Diagnostic Pathway for Women

How to diagnose IC/BPS in women

IC/BPS is a diagnosis of exclusion requiring systematic evaluation, and women make up the overwhelming majority of cases. Following a structured diagnostic pathway reduces a woman's time to diagnosis and prevents unnecessary antibiotic courses and invasive procedures.

Diagnostic Pathway for Women

A structured approach to diagnosing women with IC/BPS

01

Symptom Assessment

Apply validated tools: ICSI/ICPI (IC Symptom/Problem Index), PUF score, and O'Leary-Sant questionnaire with the woman presenting. Minimum 6 weeks of symptoms required for diagnosis.

ICSI/ICPIPUF ScoreO'Leary-Sant
02

Urinalysis & Culture

Exclude bacterial UTI via midstream urine culture. IC/BPS diagnosis requires absence of infection. Microscopic hematuria warrants upper tract imaging and cystoscopy.

MSU CultureUrinalysisUrine Cytology
03

Cystoscopy ± Hydrodistension

Identify Hunner lesions (present in ~10% of IC/BPS) or glomerulations post-hydrodistension. Biopsy if lesions seen. Rules out carcinoma in situ.

CystoscopyHydrodistensionBiopsy if indicated
04

Potassium Sensitivity Test

Intravesical KCl test demonstrates urothelial permeability. A positive result supports IC/BPS diagnosis and predicts response to GAG-layer therapies.

Intravesical KClPain/Urgency Score
05

Differential Exclusion

Exclude endometriosis, pelvic floor dysfunction, pudendal neuralgia, bladder malignancy, radiation cystitis — conditions that commonly co-occur or overlap in women. Multidisciplinary assessment recommended.

Pelvic USSUrodynamicsLaparoscopy if needed
06

Diagnosis & Classification

Apply GIBBS guideline criteria for IC/BPS diagnosis. Classify as Hunner-type vs. non-Hunner-type. Begin treatment ladder with PPS therapy accordingly.

GIBBS GuidelineHunner ClassificationMISSED Framework

ESSIC Diagnostic Criteria

  • 1.Chronic pelvic pain, pressure, or discomfort perceived to be related to the urinary bladder
  • 2.At least one other urinary symptom: persistent urgency or increased urinary frequency
  • 3.Duration of symptoms for more than 6 weeks
  • 4.Absence of confusable diseases (infection, malignancy, urolithiasis, urethral diverticulum)
  • 5.NIDDK criteria: Glomerulations on cystoscopy OR Hunner's lesions AND pain with bladder filling or urgency

Red Flags — Refer Urgently

  • Haematuria in women (visible or non-visible) — exclude malignancy first
  • Symptoms in women over 50 with smoking history — bladder cancer risk
  • New symptoms in women post-pelvic radiotherapy — radiation cystitis or fistula
  • Rapidly worsening symptoms in women — may indicate advanced pathology