Interstitial Cystitis/BPS UPOINT Phenotype System

Interstitial Cystitis(IC)/Bladder Pain Syndrome (BPS) is a chronic pelvic pain and bladder condition with painful symptoms that lasts over 6 weeks in the absence of urinary tract infection or any other clear cause.

Learn more about Interstitial Cystitis/Bladder Pain Syndrome

What is the UPOINT Interstitial Cystitis/BPS Phenotype system?

Canadian Professor, Urologist and pelvic pain specialist, Dr. Curtis Nickel and Dr. Daniel Shoskes developed the Interstitial Cystitis/BPS UPOINT Phenotype system that helps with both cause and diagnosis to be able to create an achievable roadmap for the best treatment options according to the IC/BPS patients phenotype. This saves patients from enduring unnecessary treatments that may be doing more harm than good to the individuals body and nervous system.

Using this website, physicians can classify their patients into the six domains of the UPOINT system (Urinary, Psychosocial, Organ Specific, Infection, Neurologic/Systemic, Tenderness of skeletal muscles) and review treatment choices based upon that phenotype.

The UPOINT System

U | Urinary: A post void residual measured by ultrasound

P | Psychosocial: clinical depression and catastrophizing (helplessness and hopelessness about the condition)

O | Organ specific: Pain improvement with bladder emptying, tenderness of the prostate

I | Infection: Culture for mycoplasma and ureasplasma, culture of urine and (in men) expressed prostatic secretions or a post-prostate massage urine

N | Neurologic/Systemic: Ask about pain outside the pelvis and a diagnosis of other pain syndromes

T | Tenderness: Palpate the abdominal and pelvic skeletal muscles (via rectum or vagina) and check for spasm and trigger points

How is the UPOINT system different from current common medical practice?

The path to effective treatment of IC/BPS/chronic pelvic pain can be difficult. Unfortunately, most patients continue to receive continuous antibiotics despite lack of culture evidence for infection. The hope is, by using the Interstitial Cystitis/BPS UPOINT phenotype system, physicians might be open to considering other diagnostic and treatment approaches such as:

1. Only using antibiotics to treat documented infections.

2. Palpating the pelvic floor muscles and consider physical therapy or medications to help with pelvic muscle spasm and trigger points.

3. Asking about depression and catastrophizing (helplessness and hopelessness about their condition) which are common in chronic pain syndromes and which may be helped with the assistance of a psychologist or psychiatrist.

4. Only using alpha blockers or antimuscarinics for documented urinary symptoms.

5. Considering other systemic conditions which may be the cause of pelvic pain or associated with it and which may be helped by specific therapies (eg. vulvodynia, endometriosis, irritable bowel disease, fibromyalgia).

6. Considering the use of other organ specific therapies when symptoms or signs do point to bladder or prostate involvement but with negative cultures (eg. bioflavanoids, intravesical lidocaine).

Biopsychosocial multi-disciplinary team approach

Patients with the urologic pelvic pain syndromes have diverse and often multiple etiologies. It is continually shown in research that monotherapy for chronic pain conditions doesn’t work. Dr. Curtis Nickel recommends a biopsychosocial multi-disciplinary treatment approach for far more attainable results.

Biopsychosocial Approach

The Biopsychosocial approach suggests that our biology, thoughts, emotions, behaviours and social/cultural factors play an important role in healing overall human function when someone is living with chronic pain or illness.

Dr. Nickel and his team have published UPOINT outcomes from their tertiary pain clinic in Canada, reporting almost 50% of their IC/BPS patients experienced clinically significant improvement, regardless of the complexity or severity of their condition3.

They use a phenotype-directed model of patient care, using the UPOINT system to classify their patients, then have a multidisciplinary team consisting of a urologist, pelvic floor physiotherapist, psychologist and possibly Pain Specialist.

Dr. Nickel’s main treatment approach is:

  • Treat the patient: education, diet, exercise
  • Treat the bladder: medication, intravesical treatments, surgery
  • Treat the other identified pain generators: vagina, pelvic floor, bowel, endometriosis, fibromyalgia
  • Treat the “mind”

For more information about the UPOINT system, click here.


1 Giannantoni, A., Bini, V., Dmochowski, R., Hanno, P., Nickel, J. C., Proietti, S., & Wyndaele, J. (2012). Contemporary Management of the Painful Bladder: A Systematic Review. European Urology, 61, 29-53.

2 Shoskes, D. A., Nickel, J. C., Dolinga, R., & Prots, D. (2009). Clinical phenotyping of patients with chronic prostatitis/chronic pelvic pain syndrome and correlation with symptom severity. Urology, 73(3), 538-542; discussion 542-533.

3 Nickel, J. C., Irvine-Bond, K., Jianbo, L., Shoskes, D. (2014). Phenotype-directed Management of Interstitial Cystitis/Bladder Pain Syndrome. Urology, 84(1), 175-179. 

Women’s and Men’s Health Physical Therapy. (2018, May 2). 10 Tips For Managing IC / PBS From Professor Curtis Nickel.

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