What are the key diagnostic criteria for interstitial cystitis (bladder pain syndrome) in primary care?

In primary care, the approach to interstitial cystitis (bladder pain syndrome) primarily involves identifying key symptoms, ruling out other conditions, and determining the need for specialist referral, as definitive diagnostic criteria for primary care are not explicitly detailed in the provided UK guidelines ¹,²,⁴.

Key considerations for primary care include:

• Persistent Bladder or Urethral Pain: This is a central symptom that warrants consideration for referral to an appropriate specialist, such as a urologist, urogynaecologist, or nephrologist ¹,²,⁴. Urgent referral is indicated if cancer is suspected ¹,².
• Exclusion of Urinary Tract Infection (UTI): It is crucial to rule out active UTIs, as bladder pain can be a symptom of infection ¹,²,⁷.
• Assessment for 'Red Flag' Indicators: Healthcare professionals must assess for signs and symptoms that may indicate bladder cancer, necessitating a suspected cancer pathway referral. These include unexplained visible haematuria in individuals aged 45 and over, or persistent/recurrent visible haematuria after successful UTI treatment ¹,²,⁵. For those aged 60 and over, unexplained non-visible haematuria with dysuria or a raised white cell count also warrants referral ¹,²,⁵. Recurrent or persistent unexplained UTIs in women aged 60 and over should also prompt consideration for non-urgent referral for bladder cancer ¹,²,⁵.
• Other Referral Criteria: Referral to a specialist is also indicated for other concerning symptoms or findings, such as voiding difficulty, a history of chronic urinary retention, a bladder palpable on abdominal or bimanual examination after voiding, a clinically benign pelvic mass, associated faecal incontinence, suspected neurological disease, suspected urogenital fistulae, or a history of previous incontinence surgery, pelvic cancer surgery, or radiation therapy ¹,²,⁴.
• Initial Primary Care Assessments: If referral is not immediately indicated, ensuring the woman completes a bladder diary is recommended for initial assessment ¹,²,⁴. Lifestyle advice, including weight loss, modifying fluid intake, caffeine reduction, and smoking cessation, may also be offered ¹,².

While bladder symptoms can be common in conditions like Irritable Bowel Syndrome (IBS) and may support an IBS diagnosis, they are not specific diagnostic criteria for interstitial cystitis ³. The primary care role is largely to identify persistent pain, exclude other common causes, screen for serious conditions, and facilitate specialist assessment for definitive diagnosis and management of bladder pain syndromes ¹,²,⁴.