Symptoms of bladder pain syndrome (BPS)

Symptoms of bladder pain syndrome (BPS) include:

bladder pain or pain in your lower tummy or back
feeling like you need to pee, even when your bladder is empty
peeing often, usually just small amounts, during the day
waking up at night to pee
leaking out a small amount of pee if you do not get to a toilet quickly enough
pain during sex - women can find sex (penetration) painful and men can find getting an erection painful

You may also feel discomfort when your bladder fills up after drinking. You may get some relief when you pee.

Symptoms of BPS can come and go over time. There are usually times where your symptoms get worse (called flare-ups) and times where they are better.

BPS is more common in women than men and usually affects people aged 40 or above.

Non-urgent advice: See a GP if:

you have pain in your bladder, lower tummy or back that does not go away or keeps coming back
you are peeing much more than you usually do

Urgent advice: Ask for an urgent GP appointment or get help from NHS 111 if:

you have blood in your pee - blood in your pee may be bright pink, red or dark brown
you have bladder, lower tummy or back pain and you have a very high temperature or you feel very hot, or cold and shivery - these could be signs of an infection

You can call 111 or get help from 111 online.

Tests for bladder pain syndrome (BPS)

There is no single test that can diagnose bladder pain syndrome (BPS). You might need several tests to check for other conditions that could be causing your symptoms, such as a urinary tract infection (UTI).

You may need to have tests such as:

a blood test
a pee test (urine test)
a physical examination of your pelvis, and genitals (which may include an internal vaginal exam)
an ultrasound scan of your tummy
a cystoscopy to look inside your bladder using a thin tube with a camera inside it
measuring the pressure inside your bladder using a thin tube (catheter)

Treatments for bladder pain syndrome (BPS)

There is currently no cure for bladder pain syndrome (BPS). But there are treatments that can help manage your symptoms such as pain.

Your doctor will talk to you about the different options and what might work best for you.

If treatment is not working or your symptoms are severe, you may be referred to a specialist in treating bladder conditions (urologist).

Medicines

Medicines that can help the symptoms of BPS include:

everyday painkillers like paracetamol and ibuprofen
painkillers to treat nerve pain like amitriptyline, gabapentin or pregabalin
medicines that make you pee less like oxybutynin

If other treatments have not worked, you may be offered a medicine called pentosan polysulfate sodium to protect your bladder from irritation, or medicine given through a thin tube (catheter) to numb your bladder or reduce your need to pee.

Surgery

Surgery is not common for BPS, but it may be recommended if other treatments have not helped.

Possible options include:

injecting your bladder with Botulinum toxin (botox) to numb it
inserting a small device under the skin in your lower back that sends signals to the nerves controlling your bladder (the medical term for this procedure is sacral nerve stimulation)
expanding your bladder by using tissue from elsewhere in your body

Treatment and support for bladder pain syndrome (BPS)

There is other treatment and support that can help with the symptoms and problems caused by BPS.

This may include:

physiotherapy to strengthen your pelvic floor muscles
bladder retraining exercises
help with managing long-term pain
mental health support if you have low mood or anxiety
advice on what you can do if symptoms are affecting your sex life (loss of libido)

Things you can do to help with bladder pain syndrome

There are things you can do to manage the symptoms of bladder pain syndrome (BPS).

Do

keep a food diary to track what you eat and drink, as certain foods and drinks may make your symptoms worse, such as making you pee more
take regular low-impact exercise, like walking, swimming or yoga, and try relaxation techniques such as mediation, as these may help with some symptoms

Don’t

do not eat too much spicy food or acidic food (like citrus fruits)
do not have too much alcohol or caffeinated drinks, such as energy drinks, tea or coffee

Causes of bladder pain syndrome (BPS)

The symptoms of bladder pain syndrome (BPS) are caused by the inner lining of the bladder (the bladder wall) becoming irritated and inflamed. But it is unclear why this happens in some people.

It's thought it may be caused by:

your immune system mistakenly attacking your bladder wall, causing inflammation
a problem with your bladder wall which makes it easily irritated by substances in your pee

You are more likely to get BPS if you already have another long-term pain condition like fibromyalgia.

Bladder pain syndrome (BPS)