What referral criteria should I consider for patients with suspected interstitial cystitis who do not respond to initial management?

For patients with suspected interstitial cystitis who do not respond to initial management, referral to an appropriate specialist (urologist, urogynaecologist, or nephrologist) should be considered ¹,².

Key referral criteria include:

• Persistent bladder or urethral pain: This is a primary indication for referral, with urgent referral if cancer is suspected ¹,²,³.
• Failure of non-specialist management: Referral is indicated when non-specialist management is failing or chronic pain is poorly controlled ⁵. Initial management typically involves lifestyle advice (e.g., weight loss, fluid modification, caffeine reduction, smoking cessation), bladder training, and pelvic floor muscle training ¹,²,³.

Other associated symptoms that warrant specialist referral include:

• Voiding difficulty ¹,²,³.
• A history of chronic urinary retention ¹,².
• A bladder that is palpable on abdominal or bimanual examination after voiding ¹,²,³.
• A clinically benign pelvic mass ¹,²,³.
• Associated faecal incontinence ¹,²,³.
• Suspected neurological disease ¹,²,³.
• Suspected urogenital fistulae ¹,²,³.
• A history of previous incontinence surgery, pelvic cancer surgery, or radiation therapy ¹,²,³.