Interstitial Cystitis/Bladder Pain Syndrome

Abstract

This article describes a practical framework for the evaluation and treatment of interstitial cystitis/bladder pain syndrome (IC/BPS), based on and expanding from the American Urological Association (AUA) guideline. The key points in evaluation are (1) to recognize confusable diseases or comorbid disorders that require separate treatments, and (2) to recognize patient subtypes that require specialized treatment approaches (eg, pelvic pain and beyond, polysymptomatic and polysyndromic types, and patients with Hunner lesions). Treatment begins with education, including diet, stress reduction, and other self-care strategies, which have proven efficacy and are first line in the AUA guideline. Second-tier treatments include oral and intravesical medications. Further, the AUA guideline states that physical therapy should be offered to patients with pelvic floor tenderness if a qualified therapist is available. For Hunner lesions, the initial recommended treatment is cystoscopy with fulguration or triamcinolone injection. Higher-tier treatments, which involve more risks, include hydrodistention, bladder botulinum toxin injection, sacral nerve stimulation, and oral cyclosporine A. The article includes a practical algorithm to help clinicians organize their thoughts while evaluating and starting therapy for patients with IC/BPS. This review contains 4 figures, 4 tables, and 64 references. Key Words: bladder pain syndrome, Hunner lesion, interstital cystitis, polysymptomatic, polysyndromic, pelvic floor dysfuction, vulvodynia