Bladder pain syndrome / interstitial cystitis (BPS/IC)

It is 11:40 in the urogynaecology clinic. A 38-year-old teacher sits across the desk with three years of worsening suprapubic pain, 18 voids a day, three nights up, and a stack of negative urine cultures. She has seen two urologists, been told it is recurrent UTI, then anxiety, then overactive bladder. She is clutching a flask of water because she cannot last the appointment. The trap is that the diagnosis looks ordinary from the door — frequency, urgency, dysuria. The art is to recognise that the pain drives the frequency, that the culture is repeatedly sterile, and that no cystoscopy has ever been performed.^[3][9]

Overview and definition

Bladder pain syndrome / interstitial cystitis (BPS/IC) is chronic pelvic pain perceived to be related to the bladder, accompanied by lower urinary tract symptoms (urgency, frequency, nocturia) in the absence of infection or other identifiable pathology. The pain typically worsens as the bladder fills and is relieved by voiding — that pattern is the clinical fingerprint.^[1][9][14]

Two terms live side by side. Interstitial cystitis (IC) is the older North American term, coined in 1887. Bladder pain syndrome (BPS) is the ICS 2002 term, adopted by the EAU and RANZCOG-aligned literature. Both refer to the same clinical entity. The ESSIC/EAU prefer BPS, the AUA still uses IC/BPS. Japan introduced hypersensitive bladder (HSB) for the urgency-frequency phenotype without pain. The terminological soup is real — but at the station, BPS and IC are interchangeable.^[3][14]

The cardinal features you must be able to quote:^[1][9]

• Pain — suprapubic, often radiating to the urethra, vagina, lower back or thighs; worsened by bladder filling; relieved by voiding.^[1]
• Frequency — typically 10–20 voids/day, 2–5 nocturia episodes.^[1]
• Urgency — but urgency driven by pain and fear of pain, not by detrusor overactivity alone.^[1]
• Duration — at least 6 weeks (some guidelines require 6 months to align with chronicity).^[1][9]