Researchers are still trying to establish a sound definition of bladder pain syndrome, identify its pathophysiology, and suggest a treatment approach that moves beyond specialist care to more individualized treatment.
Bladder pain syndrome (BPS), also known as interstitial cystitis, is recognized but poorly defined and poorly understood. Most clinicians believe it is a combination of several different conditions, including autoimmune dysfunction, urothelial leakage, infection, central and peripheral nervous system dysfunction, genetic disease, and childhood trauma/abuse, among others. Thus, a specialist simply treating the bladder is typically not enough for successful treatment.
A recent study in the International Journal of Women’s Health took a closer look BPS in an attempt to both further establish a sound definition of the condition, identify its pathophysiology, and suggest a treatment approach that moves beyond specialist care to more individualized treatment.
The European Society for the Study of Interstitial Cystitis (ESSIC) defines bladder pain syndrome (BPS) as chronic (over 6 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 in the absence of an identifiable cause. The condition can be incredibly painful for patients and immensely deleterious on quality of life.
Among the interesting notes illustrated by the study authors:
The study also suggests a diagnostic approach that rules out other “confusable” conditions such as malignancies, infections, neurologic disease, bladder outlet obstruction, and others. After this, assessment should include urine analysis, uroflowmetry, cystoscopy with hydrodistension, and bladder biopsy as necessary. The primary goal of management, given that there is no curative treatment, is to improve the patient’s quality of life.
First-line treatments should include amitriptyline, pentosanpolysulfate, and hydroxyzine.Hydroxyzine, a histamine type 1 (H1)-receptor antagonist, blocks histamine release in the bladder by inhibiting mast cell degranulation, but there are as yet no randomized, controlled trials supporting its use. Cyclosporine A was also shown to be effective at treating BPS, but with serious adverse events. The study also looks at immunosuppressant drugs, injections, and intravesical treatments, physical therapy, and surgical treatments—all of which show promise, but none of which are a panacea for treatment.
“Further research on the etiology of the disease is paramount to curative treatment(s),” the study authors conclude.