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

Published: 09/12/2016

Access the PDF of this guideline.

This is the first edition of this guideline.

This is a joint guideline by the RCOG and the British Society of Urogynaecology (BSUG).

The wide spread definition for BPS is that proposed by the European Society for the Study of BPS in 2008 as ‘pelvic pain, pressure or discomfort perceived to be related to the bladder, lasting at least 6 months, and accompanied by at least one other urinary symptom, for example persistent urge to void or frequency, in the absence of other identifiable causes’. More recently, the American Urological Association has described BPS as ‘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’; this definition is preferable as it allows treatments to be initiated soon after symptom presentation. BPS may be associated with negative cognitive, behavioural, sexual or emotional consequences, as well as symptoms suggestive of sexual dysfunction according to the European Association of Urology. 

BPS is a chronic condition with unknown aetiology. As the definition of BPS has evolved, it is seen now as a diagnosis of exclusion with no definitive diagnostic test; hence, it is difficult to estimate prevalence, which can be dependent on whether symptoms are clinician assigned or patient reported. A number of expert panels have published symptom-based diagnostic criteria for BPS. All include the symptoms of pain related to the bladder, at least one other urinary symptom, absence of identifiable causes and minimum duration of symptoms of 6 weeks to 6 months. Although there are very limited data on BPS in the UK, a survey of urogynaecologists has shown variable practice regarding its diagnosis and management.

Declaration of interests (guideline developers)

Dr SA Tirlapur MRCOG, London: None declared.

Mrs JV Birch, Pelvic Pain Support Network, Poole: None declared.

Dr CL Carberry MD, Providence, Rhode Island, USA None declared.

Professor KS Khan FRCOG, London: None declared.

Dr PM Latthe MRCOG, Birmingham: Dr Latthe has received speaker fees from Astellas and Pfizer; has also received support towards attending conferences Trustee of COB (Bladder Health now)

Dr S Jha FRCOG, Sheffield: Dr Jha has in the past received funding from Ethicon/Boston/Pfizer/Astellas to attend conferences. Dr Jha has also been on the Advisory board for Astellas for Betmiga.

Dr KL Ward MRCOG, Manchester: Dr Ward is a member of the United Kingdom Continence Society, British Society of Urogynaecology, European Association of Urology, International Urogynecological Association and International Continence Society, and is an associate of The British Association of Urological Surgeons Limited.

Ms A Irving, Cystitis and Overactive Bladder Foundation, Birmingham: Ms Irving is a Trustee for The Cystitis and Overactive Bladder Foundation.