Diagnosing Interstitial Cystitis: The First Challenge
Diagnosing interstitial cystitis can be difficult, and it often takes patients years to be correctly diagnosed. IC remains a condition diagnosed by exclusion - it's defined as the presence of pelvic pain and pressure, accompanied by urinary symptoms, in the absence of any other discernible cause. Urinary tract infections, bladder cancer, and STDs are often tested for prior to a patient receiving an IC diagnosis, and estimates show that nearly 90% of patients remain undiagnosed. Even worse, the months or years it takes to diagnose can prevent patients from getting help while the condition is relatively new and easier to treat.
Researchers have been very active in this area, trying to find a way to conclusively diagnose IC, without the long wait or a series of painful (and often useless!) tests like the postassium sensitivity test or cystoscopy.
Urine Markers to Diagnose Interstitial Cystitis
One of the most promising areas of research has been into urine markers - compounds that are found in the urine that can be detected with a simple urinalysis, rather than invasive bladder procedures. A recent review article from researchers at Winthrop University Hospital, Tufts School of Medicine, and the State University of New York has summarized recent progress in this area.
They've concluded that a specific urinary marker, known as antiproliferative factor (APF), is the most promising out of the dozens that have been evaluated.
A good marker has to do two things - be both highly sensitive and highly specific.
Correctly diagnose the vast majority of IC cases - The test must be sensitive enough to catch almost all cases. This is known as 'high sensitivity.'
Avoid too many false positives - The marker must be specific to IC cases, so it doesn't mis-diagnose many patients (this is a major issue with both the potassium sensitivity test and a cystoscopy looking for red spots in the bladder). This is known as 'high specificity.'
While more research remains to be done to test that this marker meets those criteria, initial results have certainly been promising. The hope is that - one day - IC will be just as easy to diagnose as a simple UTI, allowing patients to begin getting treatment and help almost immediately.
Dr. Nicole Cozean is the founder of PelvicSanity physical therapy, Orange County's premier pelvic floor physical therapy clinic. One of only 270 PTs to be board-certified in the pelvic floor, and the first PT to serve on the ICA Board of Directors, Nicole is the author of the acclaimed and best-selling book The Interstitial Cystitis Solution (2016). She is an adjunct professor at her alma mater, Chapman University. The PelvicSanity blog focuses on presenting practical, positive information to help patients beyond the walls of Nicole's clinic.