Sites Of Pain From Interstitial Cystitis/Painful Bladder Syndrome

Main Category: Urology / Nephrology
Article Date: 15 Nov 2008 - 1:00 PDT

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UroToday.com - Pain is the major symptom of BPS/IC. Multiple pain sites are common. There is a dearth of information in the literature with regard to characterization of this pain. Suprapubic pain is prominent and some believe that it is necessary to make the diagnosis. Many patients report different and/or additional sites, particularly in the urethra, genitalia, and lower back.

Dr. John Warren and colleagues from Baltimore performed a careful, systematic analysis of pain experienced by BPS patients to look for patterns that might yield clues to pathogenesis. Only women were studied, and criteria included age 18 or older with a one year or greater history of a syndrome comprising pain perceived to be related to the bladder and 2 or more episodes of frequency, urgency, or nocturia. Of 314 patients, 84% returned questionnaires. 226 reported pain within the last month and met criteria for inclusion in the study.

This manuscript is somewhat complex to read, but Warren's conclusions are well thought-out, well-supported, and very understandable. He found that 66% of the patients reported multiple pains. These could be consolidated at 4 sites: suprapubic, urethral, genital, and nongenitourinary. There was little evidence that pain at one site influenced pain at another site. With regard to frequency, suprapubic pain > urethral > genital > nongenitourinary. Patients with urethral (38%) or genital (27%) pain did not differ from those without such pain.

The multiplicity of sites and the suprapubic prominence, adjectival descriptors, and responses to provocation are similar to reports of others. The findings suggest that the multiple sites of pain in the same patient could be attributable to a single illness. The suprapubic area is the most common pain site, and is the site of the worst and most frequent pain. The authors point out that while bladder filling evokes pain in BPS, this fact in and of itself does not distinguish between the bladder as the pain generator and as a referral site of pain generated from another site. However, central sensitization probably explains the multiplicity of pain sites in BPS.

Women who in other contexts might have been diagnosed with urethral syndrome or vulvodynia, in this study, did not differ in pertinent variables from women who had BPS without pain at these sites.

Warren JW, Langenberg P, Greenberg P, Diggs C, Jacobs S, Wesselmann U
J Urol. 2008 Oct;180(4):1373-7
doi:10.1016/j.juro.2008.06.039

Written by UroToday.com Contributing Editor Philip M. Hanno, MD, MPH

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