Interstitial Cystitis Differential Diagnoses

Updated: Aug 19, 2022
  • Author: Eric S Rovner, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Diagnostic Considerations

Diagnosing interstitial cystitis remains difficult even more than a century after it was described by Skene, in 1887. No pathognomonic findings exist with regard to patient history, physical examination findings, laboratory findings, or cystoscopy findings. The exclusion of other clinical entities remains the foremost goal of the workup and evaluation of patients thought to have this condition.

A careful, complete, and empathetic history and physical examination are critical. Cystoscopy is an adjunctive, although important, study. The classic Hunner ulcer in the setting of a small-capacity bladder (ie, assessed under anesthesia) is rarely seen to confirm the diagnosis with certainty. Until interstitial cystitis is defined completely or a definitive marker becomes universally available, the diagnosis remains one of exclusion.

The differential diagnosis of urinary frequency, urgency, and/or pain includes the following types of conditions:

  • Infectious or inflammatory
  • Gynecologic
  • Urologic
  • Neurologic

Infectious or inflammatory conditions to consider include the following:

  • Recurrent urinary tract infection (UTI)
  • Urethral diverticulum
  • Infected Bartholin gland or Skene gland
  • Vulvovestibulitis
  • Tuberculous/eosinophilic cystitis
  • Vaginitis (eg, bacterial, viral [eg, herpes])
  • Schistosomiasis

Gynecologic causes to consider include the following:

  • Pelvic malignancy or mass (eg, fibroid, endometrioma)
  • Endometriosis
  • Mittelschmerz
  • Pelvic inflammatory disease
  • Genital atrophy

Urologic causes to consider include the following:

  • Bladder cancer or carcinoma in situ (CIS)
  • Radiation cystitis
  • Overflow incontinence
  • Acontractile detrusor
  • Prostatodynia
  • Chronic pelvic pain syndrome
  • Bladder outlet obstruction (eg, urinary retention with overflow incontinence)
  • Large postvoid residual volume
  • Open bladder neck (eg, intrinsic sphincteric deficiency, urolithiasis, urethritis)

Neurologic causes to consider include the following:

  • Neurogenic detrusor overactivity
  • Parkinson disease
  • Lumbosacral disk disease
  • Spinal stenosis
  • Spinal tumor
  • Multiple sclerosis
  • Cerebrovascular accident

Other possible diagnoses to consider include the following:

  • Dysfunctional voiding
  • Vulvodynia
  • Pelvic floor myalgia
  • Degenerative joint disease
  • Hernia
  • Inflammatory bowel disease
  • Gastrointestinal neoplasm
  • Diverticulitis
  • Adhesions from prior surgery

Clinically, the practitioner is somewhat obligated to consider these potential alternative diagnoses prior to diagnosing interstitial cystitis. The implications of a diagnosis of interstitial cystitis are profound in that it is a chronic condition without universally effective therapy.