Management of bladder pain syndrome GTG 2016

Question 1

What is ESSIC definition of bladder pain syndrome?

Answer 1

pelvic pain, pressure or discomfort perceived to be related to the bladder, lasting 6 months and accompanied by at least one other urinary symptom – persistent urge to void or frequency, in the absence of other identifiable causes

Question 2

Other names for bladder pain syndrome?

Answer 2

interstitial cystitis and painful bladder syndrome

Question 3

Prevalence of bladder pain syndrome?

Answer 3

2.3-6.5%

Question 4

Things to consider whilst taking history for bladder pain syndrome

Answer 4

o Previous pelvic surgery, UTI, STI, bladder disease, autoimmune disease.
o Commonly associated: Fibromyalgia, chronic fatigue syndrome, IBS, vulvodynia, endometriosis, autoimmune conditions – lupus/sjogrens
o Hx of physical or sexual abuse
o Current or current use oral contraceptives – may be associated BPS.

Question 5

Examination for bladder pain syndrome

Answer 5

o Exam – rule out bladder distention due to urinary retention, hernias, painful trigger points. Genital examination? atrophy, prolapse, vaginitis, trigger points – urethra, vestibular glands, vulvar skin or bladder.

o Assess for cervical pathology, bimanual examination

Question 6

Investigations for bladder pain syndrome

Answer 6

• Bladder diary (frequency volume chart)
  o 3 day diary – classifcally void small volumes – 1st morning void helpful to assess functional capacity of bladder.
  o Consider post void bladder scan if cocerns with bladder emptying.
• USS
• Food diary – specific food flares
• Urine test - ?UTI
• Consider cystoscopy if suspicion of urological malignancy
  o Persistent microscopic haematuria

Consider urodynamic testing if co-existing BPS and overreactive bladder that no responsive to treatment

Question 7

Average voided volume and frequency in BPS vs asymptotic women

Answer 7

BPS: less than 100 mL in IC (86‒174) mL, 17-25/day

Asymptomatic: 289 mL, 6/day

Question 8

What proportion have improve symptoms with dietary modification alone?

Answer 8

87%

Question 9

Management of bladder pain syndrome

Answer 9

• Diet (avoid caffeine, ETOH, acidic food)
• Stress & regular exercise
• Analgesia

If failed
- PO amitriptyline or cimetidine

Question 10

What intravesical treatment can be offered for bladder pain syndrome?

Answer 10

lidocaine, hyaluronic acid, Botox, dimethyl sulfoxide (DMSO), heparin, chondroitin sulphate

Question 11

Risk of self-catheterisation with botox?

Answer 11

7%

Question 12

What lesions can sometimes be identified on cystoscopy, how often are these seen?

Answer 12

Hunner lesions (ulvers)
16% - associated more severe
Majority of cystoscopy normal, helps rule out malignancy

Question 13

What treatment can be offered if Hunter lesions visable?

Answer 13

Cystoscopy fulguration and laser treatment

Question 14

Other specilist to aid in treatment of BPS?

Answer 14

Pelvic physiotherapist - bladder retraining
Psychological support
Patient support groups