International Urogynecology Journal

, Volume 24, Issue 8, pp 1295–1301 | Cite as

Pain in interstitial cystitis/bladder pain syndrome: do characteristics differ in ulcerative and non-ulcerative subtypes?

  • Kim A. Killinger
  • Judith A. Boura
  • Kenneth M. Peters
Original Article


Introduction and hypothesis

Key differences between interstitial cystitis/bladder pain syndrome (IC/BPS) subtypes (with and without Hunner’s ulcer) have been noted. We hypothesized that pain characteristics in women grouped by IC/BPS subtype would differ.


A survey was mailed to 749 women to assess IC/BPS pain and other characteristics. Cystoscopy/hydrodistention reports were reviewed for presence/absence of Hunner’s ulcer. The McGill Pain Questionnaire Short Form© (MPQ-SF), Brief Pain Inventory (BPI), and Interstitial Cystitis Symptom and Problem Indices (ICSI-PI) assessed symptoms. Data were analyzed with Pearson’s chi-square, Fisher’s exact, t tests, and Wilcoxon rank tests.


Of the 214 women that returned a survey (36 ulcerative and 178 non-ulcerative IC/BPS), similar proportions in each group reported that certain foods, exercise, and/or stress triggered symptoms. Fewer ulcerative patients reported pain with vaginal penetration than non-ulcerative (5/33, 15.2 % vs 76/160, 47.5 %; p = 0.0006). On the BPI, the ulcerative and non-ulcerative groups reported similar numbers of painful areas (mean 4.1 ± 6.1 and 4.1 ± 3.8; p = 0.33), and lower abdominal/pelvic pain was reported most (13/35, 37 % vs 79/172, 46 %; p = 0.34) followed by lower back pain (12/35, 34 % vs 69/172, 40 %; p = 0.52). Even though ICSI-PI, MPQ-SF, and BPI scores/responses did not differ, on the MPQ-SF the three words most frequently used by ulcerative patients to describe their pain were sharp, stabbing, and hot burning, and in non-ulcerative were aching, cramping, and tender.


These measures did not reveal any significant differences in pain between subtypes. More research is needed in larger samples to determine whether differences exist.


Cystitis, interstitial Pelvic pain Ulcer 



Philanthropic funding was provided by Ministrelli Program for Urology Research and Education (MPURE).

Conflicts of interest



  1. 1.
    Rodríguez MA, Afari N, Buchwald DS et al (2009) Evidence for overlap between urological and nonurological unexplained clinical conditions. J Urol 182:2123–2131PubMedCrossRefGoogle Scholar
  2. 2.
    Peeker R, Fall M (2002) Toward a precise definition of interstitial cystitis: further evidence of differences in classic and nonulcer disease. J Urol 167:2470–2472PubMedCrossRefGoogle Scholar
  3. 3.
    Fitzgerald MP, Brensinger C, Brubaker L, Propert K, ICDB Study Group (2005) What is the pain of interstitial cystitis like? Int Urogynecol J Pelvic Floor Dysfunct 17:69–72PubMedGoogle Scholar
  4. 4.
    Peters KM, Killinger KA, Mounayer MH, Boura JA (2011) Are ulcerative and nonulcerative interstitial cystitis/painful bladder syndrome 2 distinct diseases? A study of coexisting conditions. Urology 78(2):301–308PubMedCrossRefGoogle Scholar
  5. 5.
    Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, van Kerrebroeck P, Victor A, Wein A et al (2002) The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 21:167–178PubMedCrossRefGoogle Scholar
  6. 6.
    Melzack R (1987) The short-form McGill Pain Questionnaire. Pain 30:191–197PubMedCrossRefGoogle Scholar
  7. 7.
    Keller S, Bann CM, Dodd SL, Schein J, Mendoza T, Cleeland C (2004) Validity of the Brief Pain Inventory for use in documenting the outcomes of patients with noncancer pain. Clin J Pain 20:309–316PubMedCrossRefGoogle Scholar
  8. 8.
    O’Leary MP, Sant GR, Fowler FJ Jr, Whitmore KE, Spolarich-Kroll J (1997) The interstitial cystitis symptom index and problem index. Urology 49(5A Suppl):58–63PubMedCrossRefGoogle Scholar
  9. 9.
    Braunstein R, Shapiro E, Kaye J, Moldwin R (2008) The role of cystoscopy in the diagnosis of Hunner’s ulcer disease. J Urol 180:1383–1386PubMedCrossRefGoogle Scholar
  10. 10.
    Koziol JA, Adams HP, Frutos A (1996) Discrimination between the ulcerous and the nonulcerous forms of interstitial cystitis by noninvasive findings. J Urol 155:87–90PubMedCrossRefGoogle Scholar
  11. 11.
    Tomaszewski JE, Landis JR, Russack V, Williams TM, Wang LP, Hardy C, Brensinger C, Matthews YL, Abele ST, Kusek JW, Nyberg LM, Interstitial Cystitis Database Study Group (2001) Biopsy features are associated with primary symptoms in interstitial cystitis: results from the interstitial cystitis database study. Urology 57(6 Suppl 1):67–81PubMedCrossRefGoogle Scholar
  12. 12.
    Peeker R, Aldenborg F, Fall M (1998) The treatment of interstitial cystitis with supratrigonal cystectomy and ileocystoplasty: difference in outcome between classic and nonulcer disease. J Urol 159:1479–1482PubMedCrossRefGoogle Scholar
  13. 13.
    Warren JW, Langenberg P, Greenberg P, Diggs C, Jacobs S, Wesselmann U (2008) Sites of pain from interstitial cystitis/painful bladder syndrome. J Urol 180:1373–1377PubMedCrossRefGoogle Scholar
  14. 14.
    Peters KM, Carrico DJ, Kalinowski SE, Ibrahim IA, Diokno AC (2007) Prevalence of pelvic floor dysfunction in patients with interstitial cystitis. Urology 70:16–18PubMedCrossRefGoogle Scholar
  15. 15.
    Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, Monga A, Petri E, Rizk DE, Sand PK, Schaer GN (2010) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J 21:5–26PubMedCrossRefGoogle Scholar
  16. 16.
    Simon LF, Landis JR, Erickson DR, Nyberg LM (1997) The Interstitial Cystitis Data Base Study: concepts and preliminary baseline descriptive statistics. Urology 49(5A Suppl):64–75PubMedCrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2012

Authors and Affiliations

  • Kim A. Killinger
    • 1
  • Judith A. Boura
    • 1
    • 2
  • Kenneth M. Peters
    • 1
    • 2
  1. 1.William Beaumont HospitalRoyal OakUSA
  2. 2.Oakland University William Beaumont School of MedicineRochesterUSA

Personalised recommendations