“Bladder pain syndrome” Flashcards
What initial clinical assessment should be performed for bladder pain syndrome?
- principles of management of chronic pain should be used for the initial assessment of this condition.
- thorough medical history & physical examination
What baseline investigations should be performed for bladder pain syndrome?
- bladder diary (frequency volume chart)
- food diary may if specific foods flare-up symptoms.
- Urine (UTI, prerequisite for diagnosis)
- urinary ureaplasma & chlamydia can in symptomatic with negative urine cultures and pyuria.
- suspicion of urological malignancy, urine cytology .
- Cystoscopy & referral to urology (local protocols.)
What are the differential diagnoses for bladder pain syndrome?
BPS is a diagnosis of exclusion and other conditions should be excluded.
What investigations are used to diagnose BPS?
not recommended for the diagnosis.
- Bladder biopsies
- hydrodistention
- Cystoscopy not confirm or exclude diagnosis of BPS, but is required to diagnose/exclude other conditions that mimic BPS.
should not be used in diagnosis
- Potassium sensitivity test,
- urodynamic assessment and
- urinary biomarkers .
- Urodynamic considered if coexisting BPS and OAB (and/or SUIe and/or voiding dysfunction) that are not responsive to treatment.
How can we classify the severity of BPS?
- validated symptom score to assess baseline severity of BPS and assess response to treatment.
- visual analogue scales for pain severity
What is the effect of BPS on quality of life (QoL)?
- can have low self-esteem, sexual dysfunction and reduced QoL.
- may have other coexistent conditions impacting on their QoL.
What is the initial management of BPS?
first-line Conservative treatments
- avoidance: caffeine, alcohol, & acidic foods & drinks.
- Stress management
- regular exercise
- Analgesia
- acupuncture (limited data )
Pharmacological treatments
- first-line conservative treatments FAILED:
- referred to secondary care.
- Oral amitriptyline or cimetidine (Cimetidine not licensed & only by clinician specialised)
Intravesical treatments
- If conservative & oral treatments FAILED:
- Individualised approach.
- referral to specialist centre with expertise in chronic pain management and MDT
Intravesical lidocaine.
Intravesical heparin.
Intravesical hyaluronic acid.
Intravesical chondroitin sulfate.
Intravesical injection of botulinum toxin A (Botox).
Intravesical dimethyl sulfoxide (DMSO).
Further treatment options of BPS
after referral to pain clinic and discussion MDT meeting.
if Hunner lesions are identified at cystoscopy
- Cystoscopic fulguration and
- laser treatment, and
- transurethral resection of lesions
after Initial (conservative, oral and/or intravesical treatments) FAILED,
- Neuromodulation (PCTNS /PCSNS), in MDT
- Oral cyclosporin
if conservative and oral FAILED
- Cystoscopy with or without hydrodistension
last-line treatment in refractory BPS.
- Major surgery
What is the initial management of BPS?
conservative, oral and/or intravesical treatments
Treatments that are not recommended for bladder pain syndrome?
ORAL
- hydroxyzine
- pentosan polysulfate
- Long-term antibiotics,
- long-term glucocorticoids
INTRAVESICAL
- resiniferatoxin,
- Bacillus Calmette–Guerin,
- highpressure long-duration hydrodistension
BPS and pregnancy
- effect of pregnancy on severity of BPS symptoms variable.
- safe in pregnancy: oral amitriptyline, intravesical
heparin.
DMSO
- one course of may be used prior to pregnancy for symptom remission with good pregnancy outcomes (delivery at term, normal birth weight and postnatal symptom control), DMSO known to be teratogenic in animal studies.
Role of primary care in BPS
- History,
- urinalysis and
- physical examination
What is the role of the MDT – physiotherapist, pain team, clinical psychologist in BPS?
- Referral to a physiotherapist may improved
refractory BPS
1- psychological support or counselling:Consider referring patients with for if
- impacting QoL or
- patient requests a referral.
2- referred to MDT to explore alternative treatment options.
- may benefit from neuromodulation should be referred to MDT before treatment start
What is the role of support groups in BPS?
- written information about patient organisations that provide evidence based information.
