Clinical Subject Page

Interstitial Cystitis (IC)

Interstitial Cystitis (IC) is a chronic bladder pain condition characterized by pain, pressure, or discomfort perceived to originate from the bladder, usually associated with urinary frequency and urgency. Interstitial Cystitis (IC) occurs without a proven urinary infection or another identifiable cause that fully explains the symptoms

Also called

Bladder Pain Syndrome (BPS)

ICD-10

N30.10

Specialty

Urology

Onset

Chronic

Reviewed

August 2026

On This Page

Overview

Overview
Etiology & Risk Factors

Etiology & Risk Factors
Pathophysiology

Pathophysiology
Clinical Presentation

Clinical Presentation
History Taking

History Taking
Physical Examination

Physical Examination
Investigations

Investigations
Diagnosis

Diagnosis
Management

Management
Complications

Complications
Prognosis

Prognosis
Key Points / Clinical Pearls

Key Points / Clinical Pearls

Overview

–Interstitial Cystitis (IC) is a chronic, symptom-based condition that can significantly affect quality of life. The typical pattern is bladder or pelvic pain that worsens as the bladder fills and improves, at least temporarily, after urination.

Two important clinical patterns are recognized:

IC with Hunner lesions: distinctive inflammatory lesions visible on cystoscopy.
Non-Hunner IC: no Hunner lesions are identified.

-The exact cause is unclear, and symptoms may overlap with Urinary Tract Infection (UTI), Overactive Bladder (OAB), Chronic Pelvic Pain Syndrome (CPPS), pelvic floor dysfunction, and other pelvic disorders.

Teaching point Bladder pain that worsens with filling and improves after voiding, especially with repeatedly negative urine cultures, is a classic clinical clue for Interstitial Cystitis (IC).

Etiology & Risk Factors

-Etiology

–The exact cause of Interstitial Cystitis (IC) is not fully understood. Proposed mechanisms include:

Defective bladder epithelial barrier
Chronic inflammation
Abnormal mast-cell activity
Peripheral nerve sensitization
Central pain sensitization
Pelvic floor dysfunction

-Risk Factors

Female sex
Chronic pelvic pain disorders
Pelvic floor dysfunction
Other chronic pain syndromes
Previous bladder or pelvic inflammation

Pathophysiology

Bladder epithelial dysfunction or another trigger → increased bladder wall permeability and irritation → inflammation and abnormal nerve activation → peripheral sensitization → central sensitization → chronic bladder pain → urgency and frequency

Clinical Presentation

–Symptoms

Chronic bladder or suprapubic pain
Pelvic discomfort or pressure
Pain worsening with bladder filling
Temporary relief after urination
Urinary frequency
Urinary urgency
Nocturia

-Signs:

Physical examination may be normal.

Possible findings include:

Suprapubic tenderness
Bladder tenderness
Pelvic floor muscle tenderness
Increased pelvic floor muscle tone

Important Note Repeated positive urine cultures are not typical of uncomplicated Interstitial Cystitis (IC) and should prompt investigation for recurrent infection or another diagnosis.

History Taking

-Ask about:

Duration and location of pain
Relationship between pain and bladder filling
Relief after urination
Urinary frequency and urgency
Nocturia
Dysuria
Hematuria
Sexual pain
Previous Urinary Tract Infection (UTI)
Previous urine culture results
Pelvic surgery or trauma

Physical Examination

-General Examination

Assess general wellbeing
Assess the impact of chronic pain
Look for fever or systemic illness suggesting another diagnosis

-System-Specific Examination:

Assess suprapubic tenderness
Examine the external genitalia when appropriate
Assess pelvic floor tenderness or muscle spasm
Perform a focused pelvic examination when clinically indicated

Investigations

-Biochemistry / Specific Tests

Urinalysis
Urine culture to exclude Urinary Tract Infection (UTI)
Voiding diary to document frequency and voided volumes

-Imaging

Not routinely required for uncomplicated Interstitial Cystitis (IC).

Ultrasound or other imaging may be used when an alternative structural abnormality is suspected.

-Special / Confirmatory Tests

There is no single confirmatory test.

Cystoscopy

May be used to:

Identify Hunner lesions
Evaluate persistent or unexplained symptoms
Investigate hematuria
Exclude other bladder pathology when indicated

A normal cystoscopy does not exclude IC.

Bladder Biopsy

Not routinely required.

It may be performed when malignancy or another specific pathology needs to be excluded.

Diagnosis

-The diagnosis of Interstitial Cystitis (IC) is based on:

Chronic bladder-related pain or pressure → associated urinary frequency or urgency → characteristic relationship with bladder filling → exclusion of infection and other identifiable causes

Home Home Clinical Cases Urology System Clinical Cases Interstitial Cystitis (IC)

Management

1. Definitive Treatment

There is no single definitive cure for Interstitial Cystitis (IC). Management is individualized and aims to reduce pain, improve bladder symptoms, and restore quality of life.

2. Medical Treatment

Depending on the patient’s symptoms and local practice:

Simple analgesics or nonsteroidal anti-inflammatory drugs (NSAIDs)
Neuropathic pain medications
Tricyclic antidepressants
Other bladder-directed medications in selected patients

Repeated antibiotics should be avoided without evidence of bacterial infection.

3. Surgical / Procedural Treatment

No routine surgical treatment.

Selected patients may require:

Endoscopic treatment of Hunner lesions
Bladder-directed procedures for refractory symptoms

Major surgery is reserved for rare, severe, treatment-resistant disease.

4. Supportive Management

Patient education
Identification and avoidance of individual triggers
Adequate hydration

Complications

Chronic pelvic pain
Sleep disturbance
Sexual dysfunction
Anxiety
Depressive symptoms
Reduced quality of life

Prognosis

Interstitial Cystitis (IC) is usually chronic and fluctuating. Symptoms may improve, worsen, or recur over time. Although there is no universal cure, many patients achieve meaningful improvement with individualized, multimodal management.

Key Points / Clinical Pearls

Interstitial Cystitis (IC) is a chronic bladder pain condition.
It is also known as Bladder Pain Syndrome (BPS).
Pain often worsens with bladder filling.
Pain may improve temporarily after urination.
Frequency and urgency are common symptoms.
Repeated negative urine cultures support the diagnosis.
IC is a diagnosis of exclusion.
There is no single confirmatory test.
A normal cystoscopy does not exclude IC.
Cystoscopy can identify Hunner lesions.
Urine culture is important to exclude Urinary Tract Infection (UTI).

American Urological Association (AUA). Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome: AUA Guideline .
European Association of Urology (EAU). EAU Guidelines on Chronic Pelvic Pain .
Hanno PM, Erickson D, Moldwin R, Faraday MM. Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome: AUA Guideline Amendment. J Urol. 2015;193(5):1545-1553. Journal of Urology .
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;53(1):60-67. PubMed .
Hanno P, Dmochowski R. Status of International Consensus on Interstitial Cystitis/Bladder Pain Syndrome/Painful Bladder Syndrome: 2008 Snapshot. Neurourol Urodyn. 2009;28(4):274-286. PubMed .
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Interstitial Cystitis (Bladder Pain Syndrome) . National Institutes of Health.
National Library of Medicine (NIH). Interstitial Cystitis/Bladder Pain Syndrome . StatPearls.