Bladder Pain Syndrome/Interstitial Cystitis (BPS/IC), as defined by the International Continence Society, is a chronic pelvic pain condition characterized by persistent pain, pressure, or discomfort perceived to be related to the urinary bladder, accompanied by lower urinary tract symptoms in the absence of identifiable pathology (1). Physiotherapeutic interventions are included among conservative and multimodal management options for BPS/IC (2). However, evidence regarding their effectiveness remains limited and inconclusive. Therefore, this systematic review aimed to evaluate the effects of physiotherapeutic interventions on pain and urinary symptoms in individuals with BPS/IC.

This systematic review was conducted in accordance with the PRISMA 2020 guidelines and prospectively registered in PROSPERO (CRD42024539744). A comprehensive search of PubMed and Web of Science databases was performed up to August 2025 without language restrictions. Randomized controlled trials (RCTs) and prospective non-randomized studies investigating physiotherapeutic interventions in adults with BPS/IC were included. Two reviewers independently performed study selection, data extraction, and risk of bias assessment using the RoB-2 and ROBINS-I tools. Certainty of evidence was evaluated using the GRADE criteria. Due to substantial clinical and methodological heterogeneity across intervention types, outcome measures, and follow-up durations, the findings were synthesised narratively.

A total of 12,305 records were identified, and 14 studies involving 609 participants (422 in RCTs and 187 in prospective studies) met the inclusion criteria. Eight studies were RCTs, and six were single-arm prospective studies. Interventions included electrotherapy modalities such as extracorporeal shock wave therapy (ESWT), posterior tibial nerve stimulation (PTNS), and transcutaneous electrical nerve stimulation (TENS), as well as manual therapies (e.g., myofascial release and Thiele massage), bladder training, biofeedback, and exercise-based approaches.
Most studies, including randomized controlled trials, reported short-term improvements in pain and urinary symptoms. Moderate-certainty evidence suggested that ESWT may provide short-term pain relief. Manual therapy demonstrated potential benefits; however, findings were inconsistent, particularly for Thiele massage. Other interventions showed variable findings, with no clear or sustained effects.
Methodological quality was generally low, with most studies presenting a high or serious risk of bias. Many RCTs did not report sample size calculations, limiting confidence in statistical power. Long-term follow-up data were scarce.

This systematic review indicates that physiotherapeutic interventions may contribute to short-term improvements in pain and urinary symptoms in individuals with BPS/IC; however, the overall strength of the evidence is limited by heterogeneity and methodological concerns. Electrotherapy approaches, particularly ESWT, appear to demonstrate a more consistent pattern of short-term benefit, whereas evidence for other interventions remains variable and less robust. Manual therapy may be more effective in selected patients, particularly those with pelvic floor dysfunction or myofascial involvement. Additionally, inconsistent reporting of prior and concomitant treatments limits the ability to determine the precise role of physiotherapy in the treatment pathway. Overall, physiotherapeutic interventions appear more suitable as adjunctive components within individualized, multimodal management strategies rather than as standalone treatments.

Physiotherapeutic interventions may be considered as part of individualized conservative management for short-term symptom relief in patients with BPS/IC. However, the current evidence is limited by low methodological quality, high risk of bias, lack of adequate statistical power, and insufficient long-term data. High-quality, adequately powered randomized controlled trials with standardized protocols and longer follow-up are required to clarify the effectiveness and clinical role of physiotherapy in BPS/IC.

Doggweiler, R., Whitmore, K. E., Meijlink, J. M., Drake, M. J., Frawley, H., Nordling, J., Hanno, P., Fraser, M. O., Homma, Y., Garrido, G., Gomes, M. J., Elneil, S., van de Merwe, J. P., Lin, A. T. L., & Tomoe, H. (2017). A standard for terminology in chronic pelvic pain syndromes: A report from the chronic pelvic pain working group of the international continence society. Neurourology and urodynamics, 36(4), 984–1008. https://doi.org/10.1002/nau.23072
Clemens, J. Q., Erickson, D. R., Varela, N. P., & Lai, H. H. (2022). Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome. The Journal of urology, 208(1), 34–42. https://doi.org/10.1097/JU.0000000000002756

Continence 19S (2026) 102762
DOI: 10.1016/j.cont.2026.102762