Diagnosing IC/BPS
IC/BPS (interstitial cystitis/bladder pain syndrome) is usually diagnosed based on your symptoms, a physical exam, and basic urine tests. There is no single test that proves you have IC/BPS in every case.
A common pattern in IC/BPS is an unpleasant bladder feeling (pain, pressure, discomfort, or burning) that is often worse as the bladder fills and/or better after you urinate, for at least six weeks.
- What you feel:
- Pain, pressure, discomfort, or burning in the lower belly/pelvis
- Pain may spread to the urethra or perineum (area between genitals and anus)
- Some people don’t call it “pain,” but still have a strong, unpleasant sensation
- How it relates to urinating/peeing:
- Do symptoms get worse as the bladder fills?
- Do symptoms improve after you empty your bladder?
- Do you have pain/burning while urinating?
- Bladder symptoms
- Urgency (a strong need to urinate) due to discomfort/pain (not mainly fear of leaking)
- Frequency (urinating often; many people with IC/BPS urinate 10+ times/day)
- Nocturia (waking at night to urinate), sometimes because pain interrupts sleep
- Symptoms may flare (get better and worse over time)
- How long your symptoms have lasted:
- The American Urological Association defines “chronic” as symptoms lasting for at least six weeks.
- Possible triggers or overlapping issues
- Menstrual cycle changes (if applicable)
- Past infections and whether symptoms persist between infections
- Medication use that affects sleep/urination
- Recreational ketamine use (important to ask about because it can cause a cystitis that mimics IC/BPS)
Your clinician may perform:
- An abdominal exam
- A pelvic exam (and a rectal exam in men)
They are looking for:
- Pelvic floor muscle tightness or tenderness
- In women, signs of vulvar skin conditions or tenderness
- Whether pressing on the bladder area reproduces your symptoms (sometimes symptoms show up mainly when the bladder is full)
There are various tests your healthcare provider may want to perform, depending on your medical history and symptoms.
Tests most people should expect:
- Urinalysis (UA)
- Looks for signs of infection and other clues (like blood in the urine).
- Urine culture
- Looks for bacteria that would mean an active infection.
Both of these tests help rule out active infection and other conditions that can cause similar symptoms.
Tests you may be asked to do (often helpful):
- Bladder diary (voiding diary)
- You track when you urinate, how often, and sometimes how much.
- Helps show your functional bladder capacity and the level of frequency/nocturia.
- In IC/BPS, voided volumes are often low and similar each time (unlike overactive bladder, where volumes may vary more).
- Post-void residual (PVR)
- Measures how much urine is left in the bladder after you urinate.
- If it’s high, your provider may look for obstruction or emptying problems.
A test that may be used early in many patients:
- Cystoscopy (looking inside the bladder with a small camera)
- Helps identify Hunner lesions, seen in about 10% of IC/BPS cases.
- Finding a Hunner lesion can change treatment planning.
- Can also help rule out serious problems (for example, carcinoma in situ).
- If a lesion looks suspicious, a biopsy may be done to rule out cancer.
- Hydrodistension done mainly to “prove” IC/BPS
- Hydrodistension can be a treatment, but it usually adds little diagnostic value.
- Glomerulations (pinpoint bleeding after distension) are nonspecific and not required for diagnosis.
- Potassium Sensitivity Test (PST)
- Can be positive in other conditions (radiation cystitis, acute bacterial cystitis, prostatitis, overactive bladder).
- Can cause pain.
- Not diagnostic by itself; limited usefulness.
- Anesthetic bladder challenge (lidocaine) as a standalone diagnostic
- Pain improvement may suggest the bladder is a pain source and may also be therapeutic. However, it is not diagnostic on its own and does not predict which treatment will work.
Bring and be ready to discuss:
- Your main symptoms (pain/pressure/burning/discomfort)
- Whether symptoms get worse with bladder filling and/or better after urinating
- How long symptoms have lasted (especially whether 3+ months)
- How often you urinate in the day and at night (a rough estimate is fine)
- Any symptom flares and possible triggers
- Past urine cultures/UTIs and whether symptoms persist between infections
- Current medications (especially those affecting sleep or urination)
- Any pelvic conditions (endometriosis, vulvar pain) or pelvic floor issues
- Any history of pelvic radiation, chemotherapy, or cancer
You may have:
- Urine testing: urinalysis + urine culture
- Physical exam: abdomen + pelvic exam (and rectal exam in men)
- A plan for a bladder diary
- Possible cystoscopy, especially if Hunner lesions are suspected
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