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Interstitial cystitis (bladder pain syndrome)

Last reviewed: 2 Apr 2025
Last updated: 09 Feb 2023

Summary

Definition

History and exam

Key diagnostic factors

  • food or stress triggers
  • urinary urgency
  • urinary frequency
  • urinary incontinence
  • nocturia
  • dysuria
  • pelvic-floor pain
  • dyspareunia
  • worsening of symptoms before menses
  • urethral pain
  • bladder neck pain
  • suprapubic pain
  • levator ani pain
  • pain after placement of Foley catheter
Full details

Other diagnostic factors

  • fibromyalgia
  • vulvar vestibulitis
  • vulvodynia
  • features of systemic lupus erythematosus
  • migraine
  • features of rheumatoid arthritis
  • features of chronic fatigue syndrome
  • allergies
  • sexual/domestic abuse
  • scrotal or anal pain
Full details

Risk factors

  • age 20 to 60 years
  • female sex
  • positive family history
  • sexual or domestic abuse
  • white ethnicity
Full details

Diagnostic tests

1st tests to order

  • urinalysis with microscopy and culture
  • vaginal wet prep
  • voiding diary
  • urine cytology
Full details

Tests to consider

  • cystoscopy with hydrodistention of bladder
  • bladder biopsy
Full details

Emerging tests

  • stress protein gene assay
  • urine antiproliferative factor
  • urine nerve growth factor (NGF)

Treatment algorithm

ONGOING

nonulcerative interstitial cystitis

ulcerative interstitial cystitis

Contributors

Authors

Kenneth M. Peters, MD

Professor and Chairman

Department of Urology

Oakland University William Beaumont School of Medicine

Chair

Department of Urology

Beaumont Health System

Royal Oak

MI

Disclosures

KMP declares that he has no competing interests.

Hailey Eisner, DO

Fellow, FPMRS Urology

Oakland University William Beaumont School of Medicine

Auburn Hills

MI

Disclosures

HE declares that she has no competing interests.

Priya Padmanabhan, MD, MPH

Professor of Urology

Oakland University William Beaumont School of Medicine

Auburn Hills

MI

Disclosures

PP declares that she has no competing interests.

Acknowledgements

Dr Kenneth M. Peters, Dr Hailey Eisner, and Dr Priya Padmanabhan would like to gratefully acknowledge Dr Lauren Tennyson, Dr Natalie Gaines, Dr Serge P. Marinkovic, Dr Robert Moldwin, Dr Stuart L. Stanton, Dr Lisa M. Gillen, Dr Christina Marinkovic, and Dr Michael Ehlert, the previous contributors to this topic.

Disclosures

LT, NG, SPM, RM, SLS, LMG, CM, and ME declare that they have no competing interests.

Peer reviewers

Nissrine Nakib, MD

Assistant Professor

Director of Female Urology and Urodynamics

University of Minnesota

Minneapolis

MN

Disclosures

NN declares that she has no competing interests.

Neil Baum, MD

Urologist

Touro Medical Office

New Orleans

LA

Disclosures

NB declares that he has no competing interests.

Charles Butrick, MD

Director

The Urogynecology Center

Overland Park

KS

Disclosures

CB declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Clemens JQ, Erickson DR, Varela NP et al. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome: AUA guideline amendment. J Urol. 2022 July;208(1):34-42.Full text

Engeler D, Baranowski AP, Berghmans B, et al. European Association of Urology. Guidelines on chronic pelvic pain. 2022 [internet publication].​Full text

van de Merwe JP, Nordling J, Bouchelouche P, et al. Diagnostic criteria, classification, and nomenclature for painful bladder syndrome/interstitial cystitis: an ESSIC proposal. Eur Urol. 2008 Jan;53(1):60-7. Abstract

Cox A, Golda N, Nadeau G, et al. CUA guideline: diagnosis and treatment of interstitial cystitis/bladder pain syndrome. Can Urol Assoc J. 2016 May-Jun;10(5-6):E136-55.Full text  Abstract

Imamura M, Scott NW, Wallace SA, et al. Interventions for treating people with symptoms of bladder pain syndrome: a network meta-analysis. Cochrane Database Syst Rev. 2020 Jul 30;7(7):CD013325.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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