Interstitial Cystitis / Bladder Pain Syndrome
IC/BPS is bladder-centred pain with filling, relieved by voiding, in the absence of infection or other cause — a diagnosis of exclusion managed in escalating steps.
The big picture
The bladder behaves as a pain generator: as it fills, pain and urgency rise; voiding brings relief. The urothelial barrier and sensory nerves are dysfunctional. It is a clinical, exclusion diagnosis — you must rule out infection, malignancy and other causes first.
Pain on filling relieved by voiding + negative cultures = think IC/BPS; escalate treatment stepwise and look for Hunner lesions, which have their own therapy.
Symptom sorter
The common presentation.
Diagnostic algorithm
Each step answers one question. Tap to expand.
Treatment ladder
Escalate stepwise from conservative measures, through oral and intravesical therapy, to procedures — treating Hunner lesions directly when present.
Drug selector
Hunner-lesion IC
See a Hunner lesion → treat the lesion.- Targets
- Discrete inflammatory bladder-wall lesions on cystoscopy.
- Onset
- See detail
- Use when
- Has specific, effective lesion-directed therapy.
- Side effects
- Fulguration/triamcinolone injection of lesions; may respond when other measures fail.
Procedure chooser
- Major reconstructive surgery (e.g. cystectomy/diversion) only as a last resort
Complications
- Chronic pain and reduced bladder capacity
- Sleep and quality-of-life impairment
- Depression/anxiety
- Drug side effects
- Procedure-related risks
- Avoid unnecessary antibiotics
- Exclude malignancy before labelling
- Escalate stepwise
- Multidisciplinary pain care
Red flags
Exclude bladder cancer before attributing symptoms to IC/BPS.
Consider genitourinary tuberculosis.
Cystoscopy to exclude CIS/bladder cancer.
Memory hooks
Fills → pain; voids → relief.
Negative cultures, chronic pain = IC/BPS.
Hunner lesion → treat the lesion.
Step up, do not jump to surgery.
Board traps
Recurrent 'UTI' with negative cultures and fill-pain — IC/BPS.
Hunner lesion present but only oral therapy given — treat the lesion.
New irritative symptoms in an older smoker — exclude cancer first.
Clinical cases
A 45-year-old woman has 2 years of suprapubic pain that worsens as her bladder fills and improves immediately after voiding, with urinary frequency. Multiple urine cultures are negative and antibiotics have not helped.
What is the likely diagnosis and an important next test?