Improvement in sexual functioning in patients with interstitial cystitis/painful bladder syndrome

Effects of onabotulinum toxin-A injection on sexual function in women with refractory interstitial cystitis/bladder pain syndrome: A prospective study

OBJECTIVES

To determine the effect of intravesical onabotulinum toxin-A (BoNT-A) treatment on sexual functions in female patients with refractory interstitial cystitis/bladder pain syndrome (IC/BPS).

METHODS

Female patients with IC/BPS refractory to previous treatments were included in the study between January 2020 and April 2022. Patients were treated with the trigone-sparing injection (Group 1) or trigone-included injection (Group 2) techniques. 100 Units of BoNT-A was applied submucosally on 20 different points. The patients were evaluated with visual analog scale (VAS), O'Leary-Sant Interstitial Cystitis Symptom Index (ICSI), Interstitial Cystitis Problem Index (ICPI), Female Sexual Function Index (FSFI) questionnaires, 3-day voiding diary, uroflowmetry, and post-voiding residual volume analysis in the preoperative period, as well as on the 30th and 90th days postoperatively. For the repeated measurements, analysis of variance was used to assess the time-dependent variation across groups.

RESULTS

The baseline FSFI score of the patients was 15.96 ± 3.82. Following the treatment, the FSFI scores were 22.43 ± 4.93 and 24.41 ± 5.94 on the 30th and 90th days, respectively (p < .001). We observed statistically significant improvement in all FSFI subdomains (p < .05). Statistically significant improvements with treatment on ICSI, ICPI, and VAS scores were achieved (p < .05). Preoperative FSFI scores were similar in Group 1 and Group 2 (p = .147). While the preoperative FSFI scores were 17.00 ± 3.73 and 14.84 ± 3.72 for Group 1 and Group 2, respectively, the scores after the treatment were 22.85 ± 5.01 and 21.98 ± 5.01 on the 30th day, and 24.62 ± 6.06 and 24.19 ± 6.05 on the 90th day postoperatively. Significant improvement was observed in FSFI scores with treatment, and no difference was observed between the two groups in terms of treatment response (p = .706).

CONCLUSIONS

Intravesical BoNT-A injection in the treatment of women with refractory IC/BPS improves sexual functions. It also significantly improves pain and symptom scores. Both trigone-sparing and trigone-including injections are similarly safe and effective.

Quality of Life and Treatment Modalities in Patients with Interstitial Cystitis: The Patients' Perspective

BACKGROUND

Quality of life (QoL)-based outcomes are hardly incorporated into interstitial cystitis/bladder pain syndrome (IC/BPS) guidelines, because studies are limited and outdated. Therefore, guidelines might not reflect the current clinical situation accurately. Secondly, guidelines suggest using a multimodal approach for BPS/IC management, but data on the patient-perceived efficacy of these therapies are limited. The aim of this study is to investigate the perception of IC/BPS patients of their QoL, to determine which treatments they have received, and to examine how they evaluate the efficacy of these various (alternative) therapies.

METHODS

A quantitative retrospective database evaluation was performed, with data from an existing IC/BPS patient survey (n = 217) that was conducted in 2021. This survey contained QoL data based on validated questionnaires such as EQ-5D 5L.

RESULTS

The QoL of patients is affected significantly by IC/BPS. This is evident from the various affected domains on the EQ-5D 5L. The symptom severity was negatively affected by a delay in diagnosis, and there were clear differences in QoL domains between females and males. Secondly, coagulation therapy and intravesical glycosaminoglycan (GAG) therapy were most appreciated by patients. Other (alternative) treatments were commonly utilized, although some had doubtful results and high discontinuation rates.

CONCLUSION

QoL is considerably impaired in IC/BPS patients. The diverse responses and adherence to various treatments warrant a personalized approach (phenotype-oriented therapy). To achieve QoL improvement, it is important to incorporate the patient's perspective in treatment guidelines.

Bladder pain syndrome and sexual function: a systematic review and meta-analysis

INTRODUCTION AND HYPOTHESIS

Bladder pain syndrome (BPS)/interstitial cystitis can adversely affect physical, mental, and sexual health. The aim of the systematic review is to compare sexual function between patients with BPS and healthy controls and to examine whether or not treatment of BPS improves sexual function.

METHODS

A literature search was conducted on Embase, Medline, and other databases. Studies comparing sexual function in BPS patients with healthy controls and before/after treatment were included. Where appropriate, data were pooled in a meta-analysis, using a random effects model and the standardised mean difference (SMD) was used for comparison.

RESULTS

Out of 384 studies initially identified, 26 studies met the inclusion criteria for the systematic review and 11 for the meta-analysis. Six studies compared sexual function in BPS cases with healthy controls. All studies found that the Female Sexual Function Index (FSFI) was worse in BPS cases than in controls. Pooled data from 5 studies showed that the SMD was -1.02 (CI -1.64, -0.4) in total FSFI scores between the cases and controls, p=0.001. Further analysis showed better sexual function in all FSFI subdomains in healthy controls. Five studies compared sexual function in BPS patients before treatment with after treatment. Pooled data from 3 studies showed an overall improvement in total FSFI score after intravesical treatment: SMD=0.69 (CI 0.23, 1.14), p=0.003. Further analysis showed improvement in all subdomains.

CONCLUSION

Our review suggests that sexual function might be worse in BPS patients than in the general population, but it seems to improve with intravesical BPS treatment.

Sexual dysfunction in women with interstitial cystitis/bladder pain syndrome: Do onabotulinum toxin-A injections improve sexual function?

INTRODUCTION

Interstitial cystitis/bladder pain syndrome (IC/BPS) has a negative impact on female sexual function. We aimed to evaluate the effect of intravesical botulinum toxin-A (BTX-A) injection on the improvement of sexual dysfunction and urinary symptoms using the multi-domain female sexual function Index (FSFI), interstitial cystitis symptom index (ICSI), and interstitial cystitis problem index (ICPI).

MATERIAL AND METHOD

The data of the 23 patients (study group) who received intravesical BTX-A with the diagnosis of IC/BPS were reviewed. Twenty-three age-matched healthy, sexually active women were determined as the control group. Patients received 100 U BTX-A submucosally injections, including the trigone. One hundred units of BTX-A were diluted to 20 cc 0.9% saline, and 1  cc was then applied submucosally on 20 different points of the bladder wall (5 U/1 mL per site). The study group was asked to fill out FSFI, ICSI, and ICPI, as well as the visual analog scale (VAS) and bladder diary before and 3 months after the treatment. Patients in the control group completed the same questionnaires once. The pre- and post-treatment questionnaire scores were compared in the study group. The study group's data were also compared to the control group.

RESULTS

Compared to the pretreatment period, the study group showed statistically significant improvement in the total FSFI score and each domain of the FSFI after BTX-A injection. The mean total FSFI score and three domains of FSFI (desire, lubrication, pain) reached to the score of the control group following BTX-A injection. Statistically significant improvements were also shown in scores of ICSI, ICPI, and VAS. (p < 0.05).

CONCLUSION

IC/BPS is associated with a very high incidence of sexual dysfunction. Intravesical BTX-A injection may provide significant improvement in sexual dysfunction in women with IC/BPS.

Examining vaginal and vulvar health and sexual dysfunction in patients with interstitial cystitis (UNICORN-1 study)

INTRODUCTION AND HYPOTHESIS

The Vaginal Health Index Score (VHIS) and vulvodynia swab tests are used to assess vaginal health and vulvodynia. However, few studies have used these tests in patients with interstitial cystitis/bladder pain syndrome (IC/BPS). IC/BPS is a chronic, debilitating disorder, characterised by urinary frequency, urinary urgency and pelvic pain. It adversely affects organs adjacent to the urinary system, leading to complications of sexual dysfunction. This study was aimed at understanding sexual dysfunction in patients with IC/BPS, as well as deterioration of vaginal health and vulvodynia.

METHODS

This study compared the vaginal health of IC/BPS patients with that of asymptomatic control individuals. The Pain Urgency Frequency (PUF) score, Female Sexual Function Index (FSFI), VHIS, and vulvodynia swab tests, were used as tools. The PUF and FSFI are questionnaire-based surveys of bladder symptoms and sexual function respectively. VHIS evaluation and vulvodynia swab tests are performed by physicians. The PUF was used to assess baseline IC/BPS symptoms to validate the patient population, and FSFI, vulvodynia swab tests and VHIS were used to determine between-group differences.

RESULTS

Thirty-seven patients were recruited in each group. The IC/BPS group had a higher PUF score (18.19±3.51 vs 3.56±2.35; p<0.05), worse total FSFI (15.72±4.46 vs 26.3±4.93; p<0.05), and worse vulvodynia swab test and total VHIS (11.59±2.87 vs 22.05±3.05; p<0.05) scores than those of the control group.

CONCLUSIONS

Asian women with IC/BPS experienced greater sexual dysfunction, worsened vaginal health and increased vulvodynia compared with control individuals. Information on vaginal and vulva health is very useful in evaluating IC/BPS patients.

Interstitial Cystitis/Bladder Pain Syndrome Treatment: A Systematic Review of Sexual Health Outcomes

INTRODUCTION

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic condition with highly prevalent negative consequences on sexual health and quality of life. However, there is a lack of consensus regarding treatment options that improve sexual function in this population. This study aims to review the current literature on sexual health outcomes in patients treated for IC/BPS.

METHODS

We conducted a systematic review of the literature on sexual health outcomes after treatment of IC/BPS. PubMed, MEDLINE, EMBASE, CINHAL, and Google Scholar were queried, and results were screened using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria for this review were: IC/BPS was clearly defined in the cohort, sexual health outcomes were measured as the primary or a secondary outcome, manuscript was written in English from January 2000 to April 2020. Studies on cystectomy were excluded as radical surgery is a confounding factor for sexual dysfunction.

RESULTS

We identified 1611 items with our search algorithm and determined that 10 studies ultimately met inclusion criteria. 4 of 10 studies reported improved sexual function after treatment. 4 of 10 studies were randomized control trials and reported no improvement in sexual function in each of the therapies that were investigated. Data were conflicting regarding the effect of intravesical hyaluronic acid.

CONCLUSION

This systematic review demonstrates the lack of focus on sexual health outcomes in studies of the IC/BPS. There was no strong evidence that any modality used to treat IC/BPS also improves sexual function despite the higher prevalence in this population. Chen A, Shahiyan RH, Anger J. Interstitial Cystitis/Bladder Pain Syndrome Treatment: A Systematic Review of Sexual Health Outcomes. Sex Med Rev 2021;xx:xx-xx.

Sexual dysfunction in women with interstitial cystitis/bladder pain syndrome: A case-control study

Introduction:

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic debilitating illness characterized by urinary frequency, urgency, and pelvic pain. IC/BPS adversely affects the sexual well-being of the patients. We used the Female Sexual Function Index (FSFI) to compare sexual dysfunction (FSD) in women with IC/BPS versus controls in an Indian cohort where such data is lacking.

Materials and Methods:

This case–control study was designed to compare the FSDs in patients with IC/BPS to that of asymptomatic controls. Pelvic Pain and Urgency/Frequency (PUF) Questionnaire scores and FSFI scores were used as tools for this study.

Results:

Thirty-two patients were recruited in each group. Patients with IC/BPS had a significantly higher PUF score as compared to the control group (7.843 vs. 3.656). These patients also scored worse on the total adjusted FSFI score (18.678 ± 4.531 vs. 28.05 ± 4.318; P < 0.05) and individually in all domains of sexual function. Twenty-nine (90.62%) patients of the IC/BPS group had FSD as compared to 12 (37.5%) of patients in the control group. Pain was the most common presenting complaint and was seen in 65.25% of patients in the IC/BPS group as compared to only 31.25% of patients in the control group.

Conclusion:

The results of our study show that women with IC/BPS have more pain and sexual dysfunction than controls.

Outcomes of intravesical chondroitin-sulfate and combined hyaluronic-acid/chondroitin-sulfate therapy on female sexual function in bladder pain syndrome

INTRODUCTION AND HYPOTHESIS

Our aim was to determine the efficacy of intravesical chondroitin sulfate (CS) and combined hyaluronic acid/chondroitin sufate (HA/CS) treatment and their effects on sexual function of females with interstitial cystitis/bladder pain syndrome (IC/BPS).

METHODS

A total of 68 female patients with IC/BPS between 2012 and 2018 were reviewed. Thirty-three patients were treated with combined HA/CS and 28 patients were treated with CS. Instillations were performed weekly for the first month, biweekly for the second month, and monthly in the third and fourth months. Before and after the sixth month of the treatment, all patients were evaluated with the Female Sexual Function Index (FSFI), visual analog pain scale (VAS), interstitial cystitis symptom index (ICSI), interstitial cystitis problem index (ICPI), and voiding diary, and changes were recorded.

RESULTS

A statistically significant improvement was determined for FSFI, VAS, ICSI, and ICPI scores after treatment in both groups. Among baseline characteristics, a weak but significant negative correlation was determined only between the ICSI score improvement and age (rho: -0.38; p = 0.03) on statistical analysis. Compared with CS, combined HA/CS treatment was superior in terms of ICSI, ICPI, and daytime and nighttime frequency improvement (0.042, 0.038, 0.039, and 0.045; respectively). All domains of the sexual function index were significantly improved at the sixth month of intravesical therapy in both groups. A statistical difference was not found between the two groups.

CONCLUSIONS

Although it seems that intravesical HA/CS combination is superior to CS alone in terms of symptom reduction, both of them have beneficial effects on sexual function.

Sexual Dysfunction in Interstitial Cystitis

Background/Aims

Interstitial cystitis (IC)/bladder pain syndrome (BPS) is a debilitating disease characterized with urgency, frequency, and pelvic pain affecting especially women. Sexual dysfunction in female patients with IC/BPS consists of dyspareunia, altered sexual desire and orgasm frequency and insufficient lubrication is reported to negatively affect the patient's quality of life. In the present study, we aimed to determine the association between IC/BPS and sexual dysfunction and improvement in sexual dysfunction related to given treatments.

Methods

A PubMed/Medline and EMBASE search was conducted using keywords: "interstitial cystitis", "sexual dysfunction", and "bladder pain syndrome".

Conclusion

Several studies have been conducted to determine the relation between IC/BPS and sexual dysfunction. And also limited studies focusing on IC/BPS specific treatments reported significant improvements in sexual function after either oral or intravesical treatment. However, given the used different questionnaires, study protocols, patient characteristics, previous treatments and follow-up period, it is not possible to make a head-to-head comparison of the treatment effects on sexual function. Further, randomized controlled studies are needed to confirm these results and make a comparison between effects of various treatment modalities on sexual functioning in IC/BPS.

Psychosocial co-morbidities in Interstitial Cystitis/Bladder Pain syndrome (IC/BPS): A systematic review

AIMS

Psychosocial factors amplify symptoms of Interstitial Cystitis (IC/BPS). While psychosocial self-management is efficacious in other pain conditions, its impact on an IC/BPS population has rarely been studied. The objective of this review is to learn the prevalence and impact of psychosocial factors on IC/BPS, assess baseline psychosocial characteristics, and offer recommendations for assessment and treatment.

METHOD

Following PRISMA guidelines, primary information sources were PubMed including MEDLINE, Embase, CINAHL, and GoogleScholar. Inclusion criteria included: (i) a clearly defined cohort with IC/BPS or with Chronic Pelvic Pain Syndrome provided the IC/BPS cohort was delineated with quantitative results from the main cohort; (ii) all genders and regions; (iii) studies written in English from 1995 to April 14, 2017; (iv) quantitative report of psychosocial factors as outcome measures or at minimum as baseline characteristics.

RESULTS

Thirty-four of an initial 642 articles were reviewed. Quantitative analyses demonstrate the magnitude of psychosocial difficulties in IC/BPS, which are worse than average on all measures, and fall into areas of clinical concern for 7 out of 10 measures. Meta-analyses shows mean Mental Component Score of the Short-Form 12 Health Survey (MCS) of 40.80 (SD 6.25, N = 2912), where <36 is consistent with severe psychological impairment. Averaged across studies, the population scored in the range seen in clinical depression (CES-D 19.89, SD 13.12, N = 564) and generalized anxiety disorder (HADS-A 8.15, SD 4.85, N = 465).

CONCLUSION

The psychological impact of IC/BPS is pervasive and severe. Existing evidence of treatment is lacking and suggests self-management intervention may be helpful.

Chronic inflammation and quality of life in older adults: a cross-sectional study using biomarkers to predict emotional and relational outcomes

Background

This study explores relationships between chronic inflammation and quality of life, making a case for biopsychosocial modeling of these associations. It builds on research from social and clinical disciplines connecting chronic conditions, and inflammatory conditions specifically, to reduced quality of life.

Methods

Data from Wave I of the National Social Life, Health, and Aging Project are modeled using ordinal logistic and ordinary least-squares regression techniques. Inflammation is measured using C-reactive protein; quality of life is conceptualized as happiness with life overall as well as intimate relationships specifically.

Results

For most NSHAP participants, chronic inflammation significantly predicts lower odds of reporting high QoL on both emotional and relational measures. Social structural factors do not confound these associations. Inconsistent results for participants with very high (over 6 mg/L) CRP measurements suggest additional social influences.

Conclusions

Findings echo strong theoretical justification for investigating relationships between CRP and QoL in greater detail. Further research should explore possible mediation of these associations by sociomedical sequelae of chronic disease as well as social relationship dynamics. Elaboration is also needed on the mechanisms by which social disadvantage may cause chronic inflammation.

Interpretation of the Sexual Functioning Questionnaire in the presence of vulvar pain

OBJECTIVE

This study aimed to assess whether the domains identified by items on the Sexual Functioning Questionnaire (SFQ) apply to women with vulvodynia.

MATERIALS AND METHODS

Forty-one women with vulvodynia and 43 asymptomatic controls, between the ages 18 and 70 years, were assessed with a physician evaluation and a written survey that included the SFQ.

RESULTS

Women with vulvodynia had a higher likelihood of female sexual dysfunction than did controls as indicated by 5 of the seven individual SFQ domains (desire, arousal-lubrication, pain, enjoyment, and partner domains, p < .05). Scored on individual items relating to pain or penetrative sex differed more by vulvodynia presence than did items related to arousal and emotions. Compared with published SFQ psychometrics, factor analysis among women with vulvodynia demonstrated similar factor loadings in 6 of the 7 domains of the SFQ (desire, arousal-sensation, arousal-lubrication, orgasm, partner, and pain), but the enjoyment domain intermingled substantially with these other domains.

CONCLUSIONS

The SFQ factor structure is generally valid among women with vulvodynia. However, vulvodynia may impact responses to individual items on questions about pain and/or penetration, which may potentially result in erroneous interpretations.

Prevalence and correlates of sexual dysfunction among women with bladder pain syndrome/interstitial cystitis

OBJECTIVES

To examine the prevalence and correlates of general and bladder pain syndrome/interstitial cystitis (BPS/IC)-specific sexual dysfunction among women in the RAND Interstitial Cystitis Epidemiology study using a probability sample survey of U.S. households. Sexual dysfunction can contribute to a reduced quality of life for women with bladder pain syndrome/interstitial cystitis (BPS/IC).

METHODS

We telephoned 146,231 households to identify women who reported bladder symptoms or a BPS/IC diagnosis. Those who reported either underwent a second-stage screening using the RAND Interstitial Cystitis Epidemiology study high-specificity symptom criteria. The criteria were pain, pressure, or discomfort in pelvic area; daytime urinary frequency ≥10 times or urgency due to pain, pressure, or discomfort (not fear of wetting); pain that worsened as the bladder filled; bladder symptoms did not resolve after antibiotic treatment; and patients never treated with hormone injections for endometriosis. Women who met the RAND Interstitial Cystitis Epidemiology criteria (n = 1469) completed measures of BPS/IC-specific and general sexual dysfunction symptoms, bladder symptom severity, general physical health, depression, medical care-seeking, and sociodemographic characteristics.

RESULTS

Of those with a current sexual partner (75%), 88% reported ≥1 general sexual dysfunction symptom and 90% reported ≥1 BPS/IC-specific sexual dysfunction symptom in the past 4 weeks. In the multivariate models, BPS/IC-specific sexual dysfunction was significantly associated with more severe BPS/IC symptoms, younger age, worse depression symptoms, and worse perceived general health. Multivariate correlates of general sexual dysfunction included non-Latino race/ethnicity, being married, and having depression symptoms.

CONCLUSIONS

The results of our study have shown that women with BPS/IC symptoms experience very high levels of sexual dysfunction. Also, sexual dysfunction covaries with symptoms.

Correlations of interstitial cystitis/painful bladder syndrome with female sexual activity

PURPOSE

We investigated how the symptoms of interstitial cystitis/painful bladder syndrome (IC/PBS) are correlated with the sexual activity of these patients.

MATERIALS AND METHODS

A total of 87 patients were included in this study; 18 patients were diagnosed with IC and the other 69 had PBS. The diagnosis was made on the basis of the concept of IC/PBS proposed by the ICS in 2002. Patients were asked to fill in a Bristol female lower urinary tract symptom questionnaire, and symptoms were rated on a scale of from 1 to 4 or 5. Pearson's correlation coefficient was used to analyze the correlation of pain and urinary symptoms with quality of life and sexual activity.

RESULTS

The average age of the patients was 51+/-14.7 years (range, 28-74 years). Age and vulvodynia were positively correlated with one another (r=0.232), and there was a negative correlation between age and dyspareunia (r=-0.302). Among the items regarding IC/PBS and sexual activity, frequency showed a positive correlation with vulvodynia (r=0.258) in addition to an inhibited sex life (r=0.403). Urgency showed a positive correlation with an inhibited sex life (r=0.346). Vulvodynia showed a positive correlation with an inhibited sex life (r=0.259) and dyspareunia (r=0.401). The main symptoms of IC/PBS (frequency, urgency, and pelvic pain) showed a positive correlation with almost all items related to quality of life (p<0.05).

CONCLUSIONS

Frequency, urgency, and various types of pain are negatively correlated with the sexual activity of patients. This suggests that physicians should consider sexual function in the management of patients with IC/PBS.

Psychosocial phenotyping in women with interstitial cystitis/painful bladder syndrome: a case control study

PURPOSE

We characterized and compared psychosocial phenotypes in a female interstitial cystitis/painful bladder syndrome cohort and an age matched cohort without that diagnosis.

MATERIALS AND METHODS

Female patients with interstitial cystitis/painful bladder syndrome and controls without the condition completed a psychosocial phenotyping questionnaire battery, including a demographics/history form and validated questionnaires focused on a range of presenting symptoms, psychosocial parameters and quality of life. Specific measures included interstitial cystitis symptom and problem index, McGill Pain Questionnaire, Medical Outcomes Study Sleep Scale, Center for Epidemiological Studies Depression Scale, State-Trait Anxiety Inventory, Pain Catastrophizing Scale, Female Sexual Functioning Index and Multidimensional Scale of Perceived Social Support and Medical Outcomes Study Short Form-12 quality of life. Direct comparisons and correlations were made to establish group differences and the strength of associations for psychosocial parameters in patients with interstitial cystitis/painful bladder syndrome.

RESULTS

Questionnaires completed by 207 patients with interstitial cystitis/painful bladder syndrome were compared to those of 117 controls matched for age, partner status and education. Compared to controls patients reported significantly more pain (total, sensory and affective), worse physical quality of life, increased sleep dysfunction, depression, catastrophizing, anxiety, stress and moderately more sexual/social function problems. These suffering, coping and social parameters correlated with the degree of general pain but stress, anxiety, depression and catastrophizing further correlated with IC specific symptoms and strongly with decreased quality of life. Pain was strongly associated with physical quality of life, while depression, catastrophizing and stress, and to a lesser extent social support were associated with poor mental quality of life.

CONCLUSIONS

Patients with interstitial cystitis/painful bladder syndrome have significant cognitive and psychosocial alterations compared to controls.

Interstitial cystitis: an unsolved enigma

Painful bladder syndrome/interstitial cystitis (PBS/IC) is a chronic disease of unknown etiology characterized by vague bladder pain and nonspecific urinary symptoms, such as urgency and frequency. Although it was initially considered to be a rare condition, its prevalence has significantly increased, possibly because of different definitions used and greater physician awareness. Because of the multiple diagnostic criteria used, there is significant variation in its prevalence. In addition, there is often a delay in the diagnosis of PBS/IC. It affects predominantly women of middle age, and it significantly decreases quality of life. Diagnosis of PBS/IC is mainly a diagnosis of exclusion; there are no characteristic symptoms or pathognomonic findings. Therefore, it is important to rule out diseases that have a similar clinical picture (i.e., urinary infections, bladder carcinoma) but definite therapies and worse prognosis if left untreated. PBS/IC management suffers from lack of evidence; many therapies are empiric or based on small studies and case series. Treatment includes supportive therapies (psychosocial, behavioral, physical), oral treatments, and intravesical treatments, whereas other more invasive treatments such as electric neuromodulation and reconstructive surgery are reserved for refractory cases. Physicians should always keep in mind the diagnosis of PBS/IC in patients presenting with chronic urinary symptoms after excluding other more common diseases.