Physical Examination

The main goal of examination is to exclude identifiable causes that may be responsible for the patient's symptoms. Abdominal examination is usually normal in IC patients except for occasional suprapubic tenderness. On pelvic examination, identifiable diseases can be recognized or excluded. In female patients, lack of estrogen identified by inspection of atrophic mucosa, may contribute to vaginal pain, dyspareunia, and dysuria. Pelvic floor hypertonicity is suspected if the levator ani muscles are tight or tender to palpation. The urethra should be palpated to check for a mass, tenderness, or expression of pus, because this finding may indicate presence of urethral diverticulum.

Genital prolapse by itself is not usually relevant to the symptoms of IC but may coexist. A rectal examination should assess for other sources of perineal pain such as anal fissure, and the presence of masses. Rectovaginal and bimanual examinations may reveal masses or implants suggestive of endometriosis. In the classic IC patient, palpation of the anterior wall reveals a tender bladder base; pelvic floor muscle spasm and tenderness are also usually found. Occasionally trigger points may be found along the levator ani muscles.

Urinalysis and cultures are required. Urine cytology should also be obtained to rule out the possibility of carcinoma. If hematuria is found, a full urinary tract work-up should be performed to exclude malignancy.

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