Bladder Pain Syndrome: A Guide for Clinicians

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Diagnosis and Treatment Interstitial Cystitis/Bladder Pain Syndrome (2014)

Spara som favorit. Skickas inom vardagar. Laddas ned direkt. Bladder Pain Syndrome: A Guide for Clinicians provides a comprehensive update in the pathophysiology, epidemiology, terminology, evaluation and treatment of patients with pelvic pain perceived to be related to the urinary bladder. The volume covers the tremendous evolution during the last decade in our understanding of pain syndromes and their diagnosis and treatment.

It is now clear that Bladder Pain Syndrome belongs to the family of pain syndromes, and therefore treatment has moved from the treatment of the bladder to the treatment of a pain syndrome with the special problems this presents when the pain syndrome involves urinary symptoms. Interstitial Cystitis was poorly defined and the interpretation and patient selection differed enormously around the world in many ways, making exchange of information unreliable and confusing. Bladder Pain Syndrome is clearly defined and the result is a much better patient selection. This volume provides state of the art background for making a correct evaluation and diagnosis of patients with pelvic pain and voiding problems resulting in a more focused treatment to the benefit of the patients.

Bladder Pain Syndrome: A Guide for Clinicians provides a comprehensive update in the pathophysiology, epidemiology, terminology, evaluation and treatment of patients with pelvic pain perceived to be related to the urinary bladder. The volume covers the tremendous evolution during the last decade in our understanding of pain syndromes and their diagnosis and treatment.

Bladder Pain Syndrome

It is now clear that Bladder Pain Syndrome belongs to the family of pain syndromes, and therefore treatment has moved from the treatment of the bladder to the treatment of a pain syndrome with the special problems this presents when the pain syndrome involves urinary symptoms. Interstitial Cystitis was poorly defined and the interpretation and patient selection differed enormously around the world in many ways, making exchange of information unreliable and confusing.

Bladder Pain Syndrome is clearly defined and the result is a much better patient selection. Symptoms assessment forms the basis of the initial evaluation.


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Symptoms include suprapubic pain related to bladder filling, urgency, increased daytime and night-time frequency, in the absence of any identifiable pathology or infection. The location of the pain has been described in several studies and the most commonly reported sites are the bladder, urethra and vagina. The description of the pain ranges from pressure and aching to a burning sensation. Aggravating and Alleviating Factors A study of patients with the condition was used to identify factors that can aggravate and alleviate the condition.

Excluding Other Potential Causes Due to its nature of diagnosis of exclusion, it is imperative that other potential causes of bladder pain or lower urinary tract symptoms have to be considered, such as urinary tract infections, sexually transmitted infections, other bladder diseases e. The location of the pain, and relationship to bladder filling and emptying should be established. The characteristics of the pain, including trigger factors and onset, correlation with other events and description of the pain, should be recorded.

Physical examination should be performed to rule out urinary retention, hernias and painful trigger points on abdominal palpation. A genital examination should also be done to rule out atrophic changes, prolapse, vaginitis and trigger point tenderness over the urethra, vestibular glands, vulvar skin or bladder. Features of dermatosis, including vulvar or vestibular disease, should be looked for. Superficial or deep vaginal tenderness, and tenderness of the pelvic floor muscles, should be assessed during the course of the examination.

Both a 3-day bladder diary frequency volume chart and a food diary should be employed to determine the urinary habits, as well as to identify if specific foods cause a flare-up of symptoms, respectively. Investigations for urinary ureaplasma and chlamydia can be considered in symptomatic patients with negative urine cultures and pyuria. In those with persistent microscopic or macroscopic haematuria, urine cytology should be tested for the suspicion of urological malignancy.

Cystoscopy and a referral to urology should then be initiated accordingly. Bladder Pain Syndrome is a diagnosis of exclusion. The management choices for BPS are multi-varied. These range from a spectrum of conservative to invasive multi-disciplinary treatments, depending on the severity of the symptomatology.


  • Chronic Pelvic Pain!
  • Stool-based biomarkers of interstitial cystitis/bladder pain syndrome.
  • Management of Bladder Pain Syndrome (Green-top Guideline No. 70)?
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  • Bladder Pain Syndrome!
  • Conservative treatments encompass dietary modification, stress management and analgesia. Dietary avoidance of caffeine, alcohol, acidic foods and drinks citrus fruits, carbonated drinks, chocolates and tomatoes 11 may bring about improvement in symptoms.

    Management of Bladder Pain Syndrome (Green-top Guideline No. 70)

    Stress reduction such as relaxation techniques, music listening and meditation and regular exercises have also reported symptomatic improvement. Early referral to a pain specialist should be considered in patients with chronic refractory symptoms. There is, however, limited evidence on the benefits of acupuncture. Oral amitriptyline or cimetidine may be considered when first-line conservative treatments have failed. A systematic review of two randomised controlled trials using increasing titrated doses of amitriptyline between 10 mg and mg over a 4-month period showed trends in improvement in urinary urgency, frequency and pain scores in both trials compared with non-treated patients.

    All patients had symptomatic improvements, but these were more pronounced in the treatment group, especially for pain and nocturia. The small sample size and short duration of follow-up are limiting factors in this study. Multimodal therapy may be considered if single drugs are unsuccessful, but should be commenced by specialists with expertise and consideration of multidisciplinary input.

    If either conservative or pharmacological treatments have been unsuccessful, other invasive therapies may be considered or added using an individualised approach, under the guidance from a multi-disciplinary input physiotherapist, pain team, clinical psychologist, urologist, urogynaecologist.

    Kundrecensioner

    Several intra-vesical treatments using various medications may be enlisted by the multi-disciplinary team. Woman can be advised that the effect of pregnancy on the severity of BPS symptoms can be variable. A patient survey conducted by the Interstitial Cystitis Association in showed that there was a wide variation in the perception of BPS symptoms during the pregnancy and the puerperium.

    BPS was also not affected by the mode of delivery. BPS treatment options considered safe in pregnancy include oral amitriptyline and intravesical heparin. His areas of clinical practice include obstetrics childbirth , general gynaecology, female pelvic floor reconstructive surgery urinary incontinence and pelvic organ prolapse , benign gynaecology minimally-invasive surgery, postpartum pelvic floor preventive medicine and intrapartum management and obstetric emergencies.

    Eur Urol ;—7. American Urological Association. Royal College of Obstetricians and Gynaecologists. Management of Bladder Pain Syndrome. Green-top Guideline No. December J Urol ;— Symptoms of interstitial cystitis, painful bladder syndrome and similar diseases in women: a systematic review. J Urol ;—6. Neurourol Urodyn ;—8. EAU guidelines on chronic pelvic pain. Eur Urol ;—9.



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