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Bladder Pain & IC/BPS Pharmacotherapy

Pharmacotherapy for interstitial cystitis or bladder pain syndrome (IC/BPS) is individualized. The AUA 2022 guideline removed numbered treatment tiers: oral drugs and bladder instillations can be combined with appropriate behavioral and physical therapies. Evidence for many drugs remains uncertain.[1]

Oral pentosan polysulfate (PPS) is an AUA 2022 option (Grade B); CUA 2025 conditionally recommends standard care over it (low certainty), whereas EAU 2026 strongly recommends it for primary bladder pain syndrome.[1][2][3] CUA 2025 cannot identify a preferred intravesical agent or cocktail.[2] The oral hub explains the PPS benefit–risk discussion and retinal surveillance.[2]

For evidence on gabapentinoids and TCAs in neuropathic pain, and on vaginal diazepam in pelvic-floor myalgia, see Neuropathic & Pelvic Pain. For chronic pelvic pain frameworks see IC/BPS.

  • Oral IC/BPS AgentsAmitriptyline, cimetidine, hydroxyzine, PPS and selected cyclosporine use. PPS retinal toxicity is a label warning; screening and treatment continuation require individual assessment.
  • Intravesical AgentsDMSO, heparin, lidocaine and other bladder instillations for IC/BPS, with dosing, evidence and safety.

References​

1. Clemens JQ, Erickson DR, Varela NP, Lai HH. "Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome." J Urol. 2022;208(1):34–42. doi:10.1097/JU.0000000000002756

2. Doiron RC, Tadayon B, Violette PD, et al. "2025 Canadian Urological Association Guideline: Selected treatment recommendations for interstitial cystitis/bladder pain syndrome." Can Urol Assoc J. 2025;19(4):90–103. doi:10.5489/cuaj.9182

3. Engeler D, Baranowski AP, Berghmans B, et al. EAU Guidelines on Chronic Pelvic Pain. European Association of Urology; 2026. Management.