2026 Urogynecology for the Advanced Practice Provider-Urine Trouble: Tips and Tricks for Diagnosing and Managing Interstitial Cystitis and Painful Bladder Syndrome

Urine Trouble: Tips and Tricks for Diagnosing and Managing Interstitial Cystitis and Painful Bladder Syndrome

Video Transcription

Video Summary

Dr. Fields, an associate professor and program director at OHSU, delivered a practical overview of interstitial cystitis (IC) and bladder pain syndrome. He emphasized that IC is a diagnosis of exclusion with no single definitive test, so careful history-taking, bladder diaries, pelvic exam, urinalysis/culture, and post-void residual testing are essential. He highlighted common overlapping or mimicking conditions, including UTI, overactive bladder, urethral diverticulum, pelvic floor myalgia, vulvodynia, and especially endometriosis, which may coexist frequently.<br /><br />He explained proposed mechanisms such as bladder lining dysfunction, mast cell activation, and central sensitization. Treatment starts with education and behavioral changes, including avoiding bladder irritants, then progresses to pelvic floor physical therapy and medications such as antihistamines and tricyclic antidepressants. Other options include bladder instillations, cystoscopy with hydrodistension, Botox, neuromodulation, cyclosporine, and, rarely, surgery. He also noted supportive approaches like hypnosis, mindfulness, acupuncture, and the importance of setting realistic expectations and using multidisciplinary care.<br /><br />In Q&A, he discussed low-acid coffee, Prelief, and explained that methenamine is used more often for recurrent UTI than IC, with concern for vulvar irritation.

Asset Subtitle

Learning Objectives:

Identify the common presenting signs of interstitial cystitis and painful bladder syndrome.
Describe the diagnoses that may overlap or co-exist with interstitial cystitis and painful bladder syndrome.
Explain the treatment algorithm for interstitial cystitis and painful bladder syndrome and describe the mechanisms of action and side effects of various treatments.

Speaker: Ian Fields, MD, MCR

Keywords

interstitial cystitis

bladder pain syndrome

diagnosis of exclusion

pelvic floor physical therapy

endometriosis

bladder instillations

multidisciplinary care