Bladder pain syndrome: A disease which long-lasting impact on QoL

FB Dr Soarawee
Soarawee Weerasopone, MD

Minimally Invasive Uro-Oncologist
Royal Phnom Penh hospital, Kingdom of Cambodia

A huge amount of women patients who was being at my office with the annoying of urinary bladder symptom. Patients, they will realize that they are now in the phase of circling around the clinics and hospitals just because to seek out a certain medications and treatment for their conditions. And it shows up with vary of treatment in a different ways. Most often we will see a message from a physician that they were suspected on the bladder infection after unimproved antibiotics completion courses. There’s one of disease that we should consider on and pay attention to it is called “Bladder pain syndrome” or another medical term called it “Interstitial cystitis” Well, that is the topic that we are going to find out today.

Unnecessary Oral ATB
Imprecise diagnosis may lead into unnecessary antibiotic usage

Bladder pain syndrome (BPS) is a chronic painful bladder condition which was reported at least 2.7% of women in US affects. This disease can have a long-lasting impact on the quality of life along with a high medical expense by the way. BPS can be suspected when the criteria of the diagnostic is fulfill as following requirements (Reference from American Urological Association)

  1. An unpleasant sensation (pain, pressure, discomfort) perceived to be related with urinary bladder
  2. Frequent urination or urgent need to urinate
  3. The symptom might persists more than 6 weeks
  4. Absence of infection or other identifiable causes

Although there’s no a stable in diagnostic criteria presently, but we can just make diagnosis to help by level of suspicious. The patient who was suspected on BPS shall have investigation to make sure that there is no hidden disease such as infections or cancers. The endoscopic urinary bladder working up is just an optional which will make us more confident if we can find pathognomonic sign “Hunner’s ulcers” and once again, even we cannot find the ulcers, we still use “Trial of treatment” strategy anyway.

Lots of questions come up with a question like how could it happen? There are several theories trying to explain what is going on with BPS, I will summaries into 2 majors theories

Lots of theories try to explain what is the possibly cause of BPS
  1. There is a disruption at outer layer of bladder mucosa so the chemical substance or bacteria in urine directly expose to the inner layer part of bladder mucosa which contains lots of nerve ending there, resulting in unusual bladder sensation.
  2. Frequent urinary tract infection (UTI) trigger varieties of inflammation pathways at the surface of bladder mucosa leading to unusual chronic bladder sensation even infection has been subsided.

The treatment plan will be started from conservative treatment and slowly step up aggressively more while the clinical outcome is not satisfied yet. Here are examples of the treatment options

Diet alteration
Observant habit on any diet that worsen BPS is recommended
  1. Behavioral change and diet alteration
  2. Pelvic floor exercise
Stress reduction
Any kind of Stress reduction method may give benefit on BPS
  1. Stress reduction
Oral medication
Oral medication is a good trial in BPS management
  1. Oral medications – It was reported up to 77% success rate from oral medications
  2. Intravesical therapy – Up to 93% success rate from this endoscopic intervention
  3. Sacral nerve modulation – High cost and invasiveness

Most patient will be improved after the treatment but unfortunately that the remission rate is pretty high also. This kind of disease, we need to educate and reassure the patient about natural history of disease so patient won’t get any confusion. If you guys or your relatives experience in this kind of symptoms, Please make any discussion with your trusted urologist or would be honor if you text me. Thank you!

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