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Challenges and current evidence on the management of bladder pain syndrome


  • Eleftheria L. Chrysanthopoulou MD, MSc,

    1. Department of Obstetrics and Gynaecology, St George's Healthcare NHS Trust/St George's University of London, London, United Kingdom
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    • Clinical Fellow.
  • Stergios K. Doumouchtsis MSc, MPH, PhD, MRCOG

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    • Consultant Obstetrician & Gynaecologist, RCOG accredited Subspecialist in Urogynaecology, Honorary Senior Lecturer Lead Consultant for Urogynaecology and Childbirth Injury—Pelvic Health after Childbirth Services.

  • Roger Dmochowski led the peer-review process as the Associate Editor responsible for the paper.
  • Financial Disclaimer/Conflict of Interest: S.K. Doumouchtsis: Astellas Pfizer, Boston Scientific.
  • Contribution to Manuscript: S.K. Doumouchtsis: Project development, Data collection, Manuscript writing; E.L. Chrysanthopoulou: Data collection, Manuscript writing.

Correspondence to: Stergios K. Doumouchtsis, Ph.D., MRCOG, Department of Obstetrics and Gynaecology, St George's Healthcare NHS Trust/St George's University of London, Level 4 Lanesborough Wing, Blackshaw Road, SW17 0QT London, United Kingdom. E-mail:



Bladder pain syndrome (BPS) is an enigmatic condition, which can be debilitating for the patients, affecting their quality of life. Its prevalence is believed to have become markedly higher (100–300/100,000 women) than in previous years. Its etiology and pathogenesis remain unknown, and a number of theories based on clinical and experimental observations have been developed. It is difficult to be diagnosed and treated. There is a worldwide effort to standardize its nomenclature, definition, diagnosis, and treatment algorithm. The aim of this review is to critically appraise the current evidence on the diagnosis and management of BPS.


We performed a review of the literature (Pubmed, Embase, Cochrane, Google Scholar, conference proceedings) as well as consensus statements and guidelines from relevant professional societies. We have critically compared these statements and guidelines with emphasis on the controversies.


Patients may experience pain and lower urinary tract symptoms for a long time before diagnosis, affecting their mental health and work, causing stress, sleep disturbance, depression, and sexual dysfunction. BPS has been considered as one of a group of chronic pain syndromes rather than as primarily an inflammatory bladder disorder. Despite the wide range of treatments, most are empirical and inadequate, usually offering just symptom relief. There is often delay in commencing treatment, and this may result in worse prognosis.


Efforts are focused on different pathways for the early identification of this syndrome, trying to elucidate the pathogenetic mechanism, as well as introducing effective treatments. Neurourol. Urodynam. 33:1193–1201, 2014. © 2013 Wiley Periodicals, Inc.