Evaluate for IC at the onset of symptoms

Evaluate for IC in patients presenting with

  • Urinary urgency/frequency, which may include nocturia1,2
  • Pelvic pain, which may include dyspareunia1

In assessing pain, consider that

  • Pelvic pain may be constant or episodic and may be referred (lower abdomen, urethra, perineum, and medial thighs)3,4
  • Flares may be associated with menstruation and/or allergies3,4
  • Pain may be associated with sexual intercourse3,4
  • Pain may occur during bladder filling, which may be relieved with voiding1
  • Urinary urgency is associated with a desire to relieve pain versus fear of leakage5

IC diagnostic approach

Physical and lab exam

  • Thorough patient history and physical examination should be performed, asking patients specifically about voiding symptoms, location and level of pelvic pain, and pain during or after sexual intercourse1
  • Symptom duration and triggers should also be discussed1
  • Physical exam should include abdominal and pelvic examination1
    • Anterior vaginal wall or bladder-based tenderness is a key finding suggestive of IC1,6
    • Another examination finding associated with IC includes levator muscle spasm, a sign of pelvic floor dysfunction1,6
  • The basic lab exam includes
    • Urinalysis and urine culture to rule out urinary tract infection1
    • Urine cytology in select patients to rule out bladder cancer1

Cystoscopy and/or urodynamics

  • Visual examination of the bladder to exclude certain conditions and the identification of Hunner’s lesions (a lesion or ulceration characteristic of IC)1
  • Consider these tests as an aid to diagnosis, as they are not necessary for all patients and should generally be reserved for use in complex presentations1
  • Hydrodistension is not necessary for routine clinical use to establish a diagnosis of IC unless first- and second-line treatments have not provided acceptable symptom control1


  • Hanno PM, Burks DA, Clemens JQ, et al. AUA guideline for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome. J Urol. 2011;185(6):2162-2170.
  • Hanno PM. Bladder pain syndrome (interstitial cystitis) and related disorders. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology. Vol 1. 10th ed. Philadelphia, PA: Saunders Elsevier Inc; 2012;357-401.
  • Parsons CL. Interstitial cystitis: epidemiology and clinical presentation. Clin Obstet Gynecol. 2002;45(1):242-249.
  • Parsons CL, Stanford EJ, Kahn BS, Sand PK. Tools for diagnosis and treatment. Female Patient. 2002;May(suppl):12-17.
  • Rosenberg MT, Moldwin RM, Stanford EJ. Early diagnosis and management of interstitial cystitis: what primary care clinicians should know. Women’s Health Primary Care. 2004;7(9):456-463.
  • Howard FM. Physical examination. In: Howard FM, Perry CP, Carter JE, El-Minawi AM, eds. Pelvic Pain: Diagnosis and Management. Philadelphia, PA: Lippincott Williams & Wilkins; 2000:26-42.

Evaluation Tools

The Pelvic Pain and Urgency/Frequency (PUF) Questionnaire1 and the O'Leary-Sant interstitial cystitis (IC) Symptom and Problem Index2 are IC symptom evaluation tools a patient can self-administer.

These tools may help establish baseline symptom values of IC during an initial patient consultation. Each tool can be placed at the front desk for patient self-administration before a visit, or a nurse can administer each questionnaire to the patient.

The PUF Questionnaire1

Although not a validated diagnostic tool, physicians can use the PUF Questionnaire to assist in their evaluation of patients with IC. Patients’ responses to questions concerning voiding problems, persistent pelvic pain, and pain during or after sexual intercourse are weighed to determine the intensity of symptoms.1

A study showed that IC should be considered if a patient records a PUF score of ≥10,1* although lower scores may indicate IC in patients who

  • Are early in the course of the disease3
  • Have a mild case of the disease3
  • Are not sexually active3

PUF IC symptom assessment tool


O'Leary-Sant IC Symptom and Problem Index2

The O'Leary-Sant IC Symptom and Problem Index questionnaire can also be used to assess a potential IC patient. A score of ≥6 on the index increases suspicion of IC.2

O'Leary-Sant IC symptom assessment tool


Reprinted from Urology, Vol 49, O'Leary MP, Sant GR, Fowler FJ Jr, Whitmore KE, Spolarich-Kroll J, The interstitial Cystitis Symptom Index and Problem Index, Page 62, Copyright 1997, with permission from Elsevier.

A study by Parsons et al showed PUF scores ≥10 correlated with positive potassium sensitivity test (PST)1*

PUF Data Chart
PUF data chart lines
PUF data chart base
PUF data chart bar fill
PUF data chart numbers

*Although patients with IC are likely to have higher PUF scores, the questionnaire cannot exclude other conditions with similar symptoms and is not sufficient to diagnose IC independent of medical history, physical examination, and appropriate diagnostic measures.


  • Parsons CL, Dell J, Stanford EJ, et al. Increased prevalence of interstitial cystitis: previously unrecognized urologic and gynecologic cases identified using a new symptom questionnaire and intravesical potassium sensitivity. Urology. 2002;60:573-578.
  • O'Leary MP, Sant GR, Fowler FJ Jr, et al. The interstitial cystitis symptom index and problem index. Urology. 1997;49(suppl 5A):58-63.
  • Parsons CL, Tatsis V. Prevalence of interstitial cystitis in young women. Urology. 2004;64(5):866-870.