Bladder Pain Syndrome (Interstitial Cystitis): Causes & Treatment

Last updated: May 18, 2026

Soarawee Weerasopone, Urologist

Bangkok hospital Headquarter, Bangkok

Samitivej Sriracha hospital, Chonburi

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A huge amount of women patients who was being at my office with the annoying of urinary bladder pain symptom. Patients, they will realize that they are now in the phase of circling around the clinics and hospitals just because to seek out a certain medications and treatment for their conditions. And it shows up with vary of treatment in a different ways. Most often we will see a message from a physician that they were suspected on the bladder infection after unimproved antibiotics completion courses. There’s one of disease that we should consider on and pay attention to it is called “Bladder pain syndrome” or another medical term called it “Interstitial cystitis” Well, that is the topic that we are going to find out today.

Imprecise diagnosis may lead into unnecessary antibiotic usage

Bladder pain syndrome (BPS) is a chronic painful bladder condition which was reported at least 2.7% of women in US affects. This disease can have a long-lasting impact on the quality of life along with a high medical expense by the way. BPS can be suspected when the criteria of the diagnostic is fulfill as following requirements (Reference from American Urological Association)

Bladder pain syndrome criteria.

An unpleasant sensation (pain, pressure, discomfort) perceived to be related with urinary bladder
Frequent urination or urgent need to urinate
The symptom might persists more than 6 weeks
Absence of infection or other identifiable causes

Although there’s no a stable in diagnostic criteria presently, but we can just make diagnosis to help by level of suspicious. The patient who was suspected on Bladder pain syndrome shall have investigation to make sure that there is no hidden disease such as infections or cancers. The endoscopic urinary bladder working up is just an optional which will make us more confident if we can find pathognomonic sign “Hunner’s ulcers” and once again, even we cannot find the ulcers, we still use “Trial of treatment” strategy anyway.

Lots of questions come up with a question like how could it happen? There are several theories trying to explain what is going on with Bladder pain syndrome, I will summaries into 2 majors theories

Lots of theories try to explain what is the possibly cause of BPS

There is a disruption at outer layer of bladder mucosa so the chemical substance or bacteria in urine directly expose to the inner layer part of bladder mucosa which contains lots of nerve ending there, resulting in unusual bladder pain sensation.
Frequent urinary tract infection (UTI) trigger varieties of inflammation pathways at the surface of bladder mucosa leading to unusual chronic bladder sensation even infection has been subsided.

The treatment plan will be started from conservative treatment and slowly step up aggressively more while the clinical outcome is not satisfied yet. Here are examples of the treatment options

Observant habit on any diet that worsen BPS is recommended

Behavioral change and diet alteration
Pelvic floor exercise

Any kind of Stress reduction method may give benefit on BPS

Stress reduction

Oral medication is a good trial in BPS management

Oral medications – It was reported up to 77% success rate from oral medications
Intravesical therapy – Up to 93% success rate from this endoscopic intervention
Sacral nerve modulation – High cost and invasiveness

Most patient will be improved after the treatment but unfortunately that the remission rate is pretty high also. This kind of disease, we need to educate and reassure the patient about natural history of disease so patient won’t get any confusion. If you guys or your relatives experience in this kind of symptoms, Please make any discussion with your trusted urologist or would be honor if you text me. Thank you!

If you have been suffering from chronic bladder pain, frequent urination, or recurrent UTI-like symptoms that don’t respond to antibiotics, Dr. Soarawee Weerasopone offers specialist consultations at Bangkok Hospital Headquarters. Book a Consultation.

Frequently Asked Questions about Bladder Pain Syndrome

What is bladder pain syndrome (interstitial cystitis)?

Bladder pain syndrome (BPS), also known as interstitial cystitis, is a chronic condition characterized by persistent bladder pain, pressure, or discomfort lasting more than 6 weeks, accompanied by urinary frequency and urgency, in the absence of any identifiable infection or other cause. It affects approximately 2.7% of women and can significantly impair quality of life.

How is bladder pain syndrome different from a bladder infection?

Bladder pain syndrome and urinary tract infection (UTI) share similar symptoms such as bladder discomfort and frequent urination, but BPS has no bacterial cause. Unlike a UTI, BPS does not respond to antibiotics and is a chronic, recurring condition. Many BPS patients are misdiagnosed with recurrent UTIs and given repeated courses of antibiotics without improvement before the correct diagnosis is made.

What causes bladder pain syndrome?

The exact cause of BPS is not fully understood. The two leading theories involve either a disruption in the bladder mucosal lining that allows urine to irritate underlying nerve endings, or repeated urinary tract infections that trigger chronic inflammation pathways even after the infection has cleared. Both mechanisms result in hypersensitivity and persistent bladder pain.

How is bladder pain syndrome treated?

Treatment follows a stepwise approach. First-line options include dietary changes, behavioral modification, pelvic floor physiotherapy, and stress reduction. Oral medications offer up to 77% success rates, while intravesical therapy (bladder instillation) achieves up to 93% improvement. For refractory cases, sacral nerve modulation or surgical intervention may be considered.

Can bladder pain syndrome be cured?

While many patients improve significantly with treatment, BPS is often a relapsing condition with a notable remission rate. Complete cure is not always achievable, but symptoms can be well-controlled with appropriate management. Long-term follow-up with a urologist, patient education about the disease’s natural history, and individualized treatment planning are key to maintaining a good quality of life.

Disclaimer: This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is intended for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before starting any medical treatment.

Medically written & reviewed by: Dr. Soarawee Weerasopone (Dr. Pom) — Board-Certified Urologist, Bangkok Hospital Headquarters. International Fellow: Baylor College of Medicine (USA) · Juntendo University (Japan) · Chang Gung Memorial Hospital (Taiwan).

Dr. Soarawee Weerasopone

Dr. Soarawee Weerasopone (Dr. Pom) is a board-certified urologist at Bangkok Hospital Headquarters, specializing in Men’s Health, Robotic Surgery (Da Vinci System), and Kidney Stone treatment. He has completed international fellowships at Baylor College of Medicine (USA), Juntendo University Hospital (Japan), and Chang Gung Memorial Hospital (Taiwan). All medical content on this site is written and reviewed by Dr. Soarawee based on his clinical experience and international training.