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First page of The Posterior Fornix Syndrome is an important differential diagnosis for interstitial cystitis/bladder pain syndrome

Background Catalyst: a statement by Dr Magnus Fall at a meeting of invited experts in 2020 of IC/BPS (Interstitial cystitis/bladder pain syndrome),“A paradigm shift in the understanding of IC/BPS is urgent”. This review analyses such a paradigm shift. Summary The paradigm shift began serendipitously with a histologically validated cure of Hunner’s Lesion, following Posterior Fornix Syndrome (PFS) protocols for prolapse cure. Surgical data from 8 PFS studies reporting pain and urge cure found PFS was consistent with IC/BPS (Interstitial cystitis/bladder pain syndrome) definitions. No Hunner’s lesions/ulcers were noted in the 8 studies. Anatomical pathways for IC/BPS symptoms were: urge/frequency consistent with Tanagho’s descriptions of normal micturition (albeit, prematurely activated); abnormal emptying/retention with inability of pelvic muscles to open posterior wall of urethra prior to micturition; CPP: de novo impulses from pelvic visceral plexuses caused by unsupported USLs. Key messages: As PFS and IC/BPS have similar symptoms, USL repair of prolapse, can deliver improvement/cure for urge and pain symptoms, provided diagnostic criteria (e.g., speculum test) for PFS are met. Two hypotheses explain inflammatory endorgan responses observed in Hunner’s IC/BPS, and offer new research directions.

Journal Section:
Review Article
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S. Karger AG, Basel
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2025