Bladder Pain Syndrome: Rapid Evidence Review

Bladder pain syndrome is a chronic condition characterized by bladder pain associated with other urologic symptoms. It is a diagnosis of exclusion. Initial evaluation of suspected bladder pain syndrome includes a thorough history, physical examination, urinalysis, and urine culture, with cystoscopy reserved for further assessment. Symptom diaries help clarify the diagnosis, identify common triggers for flare-ups, and guide behavioral management strategies. Treatment begins with behavior and lifestyle modification and pelvic floor physical therapy. If this is inadequate, oral medications (eg, gabapentinoids, amitriptyline, antihistamines), intravesical instillation therapies, or procedural therapies (eg, neuromodulation) can be offered. Pain should be assessed at baseline and throughout the treatment course. Optimal treatment is multimodal, individualized, and multidisciplinary, frequently involving referral to urology or urogynecology specialists.