Believe it or not, but 1 in 2 of us will be affected by a urology condition in our lifetime, this is according to figures from The Urology Foundation.  That’s approximately 3.9 billion of us.  There are many differing conditions, some which are more commonly understood and known about than others. 

One particular focus of mine is working with patients who experience Bladder Pain Syndrome (BPS).  Bladder Pain Syndrome is classified in varying ways between European and American standards, which can lead to confusion in its diagnosis.

Symptoms of Bladder Pain Syndrome can include:

• Bladder Pain
• Pressure in your bladder area
• Continued feelings of wanting to empty your bladder
• Urinary urgency
• Urinary Frequency* (in the absence of a Urinary Tract Infection (UTI) and with or with out any urinary incontience)

The European Society for the Study of Bladder Pain Syndrome (PBS) proposed the following widespread definition of painful bladder syndrome/interstitial cystitis (IC) in the absence of other identifiable causes:

“pelvic pain, pressure, or discomfort perceived to be related to the urinary bladder [lasting for at least 6 months] accompanied by at least one other urinary symptom such as persistent urge to void or frequency” (Van de Merwe et al. 2008, p. 62).

In contrast, the American Urological Association (AUA) has adopted a classification of bladder pain syndrome agreed upon by the Society for Urodynamics and Female Urology:

“An unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms of more than 6 weeks duration, in the absence of infection or other identifiable causes” (Hanno & Dmochowski 2009, p. 274; AUA 2014). Tirlapur et al. (2016)

So European guidance won't diagnose until 6 months of symptom onset, whereas American guidance will diagnose at 6 weeks.

The authors of the guidelines on the management of bladder pain syndrome from the Royal College of Obstetricians and Gynaecologists (RCOG), prefer the latter definition because it allows treatments to be initiated soon after the presentation of symptoms.

The UK adopts the same guidance as America and will diagnose at 6 weeks (this is good because it means we have more chances of getting on top of symptoms before they become long standing!)

To add to diagnostic confusion, there are different names for ultimately the same conditions, these being: painful bladder syndrome, proctitis, interstitial cystitis, bladder pain and chronic UTI.

So what should patients be aware of in respect of Painful Bladder Syndrome?

Key points

• Painful Bladder Syndrome is diagnosed in the absence of an active Urinary Tract Infection (although there may be a history).
• Painful Bladder Syndrome can be with, or without urinary dysfunction/incontinence (such as urgency or frequency of needing to urinate, both during the day and at nighttime too)
• 78-87% of people with Painful Bladder Syndrome will have pelvic floor muscle dysfunction.

Seeing a Specialist Physiotherapist in this area can help you with your symptoms and covers the following:

1. Pelvic floor muscle assessment to identify and/or treat any high tone or internal trigger points
2. Information, advice and education in relation to the evidence-base towards achieving optimum self-management for lifestyle changes.
3. Bladder retraining.
4. Desensitization techniques.
5. Electro-acupuncture (posterior tibial nerve stimulation).
6. Exercise-specific rehabilitation.

Want to keep learning? Find more articles from Roseanna Grace Conway - Roseanna Grace Physiotherapy

• Pelvic Floor Health and the Importance of Pelvic Floor Exercises