Bladder pain syndrome

Bladder pain syndrome is a term that has been accepted in only the last 5-10 years.  Many experts in interstitial cystitis recognized the problem that often patients were not diagnosed until they had suffered years of pain and the diagnosis was often applied only to those who demonstrated severe findings at the time of cystoscopy.   Many of us realized that patients could have severe bladder pain symptoms but relatively normal findings on cystoscopy, yet the term interstitial cystitis did not seem to apply to them.  Bladder pain syndrome is a descriptive term that applies to a heterogeneous group of patients with bladder symptoms and therefore is much more inclusive.  Our understanding and our ability to help patients has improved as a result of this more inclusive terminology.  We now realize that some patients have a bladder centric pain disorder with significant findings on cystoscopy-some will have ulcers in their bladder triggering their bladder pain.  Another group of patients will have multiple pain generators and present with widespread pain problems including fibromyalgia, chronic fatigue syndrome, endometriosis, pelvic floor high tone dysfunction. For these patients the bladder may be one of their pain generators but there are many other causes for pain and they all must be treated.  In patients with no evidence of ulcers in their bladder (Hunner lesions) approximately 75% of patients with BPS have bladder pain as a component of a more widespread pain disorder.