Because symptoms are similar to those of other disorders of the urinary system and because there is no definitive test to identify IC, doctors must rule out other conditions before considering a diagnosis of IC. Among these disorders are urinary tract or vaginal infections, bladder cancer, bladder inflammation or infection caused by radiation to the pelvic area, eosinophilic and tuberculous cystitis, kidney stones, endometriosis, neurological disorders, sexually transmitted diseases, low-count bacteria in the urine and, in men, chronic bacterial and nonbacterial prostatitis.
The diagnosis of IC in the general population is based on
- Presence of urgency, frequency, or pelvic/bladder pain.
- Cystoscopic evidence (under anesthesia) of bladder wall inflammation, including glomerulations or Hunner's ulcers present in 90 percent of patients with IC.
- Absence of other diseases that could cause the symptoms.
Diagnostic tests that help identify other conditions include urinalysis, urine culture, cystoscopy, biopsy of the bladder wall, urine cytology, and, in men, laboratory examination of prostate secretions. The most important test to confirm IC is a cystoscopy under anesthesia.
Urinalysis and Urine Culture
These tests can detect and identify the most common organisms that infect
the urine and that may cause symptoms similar to IC. There are, however,
organisms such as Chlamydiathat cannot be detected with these tests,
so a negative culture does not rule out all types of infection. A urine
sample is obtained either by catheterization or by the "clean catch" method.
For a clean catch, the patient washes the genital area before collecting
urine "midstream" in a sterile container. White and red blood cells and
bacteria in the urine may indicate an infection of the urinary tract,
which can be treated with an antibiotic. If urine is sterile for weeks
or months while symptoms persist, the doctor may consider a diagnosis
of IC.
Culture of Prostate Secretions
In men, the doctor will obtain prostatic fluid and examine it for signs
of an infection, which can then be treated with antibiotics.
Cystoscopy Under Anesthesia with Bladder Distention
During cystoscopy, the doctor uses a cystoscope--an instrument made of
a hollow tube about the diameter of a drinking straw with several lenses
and a light--to see inside the bladder and urethra. The doctor will also
distend or stretch the bladder to its capacity by filling it with a liquid
or gas. Because bladder distention is painful in patients with IC, they
must be given either regional or general anesthesia before the doctor
inserts the cystoscope. These tests can detect bladder wall inflammation;
a thick, stiff bladder wall; and Hunner's ulcers. Glomerulations are usually
seen only after the bladder has been stretched to capacity.
The doctor may also test the patient's maximum bladder capacity--the amount of liquid or gas the bladder can hold under anesthesia. Without anesthesia, capacity is limited by either pain or a severe urge to urinate. Many people with IC have normal or large maximum bladder capacities under anesthesia. However, a small bladder capacity under anesthesia helps support the diagnosis of IC.
Biopsy
A biopsy is a tissue sample that is then examined under a microscope.
Samples of the bladder and urethra may be removed during a cystoscopy
and later examined with a microscope. A biopsy helps confirm inflammation
and rule out bladder cancer.
If you have any questions or comments on senior health nutrition, fitness, etc., go to the Senior Health Forum where we are talking about the following:
The information contained in these pages
is for educational / reference use only.
Sources:
National Institutes of Health
