The Pelvic Pain and Urgency/Frequency (PUF) Questionnaire1 and the O'Leary-Sant IC Symptom and Problem Index2 are IC-symptom screening tools a patient can self-administer. Either of these tools may help you identify the presence of IC during an initial consultation with a patient.

The Pelvic Pain and Urgency/Frequency (PUF) Questionnaire1

Patients' responses to questions concerning voiding problems, persistent pelvic pain, and pain during or after sexual intercourse are weighed to determine the intensity of symptoms.

IC should be considered if a patient records a PUF score of ≥10,*1 although lower scores may indicate IC in patients who

• Are early in the course of the disease  
• Have a mild case of the disease  
• Are not sexually active

A study by Parsons et al showed PUF scores ≥10 correlated with positive PST*1

*Although patients with IC are likely to have higher PUF scores, the questionnaire cannot exclude other conditions with similar symptoms and is not sufficient to diagnose IC independent of medical history, physical examination, and appropriate diagnostic measures.

O'Leary-Sant IC Symptom and Problem Index2

The O'Leary-Sant Interstitial Cystitis Symptom and Problem Index Questionnaire can also be used to assess a potential IC patient and is used by some IC treaters, mostly in urology practices. This questionnaire focuses on voiding symptoms but is limited by not quantifying frequency or impact on patient lifestyle and quality of life. A score of ≥6 on the index increases suspicion of IC.2

As with the PUF Questionnaire, the O'Leary-Sant Questionnaire can be placed at the front desk for self-administration before the visit, or a nurse can administer the questionnaire to the patient.

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Reprinted from Urology, Vol 49, O'Leary MP, Sant GR, Fowler FJ Jr, Whitmore KE, Spolarich-Kroll J, The interstitial Cystitis Symptom Index and Problem Index, Page 62, Copyright 1997, with permission from Elsevier.

Important Safety Information

• Contraindications: ELMIRON® is contraindicated in patients with known hypersensitivity to the drug, structurally related compounds, or excipients
• Anticoagulant Activity: ELMIRON® is a weak anticoagulant (blood thinner) which may increase bleeding. Patients undergoing invasive surgery or having signs/symptoms of underlying coagulopathy or other increased risk of bleeding (due to anticoagulant therapy or high doses of anti-inflammatory drugs) should be evaluated for the risk of hemorrhage
• Alopecia: In clinical trials of ELMIRON®, alopecia began within the first 4 weeks of treatment. Ninety-seven percent (97%) of the cases of alopecia reported were alopecia areata, limited to a single area on the scalp
• Use in Pregnancy: ELMIRON® is a Pregnancy Category B drug
• Most Common Adverse Reactions (frequency 1% to 4%): Alopecia (4%), diarrhea (4%), nausea (4%), headache (3%), rash (3%), dyspepsia (2%), abdominal pain (2%), liver function abnormalities (1%), dizziness (1%)

References:
1. Parsons CL, Dell J, Stanford EJ, et al. Increased prevalence of interstitial cystitis: previously unrecognized urologic and gynecologic cases identified using a new symptom questionnaire and intravesical potassium sensitivity. Urology. 2002;60:573-578.
2. O'Leary MP, Sant GR, Fowler FJ Jr, Whitmore KE, Spolarich-Kroll J. The interstitial cystitis symptom index and problem index. Urology. 1997;49(suppl 5A):58-63.

Although there is currently no definitive diagnostic test for IC, several diagnostic tools are available. Three common procedures are described below, and the advantages and disadvantages of each are examined.

Intravesical anesthetic challenge

Instillation of an anesthetic solution into the bladder to assess resolution of pain1

• Pros: localization of the bladder as the source of pain2; simple procedure performed in the office
• Cons: patients without pain at the time of testing cannot be assessed; may lack specificity due to local absorption of the anesthetic in a nearby location3; "rebound" pain may occur once the anesthetic solution has worn off1,3

Potassium sensitivity test (PST)

Instillation of a potassium solution into the bladder to provoke symptoms of IC4

• Pros: localization of the bladder as the source of pain; detects abnormal bladder epithelial permeability5; simple procedure performed in the office
• Cons: potential to provoke pain and may be uncomfortable for the patient; lacks specificity, particularly in patients with acute urinary tract infection and radiation cystitis6

Cystoscopy ± hydrodistention

Visual examination of the bladder for characteristic IC findings:
Hunner's ulcer and/or glomerulations (petechial hemorrhages)7

• Pros: historically considered the diagnostic gold standard; if positive, serves as visual documentation to support clinical suspicion of IC; biopsy can be performed to rule out bladder cancer
• Cons: requires general or spinal anesthesia (when combined with hydrodistention); glomerulations are not specific for IC8; absence of characteristic findings does not exclude IC9

Important Safety Information

• Contraindications: ELMIRON® is contraindicated in patients with known hypersensitivity to the drug, structurally related compounds, or excipients
• Anticoagulant Activity: ELMIRON® is a weak anticoagulant (blood thinner) which may increase bleeding. Patients undergoing invasive surgery or having signs/symptoms of underlying coagulopathy or other increased risk of bleeding (due to anticoagulant therapy or high doses of anti-inflammatory drugs) should be evaluated for the risk of hemorrhage
• Alopecia: In clinical trials of ELMIRON®, alopecia began within the first 4 weeks of treatment. Ninety-seven percent (97%) of the cases of alopecia reported were alopecia areata, limited to a single area on the scalp
• Use in Pregnancy: ELMIRON® is a Pregnancy Category B drug
• Most Common Adverse Reactions (frequency 1% to 4%): Alopecia (4%), diarrhea (4%), nausea (4%), headache (3%), rash (3%), dyspepsia (2%), abdominal pain (2%), liver function abnormalities (1%), dizziness (1%)

References:
1. Moldwin R, Brettschneider N. The use of intravesical anesthetics to aid in the diagnosis of interstitial cystitis. Poster presented at: Research Insights Into Interstitial Cystitis: A Basic and Clinical Science Symposium; October 30-November 1, 2003; Alexandria, VA.
2. Moldwin RM, Sant GR. Interstitial cystitis: a pathophysiology and treatment update. Clin Obstet Gynecol. 2002;45:259-272.
3. Rosenberg MT, Moldwin RM, Stanford EJ. Early diagnosis and management of interstitial cystitis: what nonspecialists should know. Womens Health Gynecol Edition. 2005;5:108-115.
4. Parsons CL. Potassium sensitivity test. Tech Urol. 1996;2:171-173.
5. Parsons CL, Greenberger M, Gabal L, Bidair M, Barme G. The role of urinary potassium in the pathogenesis and diagnosis of interstitial cystitis. J Urol. 1998;159:1862-1867.
6. Teichman JMH. Potassium sensitivity testing in the diagnosis and treatment of interstitial cystitis. Infect Urol. 2003;16:87-94.
7. Hanno PM. Interstitial cystitis and related disorders. In: Walsh PC, ed-in-chief; Retik AB, Vaughan ED Jr, Wein AJ, eds; Kavoussi LR, Novick AC, Partin AW, Peters CA, associate eds. Campbell's Urology. Vol 1. 8th ed. Philadelphia, PA: Saunders; 2002:631-670.
8. Waxman JA, Sulak PJ, Kuehl TJ. Cystoscopic findings consistent with interstitial cystitis in normal women undergoing tubal ligation. J Urol. 1998;160:1663-1667.
9. Hanno PM, Landis JR, Matthews-Cook Y, Kusek J, Nyberg L Jr, and the Interstitial Cystitis Database Study Group. The diagnosis of interstitial cystitis revisited: lessons learned from the National Institutes of Health Interstitial Cystitis Database Study. J Urol. 1999;161:553-557.