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Noninvasive experimental bladder pain assessment in painful bladder syndrome
Author(s) -
Tu FF,
Kane JN,
Hellman KM
Publication year - 2017
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.14433
Subject(s) - bladder pain syndrome , medicine , pain syndrome , anesthesia , interstitial cystitis , urinary system
Objective To compare bladder sensitivity between patients with pelvic pain and patients who were pain free, undergoing noninvasive, controlled bladder distension via diuresis. We also sought to measure potential mechanisms underlying bladder sensitivity. Design Prospective observational study. Setting Community teaching hospital. Population Reproductive‐age women with non‐bladder chronic pelvic pain ( CPP , n = 23), painful bladder syndrome ( PBS , n = 23), and pelvic pain‐free controls ( n = 42) Methods Participants were compared on cystometric capacity, pelvic floor pressure‐pain thresholds ( PPT s), pelvic muscle function, O'Leary‐Sant bladder questionnaire, and psychosocial instruments using Wilcoxon rank‐sum tests. Multivariate regression was used to identify factors underlying bladder pain phenotypes. Main outcome measures Pelvic floor pain thresholds; self‐reported bladder distension pain. Results Participants with PBS exhibited higher bladder distension pain than those with CPP , with both groups reporting higher pain levels than controls ( P < 0.05). No significant associations were found between bladder distension pain and pelvic muscle structure or pain sensitivity measures; however, bladder distension pain positively correlates with both vaginal PPT s adjacent to the bladder ( r = 0.46) and pain with transvaginal bladder palpation ( r = 0.56). Pain at maximal distension was less influenced by somatic sensitivity than bladder symptoms ( r = 0.35 versus r = 0.59; P < 0.05). Multivariate regression identified three independent components of bladder symptoms in PBS : bladder distension pain, bladder sensation, and somatic symptoms. Conclusions Diuresis‐induced bladder pain differentiates CPP from PBS . Experimental bladder pain is not predicted by pelvic floor sensitivity. Compared with patient‐reported outcomes it appears less influenced by psychological factors. Further study is needed to determine whether screening for experimental bladder pain sensitivity could predict future risk of PBS . Tweetable abstract Controlled, water ingestion‐provoked bladder pain can objectively identify visceral pain sensitivity.