Bladder pain syndrome (BPS): Understanding and managing bladder pain with Physiotherapy
Bladder Pain Syndrome (sometimes called Painful Bladder Syndrome or Interstitial Cystitis) is a chronic condition that causes discomfort, pain, or pressure in the bladder and pelvic area.
It can feel like a constant bladder infection that just won’t clear, yet when your doctor tests your urine, no infection is found. If this sounds familiar, you’re not alone. BPS affects thousands of women every year and can have a major impact on quality of life
What is Bladder Pain Syndrome?
Bladder Pain Syndrome is defined as ongoing pain, pressure or discomfort that seems to come from the bladder, often accompanied by urinary urgency or frequency.
You may experience:
Pain above the pubic bone, around the bladder, urethra, perineum, or lower back
Symptoms that worsen as the bladder fills and ease when you empty it (even if only briefly)
A constant urge to urinate (“urgency”) or needing to go more often (“frequency”)
Before BPS is diagnosed, it’s essential to rule out infection. Your GP can test a urine sample to exclude a urinary tract infection (UTI). If the test is clear and symptoms persist, you can be referred to a urologist, who may carry out bladder investigations.
If no infection or other cause is found, and the above symptoms continue for several weeks or months, a diagnosis of Bladder Pain Syndrome may be made.
What causes Bladder Pain Syndrome?
The exact cause isn’t fully understood, but research suggests that several factors may contribute, including:
Pelvic floor muscle tension or dysfunction: The muscles around the bladder and urethra may become overactive or tight, increasing pressure and pain.
Changes in bladder lining (urothelium): The bladder wall may become more sensitive or less protective.
Nerve sensitisation: The nerves involved in bladder sensation may become hypersensitive.
Hormonal, inflammatory, or stress-related factors: Chronic stress and pain can further sensitise the pelvic nervous system.
BPS is a complex interaction between the bladder, pelvic floor muscles, nervous system, hormones, and even emotional wellbeing.
Think of your body as having both hardware and software:
Hardware: The tissues – your bladder, pelvic floor muscles, fascia, and pelvic organs
Software: Your nervous system and brain – how your body interprets and responds to sensations from the pelvis
When pain or irritation occurs in the bladder (for example, after an infection, surgery or trauma), the nervous system may become “on alert.” Over time, it starts to overreact to normal sensations, such as bladder filling, as if they were a threat. This can cause ongoing pain, urgency and sensitivity, even when the initial trigger has healed.
Research shows changes can occur such as:
Heightened nerve sensitivity in the bladder and pelvic area
Increased brain activity in regions that control bladder awareness
Tightness and spasm in the pelvic floor muscles
Increased tension in the fascia (connective tissue) and surrounding pelvic structures
The good news? These changes are adaptations, not permanent damage. Many are reversible with the right approach and guidance.
Why BPS is no longer called interstitial cystitis
For many years, this condition was known as interstitial cystitis, a term that literally means “inflammation of the bladder wall.”
The term interstitial cystitis (IC) was replaced because most people with these symptoms don’t have bladder inflammation (“cystitis”). Only a small percentage show signs of bladder wall inflammation or ulcers. The majority have normal bladder tissue but still experience pain, urgency and frequency.
Research has shown that bladder pain often involves the pelvic floor muscles and nervous system, not just the bladder itself. The name Bladder Pain Syndrome (BPS) better reflects this broader, whole-body condition, focusing on the main symptom (pain) rather than a single cause (inflammation).
You may still see the older term “IC/BPS” in medical articles or online.
Who gets BPS?
BPS most commonly affects women aged 20–60, and women are around 10 times more likely to develop it than men.
Potential contributing factors include:
A history of bladder infections, thrush, or pelvic surgery
Hormonal changes
Pelvic or emotional trauma
Genetic predisposition (family history may increase risk)
Co-existing conditions such as irritable bowel syndrome (IBS), fibromyalgia, endometriosis, asthma, or anxiety
This overlap suggests that BPS may share mechanisms with other conditions involving nerve hypersensitivity and immune system overactivity.
Bladder Pain Syndrome and the pelvic floor
When there is pain in the pelvis, the pelvic floor often responds by tightening. Over time, this tension can make it difficult to fully relax, which can contribute to:
Pain with urination or intercourse
Difficulty emptying the bladder or bowels
Ongoing pelvic discomfort
Just like a calf cramp, a tight pelvic floor responds well to being released, stretched and desensitised.
How Women’s Health Physiotherapy can help
Women’s Health Physiotherapists are specially trained to treat pelvic pain and bladder conditions like BPS. The approach we take focuses on calming the nervous system and reducing pelvic tension.
1. Pelvic Floor Release
This involves gentle internal or external techniques to release tension in the pelvic muscles and surrounding fascia. The goal is to reduce tension and desensitise the entire pelvic area, so the bladder and pelvic floor no longer perceive normal touch or stretch as a threat.
2. Bladder Retraining and Lifestyle Education
Physios can help you identify bladder irritants (like caffeine, citrus or alcohol), plan optimal fluid intake and retrain your bladder to reduce urgency and frequency gradually.
3. Nervous System “Down-Training”
Techniques such as diaphragmatic breathing, gentle movement and relaxation exercises can help calm the nervous system’s response and reduce sensitivity in the bladder region.
4. Posture, Core, and Movement
Your Physiotherapist can assess posture and core function to reduce unnecessary tension through the pelvis. Learning how to breathe and move efficiently can reduce pressure on the bladder and pelvic floor.
5. Education and Empowerment
Understanding that pain does not always equal damage is key. A Physiotherapist will help you make sense of your symptoms and provide strategies for managing flares, movement, intimacy and day-to-day life with confidence.
New patients welcome
Bladder Pain Syndrome is a complex, multifactorial condition. By addressing both the physical “hardware” (the bladder, muscles, and fascia) and the nervous system “software,” recovery and long-term symptom relief are achievable.
If you’ve been struggling with bladder pain, urinary urgency or discomfort and your tests are clear, it may be time to see one of our Women’s Health Physiotherapists.
We may be able to help you:
Ease bladder pain
Reduce urgency and frequency
Improve pelvic floor relaxation and function
Regain control and comfort in your pelvic health.
Book An Appointment
Book an appointment with one of our Women’s Health Physiotherapists today. We’re here to help.
To make a booking, phone 07 5337 9853.
