What is bladder pain syndrome (BPS)?
What is BPS?
What are the causes of BPS?
Experts don’t know exactly what causes BPS but we do know that people with BPS seem to have the following in common:
- Some people with BPS seem to have defects in the lining inside the bladder (medically called the glycosaminoglycan, or GAG, layer). When this layer becomes defective and leaky, it may allow irritating substances such as potassium and urea in the urine to enter the bladder wall and cause irritation and pain in the deeper layers
- There is evidence that a broken GAG layer struggles to heal itself properly after it has been damaged. This could be triggered by something like a urinary tract infection. Bacteria may attach to the unprotected bladder lining and invade the deeper layers. No one specific type of bacterial infection has been identified as the culprit yet
- There are signs of inflammation in the layers of the bladder wall. Several types of cells that are involved with the immune system, and which produce various compounds that cause inflammation, have been found in the bladder wall
- The most prominent immune cells found are mast cells, which produce a substance called histamine. Histamine makes sensations from the bladder feel more intense and can enhance pain and frequency, and cause inflammation and swelling
- This long-term inflammation and irritation in the bladder layers cause changes in the nerves that carry bladder sensations, which may mean that pain is felt from sensations that should not normally feel painful (such as bladder filling)
- We know people with bladder pain syndrome are also more likely to have other autoimmune diseases
What are the symptoms of BPS?
Everyone’s bodies and bladders are different and so the symptoms of BPS can vary from person to person. The most common symptoms are:1,2
- People describe a pain or pressure that feels like it’s coming from the bladder area; this is the most common feature of BPS
- However, pain could also feel like it’s coming from other parts of the pelvic area or spreading to other areas in the pelvis e.g. the urethra (the tube from your bladder through which the urine passes when you empty your bladder) or even the lower back. It may feel like it is spreading to other parts of the pelvic area
- The pain usually worsens as the bladder fills and eases after passing urine but soon returns
- Pain may be constant or it may come and go but may be there for several weeks or months
- “Frequency” is a term used to describe a constant or more frequent need to pass urine
- Under normal circumstances, an average person urinates no more than seven times a day and does not need to get up at night to urinate more than once
- People with BPS typically have to pass urine more often during the day and get up at night more than once to use the bathroom
Urgency and a constant urge
- Some people with BPS may experience “urgency”, which is a sudden, compelling desire to pass urine that is difficult to ignore.2 Meaning you have to go NOW! Others may not experience urgency as a severe symptom
- Other people with BPS may feel a constant urge to pass urine that never goes away, even after they have just been to the toilet
Person with BPS
Person who does not have BPS
Like all diseases, symptoms and how severe they are can vary from person to person. BPS is no different.
- European Association of Urology. Guidelines on chronic pelvic pain.
Available at: https://uroweb.org/guideline/chronic-pelvic-pain/#4. Accessed March 2020
- Hanno P, et al. Bladder pain syndrome international consultation on incontinence.
Available at: https://pdfs.semanticscholar.org/65e2/1ca591824e3eb734e283d2cac21e409d9a13.pdf. Accessed January 2020