Because 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
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Tony Buffington, DVM, MS, PhD, professor of veterinary sciences at The Ohio State University, is a veteran of numerous IC investigations in both humans and cats. His latest discovery reveals new biomarkers that may identify IC and offer further insight about the condition.
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infections and bladder cancer. In men, common diseases include chronic prostatitis or chronic pelvic pain syndrome. IC is not associated with any increased risk of developing cancer.
Once other conditions are excluded, patients with characteristic signs and symptoms generally are treated for presumed IC/PBS. In certain circumstances, some clinicians may choose to evaluate further, with cystoscopy with hydrodistention under general anesthesia, urodynamic studies, or lidocaine instillation. The diagnosis of IC in the general population is based on the
- presence of pain related to the bladder, usually accompanied by frequency and urgency
- absence of other diseases that could cause the symptoms
The potassium chloride sensitivity test (PST), or Parsons' test, also has been used for diagnosis. The PST is no longer widely used in the United States because of low sensitivity and specificity, and because it is a painful test to undergo that also requires invasive urinary catheterization. This test involves instillation of potassium chloride into the bladder; a positive result is pain and reproduction of IC/PBS symptoms. However, the PST. The test also misses up to 25 percent of patients with IC/PBS.
Learn more about diagnostic testing and how to talk with your doctor about IC:
Cystoscopy with Hydrodistention
Although interstitial cystitis (IC) is a diagnosis of exclusion, there are a few standard tests, such as cystoscopy with hydrodistention, that you doctor can perform to help confirm a diagnosis of IC. Under general or regional anesthesia, this procedure uses a cystoscope to look inside your bladder after slowly stretching it with fluid (hydrodistention).
Cystoscopy with hydrodistention allows your physician to see changes inside of your bladder that are typical of IC, including the presence of or pin-point sized red marks on the blader wall, also called glomerulations or petechial hemorrhages. This procedure also allows doctors to see Hunner's ulcers (patches), which are present in a small number of people with IC.
Though helpful in learning more about what is going on with your baldder, cystoscopy with hydrodistention is no longer considered the “gold standard” in the diagnosis of IC because:
- Glomerulations can also be seen upon hydrodistention in those without IC symptoms.
- The degree of severity of the glomerulations does not correlate with the severity of IC symptoms.
- Some people with symptoms of IC have no glomerulations.
About the Procedure
Your doctor will not perform your cystoscopy with hydrodistention in his or her office. The bladder needs to be filled to a high pressure in order to see the typical abnormalities of IC, a pressure that can cause significant pain if you are not anesthetized. In addition, in-office cystoscopy may not reveal the glomerulations on your bladder and the diagnosis of IC can be missed.
Cystoscopy with hydrodistention is an outpatient surgical procedure. You will be admitted to the hospital, but in most cases, you will be discharged the same day as the procedure. Prior to this procedure, you may have basic blood work done, just as you would before any surgery. During the procedure you will receive general anesthesia, or your pelvic region will be numbed by spinal nerve-blocking agents. You will not feel any pain during the procedure.
Your physician will insert a cystoscope through your urethra and into your bladder. This "scope," which is fitted with a miniature camera, enables your physician to see the interior surface of your bladder to look for Hunner’s ulcers and other abnormalities.
Your doctor will first examine your bladder by viewing it through the cystoscope. After the initial cystoscopic examination, your physician will “hydrodistend” your bladder by filling it with fluid (80 centimeters) and keeping it full for one to five minutes before letting the fluid out. This process causes the bladder wall to stretch out (distend), allowing your physician to re-inspect your bladder with the cystoscope.
If you have IC, your physician typically sees irritated areas (glomerulations) on the bladder wall. Also, the hydrodistention allows your doctor to check your bladder capacity under anesthesia. This can be an indicator of the need for more aggressive therapies.
The cystoscope may be fitted with instruments for obtaining biopsies of your bladder wall. While biopsy is not necessary for the diagnosis of IC, it is useful in ruling out bladder cancer. A bladder biopsy can also be helpful in determining if there are increased numbers of mast cells in the bladder wall, which may support the diagnosis of IC and indicate treatment options. Your doctor should not perform any additional treatment measures, such as bladder instillations, during this procedure, since your bladder will be very vulnerable from the procedure.
Therapeutic Benefits
Hydrodistention may reduce pain and discomfort in some IC patients, and therefore may be therapeutic as well as diagnostic.
Some people with IC who are helped by hydrodistention report improvement that lasts 3 to 6 months, at which time your physician may repeat the procedure for continued therapeutic benefits. Not everyone gets relief from this procedure and it may take up to several weeks to notice any improvement. Exactly why this procedure has therapeutic benefits for some is not known.
After the Procedure
After the procedure you will be in a recovery room. As the anesthesia begins to wear off, you may experience pelvic pressure or pain. Once you are able to urinate, your physician will discharge you from the hospital.
Ask for pain-relieving medicines upon discharge from the hospital. Your physician can prescribe oral pain-reducing medicines to help reduce discomfort you may experience following the procedure. Some people experience discomfort for several weeks following the procedure, including pelvic pain or urethral burning.
A catheter is not commonly left in place after this procedure, as IC patients tend to experience pain with prolonged catheterization. Typically, your first attempts are urinating after this procedure will be painful and may contain blood.
If you have IC, the doctor usually schedules a follow-up appointment with you to discuss various IC treatment options. If you and your physician are considering bladder instillations as a possible treatment, your bladder first needs time to recover from the cystoscopy with hydrodistention. Your doctor may have you wait three to four weeks after the procedure.
Potassium Chloride Sensitivity Test
The Potassium Chloride Sensitivity Test (PST) consists of instilling a solution of potassium chloride (known chemically as KCl) into the bladder via urinary catheter. It has been suggested for two uses:
- Diagnostic test for IC.
- Predictive test for response to IC-specific medicines, such as pentosan polysulfate sodium (Elmiron)and other heparinoids, that are thought to work by coating the bladder lining.
Some common questions about the PST are addressed below:
Additionally, two IC experts recently offered opposing views about the PST in the Journal of Urology. Read more.
Is the PST an accurate diagnostic test?
The PST was originally designed as a possible diagnostic test for IC. However, there are questions about the accuracy of this test. One study found the PST to be 75 percent accurate, which means that if 100 IC patients are given this test, only 75 of these patients will be diagnosed accurately. Another study found the test to be 60 percent accurate in the diagnosis of IC.
Is the PST an accurate predictive test?
The PST is being evaluated as a predictive test. The test is thought to be able to gauge the permeability of the glycosaminoglycans (GAG) layer of the bladder, which may be defective in some IC patients. Some investigators believe that IC patients who respond positively to the test will be more likely to be helped by a specific class of IC treatments—the mucosal surface protectants (or heparinoids), such as oral Elmiron and intravesical heparin. However, its usefulness as a predictor of response to heparinoids has not been substantiated.
Is the PST painful?
During the test, patients are asked to report the degree of severity of pain and urgency that they experience while the KCl solution is in the bladder. This pain response may be present not only during, but after the test, and can last as long as days to weeks following the procedure. And, it may be difficult for patients to accurately quantify an increase in pain when they may already be in considerable pain prior to administration of the test. It has been suggested that long-acting anesthetics such as bupivacaine hydrochloride (Marcaine) and heparin be instilled into the bladder immediately after the PST, so that the potential for a painful flare-up is reduced.
Can the PST be misinterpreted?
The PST is not specific for IC. Patients with acute urinary tract infection, radiation cystitis, other inflammatory conditions of the bladder, and those receiving chemotherapy for bladder cancer may also have a positive response to the test. Also, the test may be negative, even if a patient has IC, if the patient:
- Has recently received DMSO or heparin intravesical instillations.
- Has recently undergone hydrodistention.
- Has been taking Elmiron.
- Does not exhibit bladder permeability as a part of their IC.
Should I talk to my doctor about the PST?
If your doctor feels it is necessary to administer the PST as a diagnostic test for IC, ask about:
- False negatives: Let your doctor know that the medical literature reports a 40 percent false negative rate. This means that for every 100 people with IC undergoing the test, 40 of these people will have no response to the test solution placed in their bladders. Again, this does not mean that you do not have IC. It is a limitation of the test itself.
- Post test pain treatments: Ask about a solution of Marcaine to reduce the painful symptoms that may occur minutes to hours after the test is given. Also, ask about a prescription for pain medication, since this test can trigger a flare in symptoms.
ICA Quick Poll: Tell us about your personal experience with the PST.
Talking With Your Doctor
To find out if you have IC, talk with your doctor about your symptoms. The first step in finding relief for the pain and discomfort of IC is getting a proper diagnosis. Before your appointment, answer the following questions. Discuss your answers with your doctor.
- Do you have pain and/or pressure in your lower abdomen?
- Do you urinate frequently?
- Do you have an urgent need to urinate day and night?
- Do some foods and/or beverages make your symptoms worse? If yes, which foods and/or beverages?
- Do you find that certain types of exercise make your symptoms worse? If yes, which types of exercise?
- Do you have pain during and/or following sexual intercourse?
- If you are a man, do you have discomfort or pain in the penis or scrotum?
- Do tests of your urine fail to show any signs of bacterial infection?
If you answered yes to any of these questions, talk with your doctor about these symptoms. Ask if you might have IC. Print a PDF on how to talk with your doctor about IC in English and in Spanish (Cómo hablar con su médico sobre la CI). Bring this page with you to the doctor.
Contact the ICA to fina a doctor or healthcare provider in your area:
- Healthcare providers in the United States
- List of international providers
Revised October 15, 2009