Management of Bladder Pain Syndrome (BPS): A Practical Guide

Bladder pain syndrome (BPS) is a prevalent and pervasive disease. The physical and psychological sequelae can be very burdensome for the patient, and the condition represents a real challenge for the clinician as well. With no simple pathognomonic test, finding harmony in navigating patient care can be demanding. Diagnosis and management rely upon a multidisciplinary and holistic approach. Treatment options include conservative measures and pharmacotherapies as well as bladder instillation therapies. Ultimately, surgery may be offered but only in cases of refractory disease. This article offers a pragmatic guide for clinicians managing this challenging disease.

1. Manuscript
Bladder pain syndrome (BPS) is a disease of ubiquity, and epidemiological studies estimate it to affect 1.8–51/10,000 individuals worldwide [1]. However, there is evidence to suggest that the prevalence is underreported and that less than 10% of disease sufferers receive a formal diagnosis [2]. Prior to recent changes in standardised terminology, BPS was formerly referred to as interstitial cystitis (IC) [3]. This shift in nomenclature reflects its multifactorial aetiology and the symptom-based approach, which now occupies the diagnostic workup. The burden of the BPS is substantial, regarding both physical and psychological sequelae. It has been highlighted by the World Health Organization (WHO) as a major public health issue [4, 5]. Difficulties in diagnosing the condition are mirrored by the challenges faced in treating it. Despite the availability of an abundance of novel treatments, most of these have a limited evidence basis to support their use [6]. Such is the diversity in clinical phenotypes associated with BPS, and there is a huge range in treatment strategies offered worldwide. While numerous international guidelines do exist, recommendations can be divergent [7, 8]. It can therefore be quite difficult for the clinician to find harmony in navigating patient care. Our aim was to provide an overview of a practical framework for the contemporary management of BPS.