis (IC) symptoms are similar to those of other disorders of the bladder and there is no definitive test to identify IC, doctors must rule out other treatable conditions before considering a diagnosis of IC. The most common of these diseases in both sexes are urinary tract cancer and bladder cancer.

Unlike a urinary tract infection, interstitial cystitis cannot be diagnosed with a simple urinalysis or urine culture. Rather, it’s a diagnosis of exclusion, which means that the urologist will first take a thorough history and then perform tests designed to rule out other diseases. These include infection, bladder stones, bladder cancer, kidney disease, multiple sclerosis, endometriosis, and sexually transmitted diseases. As IC has overlapping symptoms with other diseases the doctor would follow a process of elimination to establish IC.

Pelvic Exam: First the doctor would do a pelvic exam. During a pelvic exam, the doctor examines external genitals, vagina, and cervix and feels the abdomen to assess internal pelvic organs.

Urine Tests: The urologist would initially ask you to do a urine routine test and urine culture. This would help them to rule out Urinary Tract Infection.

USG of KUB: Ultrasonography (USG) of the KUB (Kidney, urethras, bladders) helps them to rule out any abnormality in the KUB. It would also help the doctor see the post void urine volume.

Cystoscopy with hydrodistension: The doctor may possibly do a procedure called cystoscopy with hydrodistension, which is performed under general anesthesia. In cystoscopy, the doctor inserts a thin tube with a tiny camera (cystoscope) through the urethra, which allows the doctor to see the lining of the bladder. Along with cystoscopy, your doctor may inject liquid into your bladder to measure your bladder capacity. Your doctor may perform this procedure, known as hydrodistention after you've been numbed with an anesthetic medication to make you more comfortable. Interestingly, distending the bladder can itself be therapeutic. About half of the patients get some relief for about three months after the procedure. The most common sign of interstitial cystitis is red pinpoint spots of blood (glomerulations) covering much of the bladder wall surface. Sometimes there are scars or lesions called Hunner’s ulcers, accompanied by low bladder capacity due to tissue stiffening (fibrosis).

Biopsy: During cystoscopy, the doctor may take a biopsy (tissue sample) of the bladder to rule out bladder cancer and look for evidence of the mast cells that indicate an allergic reaction or autoimmune response.

Urodynamic Studies: An urodynamic study is not essential to diagnose IC, however, it remains important for the confirmation of the clinical symptoms of IC. A urodynamic study may also be useful in selecting the therapeutic modalities for IC.

Potassium Chloride Sensitivity Test: Few doctors may also want to do a potassium chloride sensitivity test. In this test, your doctor places two solutions — water and potassium chloride — into your bladder, one at a time. You're asked to rate on a scale of 0 to 5 the pain and urgency you feel after each solution is instilled. If you feel noticeably more pain or urgency with the potassium solution than with the water, your doctor may diagnose interstitial cystitis. People with normal bladders can't tell the difference between the two solutions.