How to differentiate hormonal bladder symptoms from IC and pelvic floor pain

In this video, Aleece Fosnight, MSPAS, PA-C, CSC-S, CSE, IF, MSCP, HAES, the founder of the Fosnight Center for Sexual Health and a medical advisor for Aeroflow Urology, explains how clinicians can differentiate hormonally mediated bladder symptoms from overlapping conditions such as interstitial cystitis/bladder pain syndrome (IC/BPS) and pelvic floor dysfunction, which often coexist and fluctuate with the menstrual cycle.

Fosnight emphasizes that timing is one of the most valuable diagnostic clues. Symptoms that reliably flare during the late luteal phase and resolve after menstruation are more suggestive of a hormonal etiology. In contrast, symptoms that vary widely or are triggered by food, stress, sexual activity, bladder filling, or relieved by voiding are more consistent with IC/BPS.

Pain characteristics also help guide clinical reasoning. Fosnight highlights that IC/BPS, as the name suggests, is primarily pain-driven—often sharp or distinctly bladder-focused—whereas pelvic floor dysfunction more commonly presents as aching, heaviness, hesitancy, or a sensation of incomplete bladder emptying. Pelvic floor symptoms may also be associated with constipation, difficulty with bowel evacuation, or fullness in the rectal area, all of which can increase pressure on the pelvic floor and secondarily affect the bladder. Pain or spasms during or after penetration or orgasm further point toward pelvic floor involvement.

Stress and anxiety are important contributors, as they influence diaphragmatic breathing and pelvic floor muscle tension. Fosnight describes the pelvic floor as a “liaison” within the pelvis, reacting to menstrual cramps, pelvic pressure, and other stimuli, which can create a downstream effect impacting bladder function. This interconnectedness explains why overlap between conditions is so common and why clear distinctions are not always possible.

Ultimately, Fosnight underscores the importance of careful listening, detailed history-taking, and symptom tracking. Bladder diaries, journaling, and menstrual cycle records can reveal meaningful patterns. She also notes that response to interventions—such as improvement after starting oral contraceptives or eliminating dietary triggers—can provide valuable diagnostic insight. Because overlap is common, a thoughtful, patient-centered, and sometimes trial-and-error approach is often necessary to clarify the underlying drivers of symptoms.