Bladder Pain Syndrome aka Interstitial Cystitis

What is Bladder Pain Syndrome?

  • BPS is one of many Chronic Pelvic Pain Syndromes.
  • BPS is defined as persistent or recurrent pain perceived in the urinary bladder region, accompanied by at least one other symptom, such as pain worsening with bladder filling or day-time and/or night-time urinary frequency.
  • BPS was previously known as interstitial cystitis but this term has fallen out of favour.
  • BPS is an umbrella term with a number of “types” of bladder pain

Symptoms of BPS

  • Pain or Pressure in the lower abdomen with bladder filling
  • Pain with urination
  • Frequent and urgent need to urinate
  • The need to wake during the night to urinate.
  • Constantly having to wait for the stream to begin, no matter how urgent it feels.
  • Pain when performing basic tasks, such as driving, working, or having sexual intercourse.

What is the cause of BPS?

There is not one known cause for BPS but likely a number of different causes.  Some of the proposed mechanisms include:

  • Mast cell activation
  • Bladder wall infection
  • Autoimmune modulated
  • Neurogenic pain
  • Inflammation secondary to urinary toxins
  • Leaky bladder lining

Getting Your Evaluation

  • A clinical interview and standardized questionnaires are the most important part of the evaluation
    • It is important to rule out more life threatening conditions
  • Physical evaluation
  • Possible Tests
    • Urine tests, blood tests
    • Voiding diary is essential to the diagnosis
    • Cystoscopy
    • Bladder Function Tests (Urodynamics)

How is BPS treated?

BPS is a condition with fluctuating exacerbations and remissions.  The main goal of treatment is to make the symptoms more manageable and to improve your quality of life.

  • LIFESTYLE directed treatment
    • Stress management, improved sleep, regular exercise
    • Avoid bladder irritants (a few are listed here):
      • Coffee, tea (even decaf, herbal teas are ok)
      • Alcohol
      • Carbonated drinks
      • Acidic foods and drinks
      • Spicy foods
      • Artificial sweeteners
      • Avoid constipation
  • PHYSIOTHERAPY can help to relieve trigger points that can cause a “migraine” like pain in the pelvis
  • MEDICATIONS
    • Can be instilled into the bladder on a weekly basis for 6-8 weeks
    • Other medications include:
      • Bladder relaxants: Anticholinergics, B-Agonists, Botox
      • Elmiron
      • Hydroxyzine (antihistamine)
      • Tricyclic antidepressants
      • Selective Serotonin Reuptake inhibitors
  • SURGERY
    • Has a limited role
    • Bladder hydro-distension can help with increasing the size of the bladder to make it react less when filling.
    • Urethral Dilation 

 

 

Michelle Strovski, Maple Ridge Urology, Serving Maple Ridge, Coquitlam, Mission, Abbotsford, Langley, and Vancouver.