Painful Bladder Syndrome
Many women occasionally experience symptoms similar to a urinary tract infection (UTI), such as bladder pain, discomfort while urinating, and a frequent urge to urinate. These infections are often easily treated with medications and supportive strategies like increasing fluid intake.
However, if these symptoms persist without a UTI being present, it may indicate a condition known as interstitial cystitis (IC), or chronic bladder pain syndrome. IC is increasingly recognized as a common cause of chronic pelvic pain in women. Between 2.7% and 6.5% of women in the U.S. are affected by IC, translating to 3.3 to 7.9 million women who experience ongoing symptoms. Although IC cannot be cured, effective treatment options are available.
What is Interstitial Cystitis (IC)?
Interstitial cystitis is a nerve-related pain syndrome, and it often overlaps with other chronic pain conditions. First described in 1887, IC is now defined by the American Urological Association (AUA) as “an unpleasant sensation (pain, pressure, or discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms lasting more than six weeks, in the absence of infection or other identifiable causes.”
IC is considered a visceral pain syndrome, meaning the pain stems from the body’s internal organs. Pelvic nerves transmit signals more slowly than other nerves in the body and are not as clearly mapped in the central nervous system, which leads to vague, poorly localized pain. Bladder nerve stimulation is often experienced as bladder pain.
Women who frequently experience UTI-like symptoms but have negative urine cultures should be evaluated for IC. All women with chronic or subacute pelvic pain should also be screened for IC. Diagnosis involves a detailed medical history, physical exam, and potentially laboratory tests or a cystoscopy (a small camera inserted into the urethra to view the bladder).
Treatment for Interstitial Cystitis
A multimodal approach that combines various therapies is key to effectively treating IC. Some common strategies include:
- Dietary Modifications: Up to 90% of women with IC report that certain foods trigger their symptoms. Common culprits include citrus fruits, tomatoes, artificial sweeteners, coffee, tea, chocolate, alcohol, and spicy foods. Women are encouraged to explore how changes in their diet may alleviate symptoms.
- Lifestyle Adjustments: Managing stress, practicing relaxation techniques, engaging in low-impact exercise, using pain management strategies (like warm sitz baths), wearing non-restrictive clothing, and controlling fluid intake can all help manage IC symptoms.
- Physical Therapy: Women with muscle pain or spasms in the pelvic area may benefit from physical therapy targeting the abdominal wall and pelvic floor. Nerve blocks may also provide relief.
Medications are also commonly used to treat IC. These may include drugs that help restore the bladder’s protective lining or antihistamines to reduce inflammation. Additionally, some women benefit from bladder instillations, a procedure where a mixture of medications is directly introduced into the bladder over several weeks. Flares can be managed with short-term courses of instillation therapy, and continued oral medication and dietary adjustments help keep symptoms under control. Follow-up visits every 4-6 months for 1-2 years are recommended to assess progress and adjust treatment as needed.
Because IC affects women differently, treatment must be personalized. Working with a bladder health specialist will help you manage the condition effectively and take control of your symptoms.