Editing CUA: Interstitial Cystitis (2016) (section)

==== History and Physical Exam ====

===== History =====
* '''<span style="color:#ff0000">Signs and Symptoms'''
**'''<span style="color:#ff0000">Characteristic presentation includes a combination of pain, frequency, nocturia, and urgency'''
*** '''<span style="color:#ff0000">Pelvic pain is the main descriptor of IC/BPS'''
**** '''Pain that occurs only during voiding is not consistent with IC/BPS'''
***** Vulvar disorders, which cause pain when urine makes contact with the vulva, should instead be considered
**** In early or milder IC/BPS, patients may not describe frank pain, but rather describe sensations of “pressure,” “burning,” “sharp,” or “uncomfortable sensation of having to urinate.” Typically, this sensation is felt in the supra-pubic area, but it can be referred to areas located in the pelvis, including the urethra, vagina, labia, inguinal area, perineum, and/or lower abdomen or back
*** '''Frequency is the most common presenting symptom i.e. patients seek medical attention for frequency, not the pain'''
** '''Patients may describe periods of worsening symptoms, which may be triggered''' by stress, intercourse, menses, or consumption of coffee, alcohol, citrus fruits, tomatoes, carbonated beverages, and spicy foods
*** '''Symptoms of IC/BPS are generally worse a few days prior to menses, in contrast to endometriosis, which is worse during menses'''

===== Physical Exam =====
* '''<span style="color:#ff0000">Abdominal and pelvic exam</span>''', with particular focus on looking for masses, bladder distension, hernias, and tenderness.
** '''The female pelvic exam should screen for vulvodynia, vaginitis, atrophic changes, prolapse, cervical pathology, and adnexal masses or tenderness'''.
*** Point tenderness, a mass, and expression of pus on palpation of the urethra are classic signs of a urethral diverticulum.
* '''<span style="color:#ff0000">Digital rectal examination in males is essential</span>'''
* '''<span style="color:#ff0000">A musculoskeletal and focused neurological exam may also be contributory</span>'''.
** Although there is no physical finding specific to patients with IC/BPS, suprapubic tenderness and bladder neck point tenderness, in both males and females, is very often noted.
** In males, tenderness may be elicited by palpating the perineal area between the scrotum and anus
** In females, palpating the anterior vaginal wall along the course of the urethra up to the bladder neck may elicit pain.
* '''<span style="color:#ff0000">Palpation of the levator muscles</span>''' in both sexes, looking for tenderness, spasm/tight bands, and/or trigger points, is important for both diagnosis and treatment recommendations
** '''Pelvic floor or rectal spasms may respond well to pelvic floor physiotherapy'''.
** Hypo or hypersensitivity of the perineum, in combination with a weak or absent anal reflex, may suggest pudendal nerve entrapment.