Diagnosing interstitial cystitis in women with chronic pelvic pain

OBJECTIVE: To evaluate the Interstitial Cystitis Symptom Index and Problem Index as a screening tool for interstitial cystitis, and to estimate the prevalence and risk factors for interstitial cystitis in women with chronic pelvic pain. METHODS: Forty-five women scheduled to undergo laparoscopy for chronic pelvic pain were recruited. Women were questioned about lower urinary tract symptoms, administered the Interstitial Cystitis Symptom Index and Problem Index, and rated pain symptoms on a 0-10 visual analogue scale. Cystoscopy with hydrodistension and bladder biopsy was performed at the time of laparoscopy. Interstitial cystitis was diagnosed if women had a combination of: 1) urgency, 2) frequency or nocturia, and 3) positive cystoscopic findings. RESULTS: Seventeen women (38%) were diagnosed with interstitial cystitis. A score of 5 or more on the Symptom Index had 94% sensitivity (95% confidence interval [CI] 71%, 99.8%) and 93% negative predictive value (95% CI 68%, 99.8%) in diagnosing interstitial cystitis. On multivariable analysis, an elevated Symptom Index score of 5 or more (odds ratio [OR] 9.4; 95% CI 1.01, 88.1) and an elevated dyspareunia score of 7 or more (OR 5.5; 95% CI 1.10, 27.1) were risk factors for interstitial cystitis. CONCLUSION: In our sample of women with chronic pelvic pain, the prevalence of interstitial cystitis was 38%. The Interstitial Cystitis Symptom Index was a useful screening tool. Independent risk factors for the diagnosis of interstitial cystitis were an elevated Symptom Index score and an elevated dyspareunia pain score. For women with chronic pelvic pain, screening for interstitial cystitis should be performed. (C) 2002 by The American College of Obstetricians and Gynecologists.