Urogynecology Expert Forum
interstitial cystitis vs. overactive bladder
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Questions in the Urogynecology forum are answered by Bruce Crawford, MD, J. Kyle Mathews, MD, and other medical professionals and experts. Topics covered include overactive bladders, bladder pain, fallen/drooping bladder, bowel urgency, bowel prolapse, cystitis, incontinence, pain with intercourse, rectal prolapse, surgery, urinary urgency, and uterine prolapse.

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interstitial cystitis vs. overactive bladder

Dear Doctor,

I have recently been diagnosed with IC and vulvodynia, however, I am unsure if the IC diagnosis is correct. I have never had any pain with urination but have urgency and frequency of urination. I kept a log of how often I went to the restroom for my gynecologist and found that I have to urinate about every 15 minutes for over an hour if I drink a 32oz bottle of water. I tried the same thing with a 32oz bottle of water with lemon juice and found the same results. I originally went to my doctor thinking I had overactive bladder, but she thought IC was more likely. I have mentioned to her several times that I do not have any pain during urination.  I was wondering if there are any tests that can be done to determine which of these conditions-if any- that I have.  Thank you so much for your time and any help that you might be able to give me.

-Katie
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HI Katie,


Great question,

Here is the thing.  IC is a diagnosis generally assigned to patients without use of the the strick diagnostic criteria outlined by athorative bodies such as the NIDDM (http://kidney.niddk.nih.gov/kudiseases/pubs/interstitialcystitis/#diagnosis).  


How is IC/PBS diagnosed?
Because symptoms are similar to those of other disorders of the bladder and there is no definitive test to identify IC/PBS, doctors must rule out other treatable conditions before considering a diagnosis of IC/PBS. The most common of these diseases in both sexes are urinary tract infections and bladder cancer. In men, common diseases include chronic prostatitis or chronic pelvic pain syndrome. In women, endometriosis is a common cause of pelvic pain. IC/PBS is not associated with any increased risk of developing cancer.
The diagnosis of IC/PBS in the general population is based on the
• presence of pain related to the bladder, usually accompanied by frequency and urgency of urination
• absence of other diseases that could cause the symptoms
Diagnostic tests that help rule out other diseases include urinalysis, urine culture, cystoscopy, biopsy of the bladder wall and urethra, and distention of the bladder under anesthesia.

The fact is at least half of community dwelling women with complaints of urinary frequency/urgency don’t have an “overactive bladder”  i.e. unwanted bladder contractions.  Just as common is a hypersensory state or “early sensory response to filling” that cause patients to void more frequently and sometimes with concern that they will not make it to the bathroom quickly enough.  Although pain is an essential element in the diagnosis if IC/Painful Bladder Syndrome it is not generally during urination but rather between voids or after intercourse that these patients describe a central burning sensation above the pubic bone.  

Dietary factors can play an important role in IC/PBS.   Caffeine,  alcohol, carbonated drinks, spicy foods, and possibly non-steroidal anti-inflammatory medications may contribute to the hypersensory state in some individuals.   Talk to your doctor about an elimination diet if you think that dietary factors may be making the frequency problem worse.  There are numerous medications and physiotherapy treatments that may be helpful as well that your doctor should discuss with you.  Good luck
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