Bladder Pain Syndrome (BPS), also known as Interstitial Cystitis (IC), is a chronic condition characterized by pelvic pain, urinary urgency, and frequency without an identifiable cause. Standard pharmacological treatments often provide limited relief, leading to increased interest in non-pharmacological alternatives such as yoga and mindfulness-based interventions (MBIs). These interventions have shown promise in managing chronic pain conditions, but their effectiveness in BPS remains unclear. This systematic review aims to evaluate the efficacy of yoga and MBIs in managing BPS, focusing on symptom relief and quality of life improvements.

A systematic review was conducted following PRISMA guidelines. Databases including PubMed, Scopus, Cochrane Library, and Web of Science were searched for studies published between January 2010 and December 2024. The search strategy included the terms "Bladder Pain Syndrome," "Interstitial Cystitis," "Yoga," "Mindfulness," and "Non-pharmacological treatment." Inclusion criteria comprised randomized controlled trials (RCTs), systematic reviews, and observational studies that assessed yoga and mindfulness interventions in BPS patients, measuring outcomes such as pain reduction, urinary symptoms, and quality of life. One independent reviewer assessed study quality using the Cochrane Risk of Bias Tool for RCTs and the Newcastle-Ottawa Scale for observational studies.

A total of 14 studies met the inclusion criteria, encompassing 1,256 participants with a mean age range of 35 to 65 years. Five RCTs, four systematic reviews, and five observational studies were included. The interventions ranged from structured yoga programs (6–12 weeks) to Mindfulness-Based Stress Reduction (MBSR) programs. The primary outcome measures included pain severity, urinary frequency, and psychological distress. (Table 1)
-Pain Reduction: Studies reported a significant reduction in pelvic pain scores among participants practicing yoga and mindfulness. In a meta-analysis of five RCTs (n=460), a mean pain reduction of 27% (95% CI, 21%-33%) was observed compared to control groups.
-Urinary Symptoms: Four studies measuring urinary frequency showed a moderate reduction, with a mean decrease of 3.2 voids per day (95% CI, 1.8-4.6 voids).
-Psychological Well-being: Yoga and mindfulness interventions resulted in a significant reduction in anxiety and depression scores, with Cohen’s d effect sizes ranging from 0.5 to 0.8.

Yoga and mindfulness-based interventions demonstrate a promising role in the management of BPS, offering improvements in pain, urinary symptoms, and psychological well-being. The mechanisms underlying these benefits likely include enhanced pelvic floor relaxation, reduced stress-related inflammation, and improved coping strategies for chronic pain. However, variations in intervention type, duration, and study quality highlight the need for further high-quality RCTs. Some studies exhibited potential biases, including small sample sizes and lack of blinding, which may impact the generalizability of findings.

This systematic review supports the potential efficacy of yoga and mindfulness-based interventions as complementary treatments for BPS. These non-pharmacological approaches provide symptom relief and enhance quality of life in affected individuals. Future research should focus on standardized protocols and larger, multi-center RCTs to establish evidence-based recommendations for clinical practice.