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    The following IC Self-Screener was developed specifically to help evaluate the symptoms of interstitial cystitis and to help doctors come to a quicker diagnosis of the condition. If you've already been diagnosed with IC, the Self-Screener can be used as a helpful tool for tracking the progress of your treatment.

    This short questionnaire will measure the symptoms associated with IC,based on pain,urgency and frequency of urination.Complete all of the questions and then take it to your doctor.

    For each question, please select the response that best describes how you feel. Then click SEE RESULTS to go to a printable page you can take to your next appointment.

    1

    How many times do you go to the bathroom during the day?

    2 a.

    How many times do you go to the bathroom at night?

    b.

    If you get up at night to go to the bathroom, does it bother you?

    3

    Are you currently sexually active?

    4 a.

    If you are sexually active, do you now or have you ever had pain or the urge to urinate during or after sexual intercourse?

    b.

    If you have pain or the urge to urinate, does it make you avoid sexual intercourse?

    5

    Do you have pain associated with your bladder or in your pelvis (vagina, lower abdomen, urethra, perineum, testes, or scrotum)?

    6 a.

    If you have pain, is it usually:

    b.

    Does your pain bother you?

    7

    Do you have urgency after going to the bathroom?

    8 a.

    If you feel the urge to urinate, is it usually:

    b.

    Does this urge bother you?

     

    NEXT: What Is Interstitial Cystitis?


    JOURNEY TO RELIEF ®

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    IMPORTANT SAFETY INFORMATION

    • ELMIRON® should not be taken if you have a known hypersensitivity to the drug or similar drugs.
    • ELMIRON® is a weak blood thinner (anticoagulant) which may increase bleeding. Call your doctor if you will be undergoing surgery or if you are taking or will begin taking anticoagulant therapy such as warfarin sodium, heparin, high doses of aspirin, or anti-inflammatory drugs such as ibuprofen.
    • Tell your doctor:
      • If you are pregnant or plan on becoming pregnant.
      • If you have any liver problems.
    • The most common side effects are hair loss, diarrhea, nausea, blood in the stool, headache, rash, upset stomach, abnormal liver function tests, dizziness and bruising.
      • Hair loss, when it occurred, was almost always limited to a single area of the scalp.

    Tell your doctor about any side effect that bothers you or does not go away. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

    Please see full Product Information for ELMIRON®.

    Please read the ELMIRON® Patient leaflet and discuss it with your doctor.

    What is ELMIRON?
    ELMIRON® is a prescription medication used to treat the pain and discomfort of interstitial cystitis (IC). It is not known exactly how ELMIRON® works, but it is not a pain medication like aspirin or acetaminophen and therefore must be taken continuously for relief as prescribed by your doctor.

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    Last Modified December 10, 2010