Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome
Patient Guideline Summary
Publication Date: May 10, 2022
This patient summary means to discuss key recommendations from the American Urological Association (AUA) for Interstitial Cystitis/Bladder Pain Syndrome. It is limited to adults 18 years of age and older and should not be used as a reference for children.
- We will use the abbreviation IC/BPS throughout this summary to refer to Interstitial Cystitis/Bladder Pain Syndrome.
- IC/BPS is a medical condition causing pain in the pelvis and on urinating.
- Note: Its dual, non-specific name suggests how little is known about it.
- The cause of IC/BPS is not known.
- Other symptoms include bladder/pelvic pain, pressure/discomfort associated with urinary frequency and a strong urge to urinate, dyspareunia (painful sexual activity), dysuria (painful urination), ejaculatory pain in men, and pain related to menstruation in women.
- The goal of treatment is to relieve pain and restore normal urine flow.
- This patient summary focuses primarily on pain relief.
- The usual evaluation of such conditions is a complete history and physical examination to identify possible causes.
- You may be asked to keep a urination log — its quantity, duration, frequency, and associated symptoms.
- A urinalysis is required. Other tests are dictated by suggestive symptoms and signs uncovered by your initial evaluation.
- Cystoscopy is often recommended since some patients have hyper-vascular patches (an overabundance of blood vessels) on the bladder wall called Hunner lesions that suggest possible treatments.
- For such conditions there are general management principles:
- Treatment decisions should be made after shared decision-making, with the patient informed of the risks, potential benefits, and alternatives. Except for specific lesions, initial treatments should be nonsurgical.
- Initial treatment type and level should depend on symptom severity, clinician judgment, and patient preferences.
- Multiple, simultaneous treatments may be considered if it is in the best interests of the patient.
- Ineffective treatments should be stopped.
- Pain management should be continually assessed for effectiveness.
- The diagnosis should be reconsidered if no improvement occurs after multiple treatment approaches.
The list of possible treatment options includes:
- Your expectations regarding treatment success should agree with your treatment team’s understanding of the condition.
- Self-care practices and behavioral modifications that are often beneficial:
- Dietary changes that alter urine, soothe or irritate the bladder
- Heat or cold packs, bladder training, meditation, muscle relaxation
- Attention to sexual practices, clothing, constipation
- Stress management
- Physical techniques
- Trigger points
- Attention to muscle strengthening or contractures, scarring, and other tissue restrictions
- Pain prescriptions
- Urinary analgesics
- Opioid/non-opioid medications
- Other oral medications
- Pentosan polysulfate (risk of vision injuries)
Note: Long lists like this mean that many trials including combinations of treatments may be required to reach a satisfactory treatment plan. Patience and persistence are needed, as well as constant communication with your treatment team.
- Instillations into the bladder
- Local anesthetic
- Cystoscopy under anesthesia with short-duration, low-pressure hydrodistension (water pressure to stretch the bladder).
- Injections of botulinum toxin A into the bladder wall (risk of requiring catheterization to empty the bladder).
- Neurostimulation device
- Major surgery
- Bladder removal
- Urinary diversion
- For Hunner lesions
- Triamcinolone instillation into the bladder
- If unsuccessful:
- Each proposed treatment will be thoroughly explained to you. Treatment decisions will be made through discussions between you and your treatment team.
- AUA: American Urologic Association
- IC/BPS: Interstitial Cystitis/Bladder Pain Syndrome
Clemens JQ, Erickson DR, Varela NP, Lai HH. Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome. J Urol. 2022 Jul;208(1):34-42. doi: 10.1097/JU.0000000000002756. Epub 2022 May 10. PMID: 35536143.
The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.