Bladder Pain Syndrome/Interstitial Cystitis and Endometriosis: Understanding the Link
By: Dr. Mallory Stuparich, Endometriosis Surgeon, Orange County, Southern California
Bladder Pain Syndrome (BPS), also known as Interstitial Cystitis (IC), and endometriosis are two chronic conditions that often cause pelvic pain in patients, particularly those with female reproductive organs. Both disorders are painful and complex, frequently sharing overlapping symptoms, which can complicate diagnosis and treatment.
What is Bladder Pain Syndrome (Interstitial Cystitis)?
BPS/IC is characterized by irritation and inflammation of the bladder walls, leading to symptoms such as persistent pelvic pain, urinary urgency and frequency (sometimes up to 60 times per day), discomfort or pressure in the pelvic area, and pain during bladder filling or urination. The condition can cause bladder wall stiffening and scarring and significantly disrupt quality of life.
Why Do BPS/IC and Endometriosis Often Coexist?
Recent studies show a strong association between endometriosis and BPS/IC, with many patients experiencing both conditions simultaneously. The overlap in symptoms—chronic pelvic pain, pain during intercourse, urinary urgency, and pelvic pressure—leads some experts to describe them as the “evil twins” of pelvic pain.
Patients with unresolved pelvic pain after treatment for endometriosis often find that IC is an overlooked but contributing factor. Research indicates that a significant portion of women with persistent pelvic pain post-hysterectomy or without clear resolution of symptoms may actually have IC as a primary or secondary diagnosis.
Diagnosis and Treatment
Distinguishing between the two can be challenging. Pain that worsens before menstruation tends to indicate endometriosis, while pain related to bladder fullness or relief after urination suggests IC involvement.
Effective treatment of both conditions requires a multidisciplinary approach, and treating both conditions together often yields better symptom relief than addressing one alone.
BPS/IC treatment may include:
- Physical therapy for pelvic floor dysfunction
- Medications like antihistamines, pentosan polysulfate sodium, NSAIDs
- Neuromodulation therapies
- In some cases, bladder instillations or surgery may be considered
At ESSI, we emphasize a patient-centric, multidisciplinary approach to identify and treat all contributors to pelvic pain, including bladder pain syndrome and endometriosis. Early diagnosis and coordinated care are key to improving quality of life for patients suffering from these complex, overlapping disorders.
References
- https://www.healthline.com/health/endometriosis/interstitial-cystitis-and-endometriosis
- https://pmc.ncbi.nlm.nih.gov/articles/PMC3015726/
- https://onlinelibrary.wiley.com/doi/10.1002/nau.23462
- https://www.sciencedirect.com/science/article/abs/pii/S1553465019312646
- https://www.sciencedirect.com/science/article/pii/S1743919113000344
