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Interstitial cystitis / bladder pain syndrome (IC/BPS)
Bladder pain syndrome is pain, pressure or discomfort perceived as related to the bladder, with urinary symptoms such as frequency and urgency, lasting more than 6 weeks without infection or another identifiable cause; it is a diagnosis of exclusion, and treatment is multidisciplinary and individualised, with targeted treatment of Hunner lesions when present.
Why it matters in the exam
The exam shows a woman with bladder pain that worsens with filling and improves after voiding, high frequency and repeatedly negative urine cultures. Questions test the definition, the evaluation and the treatments that are not recommended. Basic evaluation: history, examination including the pelvic floor, urinalysis and culture, post-void residual and a bladder diary; cystoscopy is done when there is haematuria, risk factors for a tumour or suspected Hunner lesions, and is not mandatory for every patient. The syndrome is much more common in women and often coexists with irritable bowel syndrome, fibromyalgia and other pelvic pain, so the assessment also covers mood and sleep quality.
The 2022 AUA guideline no longer requires a fixed treatment order, but starts with simple steps and advances according to response. Options: education and self-management, avoiding foods that aggravate (coffee, citrus, spicy foods), pelvic floor physiotherapy focused on release — not strengthening by Kegel exercises — and pain management. Oral drugs: amitriptyline, cimetidine, hydroxyzine and pentosan polysulfate — which requires eye examination because of retinal damage (pigmentary maculopathy). Bladder instillations: DMSO, heparin or lidocaine.
Hunner lesions (red inflamed areas in the bladder wall) are treated with fulguration, laser or triamcinolone injection, sometimes with marked improvement. Next: botulinum toxin to the bladder, neuromodulation and ciclosporin A. Major surgery — augmentation or urinary diversion — is reserved for isolated cases not responding to any treatment. The guideline advises avoiding long-term antibiotics, systemic steroids, BCG instillation and prolonged high-pressure hydrodistension, because the risk outweighs the benefit.
Key points
- Bladder pain with symptoms for more than 6 weeks, without infection.
- A diagnosis of exclusion.
- Multidisciplinary, individualised treatment.
- Hunner lesions — targeted treatment.
- Avoid long-term antibiotics, steroids and BCG.
Summary table
| Step | Options | Note |
|---|---|---|
| Basis | Education, avoiding aggravating foods, stress management | For every patient |
| Physiotherapy | Pelvic floor release | Not Kegel strengthening |
| Oral | Amitriptyline, cimetidine, hydroxyzine, pentosan | Pentosan — eye examination |
| Instillations | DMSO, heparin, lidocaine | According to response |
| Hunner lesions | Fulguration, laser, triamcinolone | Cystoscopy diagnoses them |
| Not recommended | Long-term antibiotics, systemic steroids, BCG | Risk outweighs benefit |
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Sources
- AUA Guideline: Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome, 2022 — Diagnosis and treatment principles
- EAU Guidelines on Chronic Pelvic Pain, 2025 edition — Primary bladder pain syndrome
- Campbell-Walsh-Wein Urology, 12th edition (2020) — Bladder Pain Syndrome (Interstitial Cystitis) and Related Disorders
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.