Major surgery is rarely used for IC/BPS. It may be considered only for carefully selected patients who have severe bladder-focused symptoms and have not improved with other treatments.

Surgical options may include bladder reconstruction or urinary diversion, with or without removal of the bladder. These procedures are permanent and life-changing, so they are usually reserved for people with an end-stage, scarred, very small bladder or clear evidence that the bladder is the main source of pain.

Before surgery, the care team should carefully check for other causes of pain, such as pelvic floor problems, nerve pain, or widespread pain conditions. Surgery is less likely to help if pain comes from outside the bladder.

Patients should discuss the possible benefits, risks, long recovery, and chance that pain may continue even after surgery with a specialist experienced in IC/BPS surgery.