Figure 4

Mechanisms of the BCR and pain in overactive (IDO) and painful (PBS) bladders. Diagram of proposed mechanisms of the bladder cooling reflex and pain in patient sub-groups during the ice water test (IWT). In idiopathic detrusor overactivity (IDO) patients (a), a positive (IWT) may be a result of a loss of central inhibition and increased afferent activation, while the Pain evoked in Painful Bladder Syndrome (PBS) patients (b) may suggest sensitisation of increased afferents but preserved central inhibition.