OAB and IC/BPS: Two Conditions or a Continuum of One?

  • Kai B. Dallas
  • Carrie S. Stewart
  • Lenore A. Ackerman
  • Jennifer T. AngerEmail author
Reconstructed Bladder Function & Dysfunction (M Kaufman, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Reconstructed Bladder Function & Dysfunction
  2. Topical Collection on Reconstructed Bladder Function & Dysfunction


Purpose of Review

Overactive bladder (OAB) and interstitial cystitis/bladder pain syndrome (IC/BPS) are defined as syndromes consisting of “urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence” and “an unpleasant sensation perceived to be related to the urinary bladder, associated with lower urinary tract symptoms,” respectively. Distinguishing between the two diagnoses can be challenging and although OAB and IC/BPS are traditionally considered separate conditions, more evidence is emerging to suggest a continuum between the symptoms. This review considers the two conditions existing on a continuum by reviewing relevant definitions, phenotypes, and treatment considerations.

Recent Findings

Recent studies have suggested that up to 25% of patients with IC/BPS reported urge incontinence and 35% of patients with OAB described bladder pain. Analysis assessing validated questionnaires revealed that scores could distinguish controls from patients with storage LUTS but were not able to distinguish between those with OAB and IC/BPS. A novel scoring system spanning domain of urgency incontinence and bladder pain was validated and provided 91% diagnostic accuracy.


OAB and IC/BPS symptoms overlap significantly and it remains unclear if patients with IC/BPS and OAB are unique populations or specific phenotypes of the same condition. We propose that “OAB-dry” patients without fear of leakage may represent a variant of IC/BPS. Unbiased phenotyping based on more accurate symptomatic descriptions may help reveal the correlations of variants of lower urinary tract symptoms with both prognosis and treatment responses.


Overactive bladder Interstitial cystitis/bladder pain syndrome Urinary urgency Lower urinary tract symptoms 


Compliance with Ethical Standards

Conflict of Interest

Dr. Jennifer T. Anger is an expert witness for Boston Scientific. Dr. Kai B. Dallas, Dr. Lenore A. Ackerman, and Dr. Carrie S. Stewart declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

All procedures performed in studies involving human participants performed by the authors were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4–20.PubMedGoogle Scholar
  2. 2.
    • Lightner DJ, Gomelsky A, Souter L, Vasavada SP. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU Guideline Amendment 2019. J Urol. 2019;202(3):558–63. AUA/SUFU guidelines pertaining to the diagnosis and treatment of AUA and OAB. The current guideline included updates pertaining to relevant literature published through October 2018.PubMedCrossRefGoogle Scholar
  3. 3.
    Hanno PM, Erickson D, Moldwin R, Faraday MM, The American Urological Association. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome: AUA guideline amendment. J Urol. 2015;193(5):1545–53.PubMedCrossRefGoogle Scholar
  4. 4.
    Malde S, Palmisani S, Al-Kaisy A, Sahai A. Guideline of guidelines: bladder pain syndrome. BJU Int. 2018;122(5):729–43.PubMedCrossRefGoogle Scholar
  5. 5.
    Anger JT, Le TX, Nissim HA, Rogo-Gupta L, Rashid R, Behniwal A, et al. How dry is “OAB-dry”? Perspectives from patients and physician experts. J Urol. 2012;188(5):1811–5.PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    •• Ackerman AL, Lai HH, Parameshwar PS, Eilber KS, Anger JT. Symptomatic overlap in overactive bladder and interstitial cystitis/bladder pain syndrome: development of a new algorithm. BJU Int. 2019;123(4):682–93 In this study, a novel scoring system including urgency incontinence and bladder pain was validated with 91% accuracy in differentiating between OAB and IC/BPS.PubMedCrossRefGoogle Scholar
  7. 7.
    Kowalik CG, Cohn JA, Delpe S, Kaufman MR, Wein A, Dmochowski RR, et al. Painful bladder symptoms related to somatic syndromes in a convenience sample of community women with overactive bladder symptoms. J Urol. 2018;200(6):1332–7.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Reynolds WS, Mock S, Zhang X, Kaufman M, Wein A, Bruehl S, et al. Somatic syndromes and chronic pain in women with overactive bladder. Neurourol Urodyn. 2017;36(4):1113–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Sammarco AG, Kobernik EK, Haefner HK, Till SR, Berger MB. Lower urinary tract symptoms in a chronic pelvic pain population. Female pelvic medicine & reconstructive surgery. 2019.Google Scholar
  10. 10.
    Apostolidis A, Averbeck MA, Sahai A, Rahnama’i MS, Anding R, Robinson D, et al. Can we create a valid treatment algorithm for patients with drug resistant overactive bladder (OAB) syndrome or detrusor overactivity (DO)? Results from a think tank (ICI-RS 2015). Neurourol Urodyn. 2017;36(4):882–93.PubMedCrossRefGoogle Scholar
  11. 11.
    Macdiarmid SA, Sand PK. Diagnosis of interstitial cystitis/ painful bladder syndrome in patients with overactive bladder symptoms. Rev Urol. 2007;9(1):9–16.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Nickel JC, Shoskes D, Irvine-Bird K. Clinical phenotyping of women with interstitial cystitis/painful bladder syndrome: a key to classification and potentially improved management. J Urol. 2009;182(1):155–60.PubMedCrossRefGoogle Scholar
  13. 13.
    Hanno PM, Landis JR, Matthews-Cook Y, Kusek J, Nyberg L Jr. The diagnosis of interstitial cystitis revisited: lessons learned from the National Institutes of Health Interstitial Cystitis Database study. J Urol. 1999;161(2):553–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Abrams P, Blaivas JG, Stanton SL, Andersen JT. The standardisation of terminology of lower urinary tract function. The International Continence Society Committee on Standardisation of Terminology. Scand J Urol Nephrol Suppl. 1988;114:5–19.PubMedGoogle Scholar
  15. 15.
    Heeringa R, de Wachter SG, van Kerrebroeck PE, van Koeveringe GA. Normal bladder sensations in healthy volunteers: a focus group investigation. Neurourol Urodyn. 2011;30(7):1350–5.PubMedGoogle Scholar
  16. 16.
    Heeringa R, van Koeveringe GA, Winkens B, van Kerrebroeck PE, de Wachter SG. Do patients with OAB experience bladder sensations in the same way as healthy volunteers? A focus group investigation. Neurourol Urodyn. 2012;31(4):521–5.PubMedCrossRefGoogle Scholar
  17. 17.
    FitzGerald MP, Kenton KS, Brubaker L. Localization of the urge to void in patients with painful bladder syndrome. Neurourol Urodyn. 2005;24(7):633–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Smith AL, Nissim HA, Le TX, Khan A, Maliski SL, Litwin MS, et al. Misconceptions and miscommunication among aging women with overactive bladder symptoms. Urology. 2011;77(1):55–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Stewart MA. Effective physician-patient communication and health outcomes: a review. Cmaj. 1995;152(9):1423–33.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Greenberg P, Brown J, Yates T, Brown V, Langenberg P, Warren JW. Voiding urges perceived by patients with interstitial cystitis/painful bladder syndrome. Neurourol Urodyn. 2008;27(4):287–90.PubMedCrossRefGoogle Scholar
  21. 21.
    Abrams P, Hanno P, Wein A. Overactive bladder and painful bladder syndrome: there need not be confusion. Neurourol Urodyn. 2005;24(2):149–50.PubMedCrossRefGoogle Scholar
  22. 22.
    Krieger JN, Stephens AJ, Landis JR, Clemens JQ, Kreder K, Lai HH, et al. Relationship between chronic nonurological associated somatic syndromes and symptom severity in urological chronic pelvic pain syndromes: baseline evaluation of the MAPP study. J Urol. 2015;193(4):1254–62.PubMedCrossRefGoogle Scholar
  23. 23.
    Lapides J. Observations on interstitial cystitis. Urology. 1975;5(5):610–1.PubMedCrossRefGoogle Scholar
  24. 24.
    Nigro DA, Wein AJ, Foy M, Parsons CL, Williams M, Nyberg LM Jr, et al. Associations among cystoscopic and urodynamic findings for women enrolled in the Interstitial Cystitis Data Base (ICDB) Study. Urology. 1997;49(5A Suppl):86–92.PubMedCrossRefGoogle Scholar
  25. 25.
    Waxman JA, Sulak PJ, Kuehl TJ. Cystoscopic findings consistent with interstitial cystitis in normal women undergoing tubal ligation. J Urol. 1998;160(5):1663–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Messing E, Pauk D, Schaeffer A, Nieweglowski M, Nyberg LM Jr, Landis JR, et al. Associations among cystoscopic findings and symptoms and physical examination findings in women enrolled in the Interstitial Cystitis Data Base (ICDB) Study. Urology. 1997;49(5A Suppl):81–5.PubMedCrossRefGoogle Scholar
  27. 27.
    Fall M, Logadottir Y, Peeker R. Interstitial cystitis is bladder pain syndrome with Hunner’s lesion. Int J Urol. 2014;21(Suppl 1):79–82. Scholar
  28. 28.
    Lee UJ, Scott VC, Rashid R, Behniwal A, Wein AJ, Maliski SL, et al. Defining and managing overactive bladder: disagreement among the experts. Urology. 2013;81(2):257–62.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Nitti VW, Kopp Z, Lin AT, Moore KH, Oefelein M, Mills IW. Can we predict which patient will fail drug treatment for overactive bladder? A think tank discussion. Neurourol Urodyn. 2010;29(4):652–7.PubMedCrossRefGoogle Scholar
  30. 30.
    • Kim A, Hoe KO, Shin JH, Choo MS. Evaluation of the incidence and risk factors associated with persistent frequency in interstitial cystitis/bladder pain syndrome and the efficacy of antimuscarinic treatment. Investig Clin Urol. 2017;58(5):353–8 This study reported thatantimuscarinics do not appear to decrease urinary frequency in IC/BPS patients.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Anger JT, Zabihi N, Clemens JQ, Payne CK, Saigal CS, Rodriguez LV. Treatment choice, duration, and cost in patients with interstitial cystitis and painful bladder syndrome. Int Urogynecol J. 2011;22(4):395–400.PubMedCrossRefGoogle Scholar
  32. 32.
    Taneja R, Jawade KK. A rational combination of intravesical and systemic agents for the treatment of interstitial cystitis. Scand J Urol Nephrol. 2007;41(6):511–5.PubMedCrossRefGoogle Scholar
  33. 33.
    • Di Lena M, Tolls V, Kelly KL, Nickel JC. Mirabegron as adjuvant treatment for patients with interstitial cystitis/bladder pain syndrome. Can Urol Assoc J. 2018;12(3):E100–e4 Mirabegron, a beta-3 adrenergic receptor agonist, may be a useful adjunct to help with urgency, but not necessarily pain, in IC/BPS patients.PubMedCrossRefGoogle Scholar
  34. 34.
    Kim TH, Lee KS. Persistence and compliance with medication management in the treatment of overactive bladder. Investig Clin Urol. 2016;57(2):84–93.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    • Tutolo M, Ammirati E, Van der Aa F. What is the best treatment option for coexisting pelvic floor dysfunctions? Eur Urol Focus. 2017;3(6):532–4 Sacral neuromodulation (SNM) is used for urinary frequency, urgency, and urgency incontinence in OAB patients. Use in IC/BPS patients is limited (35), but has demonstrated efficacy in helping the frequency/urgency component of IC/BPS.PubMedCrossRefGoogle Scholar
  36. 36.
    Gajewski JB, Al-Zahrani AA. The long-term efficacy of sacral neuromodulation in the management of intractable cases of bladder pain syndrome: 14 years of experience in one centre. BJU Int. 2011;107(8):1258–64.PubMedCrossRefGoogle Scholar
  37. 37.
    •• Kuo HC, Jiang YH, Tsai YC, Kuo YC. Intravesical botulinum toxin-A injections reduce bladder pain of interstitial cystitis/bladder pain syndrome refractory to conventional treatment—a prospective, multicenter, randomized, double-blind, placebo-controlled clinical trial. Neurourol Urodyn. 2016;35(5):609–14 This prospective, multicenter, randomized, double-blinded, placebo-controlled clinical trial studied the use of Onabotulinumtoxin-A in IC/BPS patients. Onabotulinumtoxin-A was associated with significantly decreased visual analog scores (VAS) for pain and increased bladder capacity in comparison to controls.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Cedars-Sinai Medical CenterLos AngelesUSA
  2. 2.Division of Female Pelvic Medicine and Reconstructive SurgeryBeverly HillsUSA

Personalised recommendations