(Poster 80) The Impact of Delivery Mode on Bladder Pain Syndrome Treatment Patterns

Objectives: Female Bladder Pain Syndrome (BPS), or Interstitial Cystitis, is a chronic condition marked by pelvic pain or urinary symptoms without infection or other attributable pathology. It affects up to 6.5% of women and remains difficult to treat. While childbirth may influence pelvic floor health, little is known about how delivery mode affects BPS symptom burden or treatment needs. Prior studies have examined BPS incidence after delivery, but none have assessed changes in BPS management following different delivery types in patients with preexisting disease. This study aims to evaluate whether cesarean delivery increases the need for BPS treatment changes after childbirth compared to vaginal delivery.

Methods: This is a retrospective cohort study of members within a large health care organization with BPS who delivered between 2016–2022. Inclusion required minimum 2 years of BPS-coded encounters before full-term delivery and continuous plan enrollment for greater than 2 years before and after delivery. Subjects were identified through the electronic medical record. BPS treatments were identified by chart review, excluding any interventions one year before and one year after delivery. Number of treatment types before and after delivery and changes in treatment types were compared across delivery modes.

Results: Among 49 patients (36 vaginal, 13 cesarean deliveries), 82% experienced a decrease in the number of treatments following delivery. Mean (standard deviation) follow-up was 5.4 (2.2) years for vaginal and 4.2 (2.0) years for cesarean deliveries. Most patients in both groups discontinued treatment entirely: 67% of vaginal and 54% of cesarean delivery patients had zero BPS treatments after childbirth. No vaginal delivery patients increased their treatment count postpartum, while three cesarean delivery patients initiated or added therapies. Treatment concordance—defined as using the same treatments before and after delivery—was low across both groups, seen in only eight patients. Overall, vaginal delivery was associated with a more consistent trend toward treatment discontinuation, while cesarean deliveries showed slightly more variability in treatment patterns.

Conclusions: These findings suggest that the post-delivery period is associated with a substantial reduction in BPS treatment burden, regardless of delivery mode. Two-thirds of patients with vaginal deliveries and over half of those with cesarean deliveries did not seek BPS treatments after childbirth. While only cesarean patients increased their treatment count postpartum, this was observed in just three patients and may not reflect a clinically meaningful difference. Treatment concordance was generally low, indicating that patients often shifted or discontinued therapies postpartum. This pattern may reflect symptom improvement or changes in care-seeking behavior after delivery. Overall childbirth -regardless of mode of delivery- was associated with reduced treatment needs for most patients with BPS. Further research is needed to explore patient-reported outcomes, symptom resolution, and care utilization to understand how childbirth influences the trajectory of BPS.