Bladder pain syndrome

Question 1

Definition

Answer 1

• Pain related to the bladder
  +
  1 other urinary symp (urge/freq/nocturia etc) lasting at least 6 months
• Diagnosis of exclusion

Question 2

Hx in BPS

Answer 2

• Hx and examination - past surgeries, auto-immune cond, sexual abuse.
• Examine- for prolapse, atrophy, dermatosis.
• Manage as chronic pain
• Rule out possible causes- UTI/STI, prolapse, incontinence, irritable bowel, lupus, CANCER!!

Question 3

Investigations

Answer 3

• Bladder dairy
• Food diary- to monitor triggers
• Urine dip +/- MSU
• Cystoscopy and scan if concerns about cancer
• Urodynamics- if OAB symptoms

Question 4

Cystoscopy role

Answer 4

• Not compulsory
• Expected to be normal in most pts w BPS
• Perform if concerns about malignancy.
• Bladder biopsy and hydrodistenstion is NOT NEEDED for diagnosis of BPS

Question 5

Hunners lesions

Answer 5

• Prev used for diagnosis
• Need surgical mx
• Well demarcated, red mucosal lesions lacking cappilary structure, usually bleeds.

Question 6

Classification of the severity

Answer 6

• Use pt questionanaires
• Use visual analogue scales for pain to dertermine severity

Question 7

Mx of BPS- expectant

Answer 7

• Dietary changes- red caffeine, alcohol, acidic food
• Stress mx

Question 8

Mx of BPS- medical

Answer 8

• Analgesia
• Amitryptyline
• Physio - massage therapy
• Counselling if needed
• Refer to MDT

Question 9

Mx of BPS- Intravesical

Answer 9

• Intravesical lidocaine/hyaluronic acid/botox/DMSO/heparin

ONLY IF all other treatments have failed.

Question 10

Other treatment options

Answer 10

• Referal to pain clinic
• MDT discussion
• Cystoscopic fulguration/ laser rx/ trans-uretheral resection - if Hunners lesions present
• Nerve stimulation- PTNS or sacral nerve
• Oral cyclosporin