Yazici İlhan H. et al., 2026: Physiotherapeutic Management of Painful Bladder Syndrome/Interstitial Cystitis: A Systematic Review of the Literature.

Yazici İlhan H, Atabey Gerlegiz EN, Özgül S
Int Urogynecol J. 2026 May 20. doi: 10.1007/s00192-026-06696-3. Epub ahead of print.

Abstract

Introduction and hypothesis: Painful bladder syndrome/interstitial cystitis (PBS/IC) is a chronic pelvic pain condition with unclear etiology that significantly affects quality of life. Although physiotherapeutic interventions are considered low-risk conservative options and may be incorporated into multimodal management in selected patients, evidence regarding their effectiveness remains limited. This review aimed to evaluate the effects of physiotherapy on pain and urinary symptoms in PBS/IC.

Methods: This systematic review followed the PRISMA 2020 guidelines and was registered in the PROSPERO database (CRD42024539744). A comprehensive search was conducted in PubMed and Web of Science up to August 2025 without language restrictions. Titles and abstracts were screened using the Rayyan AI. Risk of bias was assessed with RoB-2 and ROBINS-I tools, and the quality of evidence was rated using GRADE criteria. Given the heterogeneity of the included studies, a narrative synthesis was conducted.

Results: Fourteen studies involving 609 participants were included-eight randomized controlled trials and six prospective single-arm studies. Common interventions included electrotherapy techniques such as extracorporeal shock wave therapy (ESWT), posterior tibial nerve stimulation (PTNS), and transcutaneous electrical nerve stimulation (TENS), along with manual therapies like myofascial release and Thiele massage. Most studies reported short-term improvements in pain and urinary symptoms, though long-term results were inconsistent. Many studies had significant methodological limitations and a high risk of bias. Moderate-quality evidence suggests that ESWT may provide short-term pain relief, while low-quality evidence indicates potential benefits from manual therapies, bladder training, and multimodal approaches.

Conclusions: Physiotherapeutic interventions may provide short-term symptom relief in PBS/IC. However, given the limited quality of existing research, more rigorous, long-term randomized trials are needed.

Comment Hans-Göran Tiselius

This review article summarizes the experience of management of patients with painful bladder syndrome / interstitial cystitis. This is a group of patients that is clinically demanding because they very often are seriously plagued by the disease. Therefore, an effective physiotherapeutic method is very desirable.

In this regard it is highly interesting to look at ESWT. Overall, there were 14 randomized studies in which VAS, ICSI (Interstitial cystitis symptom index) and ICPI (Interstitial cystitis problem index) were evaluated. The essential of this study was as follows:

Patients treated with ESWT were given low intensity ESWT with 2-3000 pulses at a frequency of 3 Hz. In three RCTs 104 patients were treated once a week for 4-8 weeks.

Measurements of urodynamic data did not show any long-term improvements, but VAS, ICSI and ICPI were improved in short-term follow-up.

In summary only vague objective clinical improvements were recorded with ESWT. Accordingly, access to non-invasive low-intensive ESWT did not show any significant clinical improvement. However, this comfortable form of treatment would be interesting to further explore with modifications in frequency and number of treatments.

Overall and unfortunately, there are no physical therapeutic methods in this report that indicate convincing effects.

Hans-Göran Tiselius