Bladder pain syndrome (BPS) or interstitial cystitis (IC) as it was formerly known, is defined as chronic (more than six months) pelvic pain, pressure or discomfort perceived to be related to the urinary bladder accompanied by at least one other urinary symptom such as persistent urge to void or frequency.

BPS includes all cases of urinary pain that cannot be attributed to other causes, such as infection or urinary stones. The severity of symptoms may vary from person to person. Patients with BPS may have a normal or reduced capacity bladder, i.e. how much urine the bladder can hold. Pain may result from the bladder filling with urine, which results in passing urine frequently during the day and night. There may be an urgency to pass urine. Symptoms may resemble those of a urine infection. Women may sometimes experience pain during vaginal intercourse.

  • How is Bladder Pain Syndrome treated? Open or Close

    Treatment is directed at controlling symptoms. It is not always possible to completely eradicate the condition. Many treatments have been used in the past with varying effect. The variety of treatments reflects the uncertainty over the underlying pathological processes involved in this condition. Sufferers may benefit from learning pelvic floor relaxation techniques and making dietary adjustments. In some cases, psychological support can be helpful.

    The following therapies may be offered to you by your consultant:

    Oral medication
    These have included antihistamine tablets, Pentosan Polysulfate Sodium (Elmiron), aspirin, ibuprofen and amitriptyline.

    Bladder Instillations
    Instilling chemical solutions into the bladder is one of the most popular therapies used today. Treatment involves placing the solution into the bladder through a catheter which takes a few seconds. The process is repeated weekly for six weeks and then monthly until symptoms settle. The length of treatment will vary from person to person.

    Examples of solutions include, chondroitin sulphate (Uracyst) and hyaluronic acid (Cystistat). The theory of this treatment is that these chemical compounds replenish the damaged surface of the bladder. Instillations are usually administered in a hospital clinic.

    Electrical stimulation
    Electrical stimulation involves stimulation of the nerves supplying the bladder and may be administered in a number of ways:

    1. TENS – this involves sending nerve impulses through the skin and can be performed at home.
    2. Sacral Nerve Stimulation (SNS) – a small battery-powered device is implanted beneath the skin of the lower back and stimulates one of the spinal nerves supplying the bladder. This treatment is only available in specialist centres.
    3. Posterior tibial nerve stimulation.

    Surgery
    Surgery is reserved for patients who have failed to respond to simpler treatments and is a last resort as it can create other problems.

  • How is Bladder Pain Syndrome diagnosed? Open or Close

    Diagnosis is usually made on the basis of symptoms, examination, investigations and the exclusion of other diagnoses. The bladder is often tender on pressing. Urine infection is excluded by examination under of a urine specimen under the microscope. Cystoscopy, examination of the inside of the bladder with a fine telescope passed through the urethra, is performed to exclude stones and cancer. The inner surface of the bladder may appear red with prominent fine blood vessels which can bleed easily, especially as the bladder is filled to capacity and then emptied. There may be scarring of the bladder lining. A cystoscopy performed under a general anaesthetic also allows the true bladder capacity to be determined and a biopsy (tissue sample may be taken for analysis). A bladder biopsy helps rule out cancer and may reveal inflammation. A cystoscopy and bladder biopsy takes about 10 minutes to perform.

  • What causes Bladder Pain Syndrome? Open or Close

    The cause is unknown, but some patients have other conditions such as irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome or other inflammatory conditions affecting other parts of the body. A number of factors are thought to be involved in the development of BPS, e.g. bacterial infection, inflammation of nerves, autoimmune mechanisms, damage to the bladder epithelium (inside lining of the bladder).