Assessing Urgency in Interstitial Cystitis/Painful Bladder Syndrome

Abstract

Objective-Interstitial cystitis/painful bladder syndrome (IC/PBS) at present is a symptom-based diagnosis. The Interstitial Cystitis Symptom Index (ICSI), also known as the O'Leary-Sant Symptom Index, is a widely used scale that assesses the 4 cardinal symptoms of IC/PBS, i.e. bladder pain, urgency, frequency, and nocturia, by asking how often each is experienced. In an ongoing case control study of recent onset IC/PBS, we compared the ICSI to questions that addressed severity of these symptoms.Methods-Recruiting nationally, we enrolled women with IC/PBS symptoms of ≤12 months. We assessed severity of pain, frequency, and urgency by Likert and categorical scales, and how often these symptoms were experienced by the ICSI. We compared these scales by frequency distributions and inter-scale correlations.Results-In 138 women with recent onset IC/PBS, scores for frequency were correlated and for pain appeared to be complementary. However for urgency, the ICSI question of "the strong need to urinate with little or no warning" consistently yielded lower scores than the severity question of "the compelling urge to urinate which is difficult to postpone". Indeed, some patients denied urgency to the ICSI question yet reported intense urgency to the severity question.Conclusions-Compared to the severity question, the ICSI underestimated the prevalence and degree of urgency. This observation is consistent with the views of others that sudden urgency does not define the sensation experienced by many IC/PBS patients. Clarifying this symptom description may assist in developing a usable case definition for IC/PBS.

Voiding urges perceived by patients with interstitial cystitis/painful bladder syndrome

“…Enrollment criteria for cases were women 18 years of age with a syndrome beginning within the previous 12 months that comprised perceived bladder pain and two of frequency, nocturia, and urgency (defined as ''the compelling urge to urinate which is difficult to postpone''). 5 Exclusionary criteria were 12 diseases with similar symptoms 8 and specific neurologic diseases that might be accompanied by a neurogenic bladder. Authorization to obtain medical records from 12 months before symptom onset through any urologic procedures was required for enrollment.…”

“…[2][3][4][5][6] Pain is important and perhaps necessary to diagnose the disease 7 and the sensation usually referred to as urgency is reported commonly by IC/PBS patients. 1,5,8 In a recent editorial, Abrams et al implied a link between these two symptoms in IC/PBS, stating that the urge to void in IC/PBS is to relieve pain. These authors differentiated this from the urge to void in overactive bladder (OAB), which they described as an urge to prevent incontinence.…”

Diagnosis of interstitial cystitis

“…11 As with the UW-IC Scale, Propert and coauthors 10 demonstrated that the ICSI and ICPI were both responsive to change in patients with IC. An interesting finding by Diggs and colleagues 12 was that the ICSI underestimated the degree of urgency in IC patients compared with questioning following the International Continence Society definition.…”

Bladder pain syndrome from urogynecological point of view: a narrative

“…39 Urgency is a characteristic symptom of overactive bladder, but a qualitative difference exists between patients with the 2 conditions. 40,41 Patients with BPS void to avoid or to relieve pain; while OAB patients, void to avoid incontinence. Symptoms of urinary urgency and frequency may precede symptoms of pain.…”