The first UK clinical guideline on the management of bladder pain syndrome (BPS) has been published today, a condition which causes pain and discomfort and can impact a patient’s quality of life.
The new guideline, jointly launched by the Royal College of Obstetricians and Gynaecologists (RCOG) and the British Society of Urogynaecology (BSUG), provides evidence-based information on the symptoms and treatment options for BPS in women, together with an understanding of the current uncertainties surrounding this condition.
BPS can be defined as pain, pressure or discomfort in the pelvis/bladder, associated with urinary symptoms (frequency, urgency, nocturia, bladder filling pain) lasting at least 6weeks, and with no identifiable cause. Moreover, BPS is between two and ﬁve times more common in women than men.
It is difﬁcult to estimate the prevalence, however, a large US study found prevalence rates of 2.3–6.5%.
The new guidelines discuss management of the condition including which initial investigations should be carried out including a thorough medical history and a physical examination.
As BPS is a diagnosis of exclusion, other conditions need to be ruled out say the guidelines. Patients can be asked to complete a bladder diary and a food diary and urine should be tested to rule out a urinary tract infection.
The guideline also highlights the impact BPS can have on a patient’s life and states that patients can have low self-esteem, sexual dysfunction and reduced quality of life as well as other co-existing conditions.
Partner and family support are therefore important and early referral to a clinical psychologist, patient support groups and cognitive behavioural therapy should be considered for persistent BPS, state the guidelines.
Treatment options for the management of BPS are discussed in the guideline including conservative options such as changes to diet and stress management. It states that changes to diet can be beneﬁcial and avoidance of caffeine, alcohol, and acidic foods and drinks should be considered.
Stress management may be recommended and regular exercise can be beneﬁcial. However, there are limited data on the beneﬁts of acupuncture, state the guidelines.
Furthermore, analgesia is recommended for the symptom of pelvic or bladder pain. The guideline also covers pharmacological treatments and further treatment options including surgery once everything else has been tried.
Lead developer of the guideline, Dr Anushka Tirlapur, O&G specialty trainee at Queen Mary University of London, said:
“Bladder pain syndrome is a chronic pain syndrome where patients can have periods of ﬂuctuating symptom severity.
“Patients will often be highly anxious about their symptoms and may present with low self-esteem and poor quality of life. These new guidelines will help healthcare professionals manage patients with this condition and they highlight organisations who can provide crucial support for coping with bladder pain syndrome.”
Professor Jonathan Duckett, Vice Chairman of the British Society of Urogynaecology (BSUG) added:
“BSUG are delighted to have partnered with the RCOG on this much needed new guideline. This provides us with a structured way to support patients with this distressing condition.”
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The following organisations provide support for BPS:
Cystitis and Overactive Bladder Foundation: http://www.cobfoundation.org
Pelvic Pain Support Network: http://www.pelvicpain.org.uk
International Painful Bladder Foundation: http://www.painful-bladder.org
Urostomy Association: http://www.urostomyassociation.org.uk