Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome

Patient Guideline Summary

Publication Date: May 9, 2022
Last Updated: March 3, 2023

Objective

Objective

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.

Overview

Overview

  • 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.

Diagnosis

Diagnosis

  • 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.

Treatment

Treatment

  • 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.
  • Your expectations regarding treatment success should agree with your treatment team’s understanding of the condition.
The list of possible treatment options includes:
  • 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
    • Acetaminophen
    • NSAIDs
    • Opioid/non-opioid medications
  • Other oral medications
    • Amitriptyline
    • Cimetidine
    • Hydroxyzine
    • Pentosan polysulfate (risk of vision injuries)
  • Instillations into the bladder
    • DMSO
    • Heparin
    • 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
    • Cystoplasty
  • For Hunner lesions
    • Electrocautery
    • Triamcinolone instillation into the bladder
    • If unsuccessful:
      • Cyclosporine A
  • Each proposed treatment will be thoroughly explained to you. Treatment decisions will be made through discussions between you and your treatment team.
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.

Abbreviations

  • AUA: American Urologic Association
  • IC/BPS: Interstitial Cystitis/Bladder Pain Syndrome

Source Citation

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.

Disclaimer

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.