A practical approach to the painful bladder syndrome. The painful bladder syndrome (PBS) is a progressive and painful disease of the bladder that may lead to fibrosis, contracture and reduction of bladder capacity. The usual symptoms are urinary urgency, frequency, nocturia, chronic pelvic pain and lower abdominal pain upon filling of the bladder. A retrospective analysis was performed on 21 women with PBS between March 1987 and March 1988. The patients were treated weekly with a bladder pillar block, bladder distention and dimethyl sulfoxide instillation. Symptomatic relief was observed in 80% of the patients so treated. The maximum bladder volume increased from 185 to 475 mL (P less than .01). The side effects were minimal. 