History and exam

Key diagnostic factors

common

food or stress triggers

Specific foods and emotional or physical stress may exacerbate symptoms in some patients.

urinary urgency

Most patients report having a strong urge to urinate, with potential loss of control not uncommon.

urinary frequency

Patients may report urinating more than 12 times per 24 hours. The average is considered to be 5 to 8 times in 24 hours with no voids at night.

Emptying the bladder frequently is associated with a decrease in pain.

urinary incontinence

Up to 30% of patients may experience involuntary loss of urine.[35]

nocturia

Patients may report urinating more than twice during the night.

dysuria

Many patients complain of painful urination.

pelvic-floor pain

Most patients report pain in the pelvic-floor area, including the pelvic diaphragm, perineum, and suprapubic region. Found in up to 50% of cases.[18]

Pain is associated with bladder filling and/or emptying and may be mild to debilitating.

dyspareunia

Many women complain of pain/discomfort during intercourse.

worsening of symptoms before menses

Women often report increased severity of symptoms in the days before the onset of menses.

urethral pain

Pain to the anterior vaginal wall underneath the female urethra may be noted on bimanual pelvic exam.

bladder neck pain

Pain to the area of the anterior vaginal wall may be noted on bimanual pelvic exam.

suprapubic pain

Pain to the body of the bladder above the pubic symphysis is common on bimanual pelvic exam.

levator ani pain

Pain to either the pubococcygeus or iliococcygeus muscle to the lateral side of the vaginal side wall (at 5 and 7 o'clock positions) may be noted on bimanual pelvic exam.

pain after placement of Foley catheter

Severe, unrelenting pain after the placement of a Foley catheter may be noted on bimanual pelvic exam.

Other diagnostic factors

common

fibromyalgia

Found in 20% of cases.[23][24]

vulvar vestibulitis

Found in 25% of cases.[7][24][25]

vulvodynia

Found in 25% of cases.[25]

features of systemic lupus erythematosus

30 times more common than in the general population.[7][24]

migraine

Found in up to 20% of cases.[26]

features of rheumatoid arthritis

Some patients have an associated autoimmune rheumatic disease. Conversely, many patients with autoimmune rheumatic diseases have either a painful or overactive bladder.[27]

features of chronic fatigue syndrome

Unknown etiology but suspected to be multifactorial and autoimmune in most instances, affecting over 1 million American and European men and women.[27]

allergies

Asthma and other allergy-mediated diseases are more common.[28]

Environmental allergies are more than 3 times more common.[36]

Inflammatory sinus problems are more prevalent, although etiology is unknown.[37]

90% of patients may encounter exacerbations of their symptoms related to certain food intolerances/allergies.[36]

sexual/domestic abuse

Up to 68% of patients may have experienced sexual abuse, 49% may have experienced domestic violence, and 78% may encounter physical abuse in their home and family.[18][19]

uncommon

scrotal or anal pain

May occur in male patients.

Risk factors

strong

age 20 to 60 years

The most common age range for presentation is 20 to 60 years. Mean age of presentation is 45 to 50 years.[11] However, occurrences in children have been rarely reported.[16]

female sex

The diagnosis is 5 times more likely in females than in males.[11]

positive family history

While not traditionally considered an inherited condition, incidence in identical twins was higher than that in fraternal twins, which may indicate a genetic association.[17]

weak

sexual or domestic abuse

Recent studies demonstrate up to 68% of patients may have experienced sexual abuse. Also 49% may experience domestic violence, and 78% may encounter physical abuse in their home and family.[18][19]

white ethnicity

Some studies suggest IC/BPS is more common among white people.[10]​[13]​

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