Pelvic pain and pressure can be challenging to diagnose. Various conditions can cause uncomfortable symptoms, such as burning while urinating, pain in the lower abdomen, and the frequent need to use the bathroom. One of them is interstitial cystitis (IC) or painful bladder syndrome. However, a diagnosis of interstitial cystitis can take a while because there is no test for IC, and other conditions with similar symptoms must often be ruled out first.

What is interstitial cystitis?
Interstitial cystitis (IC) is a collection of chronic symptoms affecting the bladder. The bladder condition is also known as painful bladder syndrome, bladder pain syndrome (BPS), or chronic pelvic pain. When the kidneys filter liquid waste products from the bloodstream, the waste, called urine, is stored in the bladder. When the bladder is full, the nerves and muscles send signals to your brain, giving you the urge to urinate.
People with IC have inflammation of the bladder lining. Interstitial cystitis bladder pain can be constant or intermittent and is usually accompanied by pressure in and around the bladder. They may feel the urge to urinate dozens of times per day and experience bladder pain and burning while urinating. Still, symptoms can vary for each patient and range from mild to severe. Diagnosis of IC is complex, and its causes are not well understood, which leads some experts to believe that it may be a group of several different diseases.
Both men and women can develop IC, but the overwhelming majority of patients are female and start experiencing symptoms in their 40s.
Complications of interstitial cystitis
About 5% of IC patients have persistent IC symptoms for more than two years, and 5% of patients have end-stage disease defined as very hard bladders with low bladder capacity and terrible pain.
Patients with severe IC frequently also have Hunner’s ulcers. Also called Hunner’s lesions or Hunner’s patches, they are a subtype of interstitial cystitis and are not ulcers in the usual sense. They are distinct areas of inflammation on the bladder wall that characterize the classic form of IC.
While there is no known cure for interstitial cystitis, a few methods can relieve its chronic pain symptoms.
Symptoms of interstitial cystitis
Symptoms of interstitial cystitis are difficult to pin down. Symptoms may come and go, disappearing without treatment sometimes, making it hard to attribute them to a specific cause. Alternatively, they may be constant for months or even years, lowering your quality of life. IC/BPS is not an infection but may feel like a bladder infection. Some common symptoms include:
- Chronic pain and pressure that increase as the bladder fills with urine
- Sharp or dull, aching pain in the pelvis, lower back, vulva, vagina, or urethra
- Painful, stinging, or burning urination (dysuria)
- Urinary frequency (more than eight times per day)
- Urinary urgency, even after emptying the bladder
- Painful sexual intercourse
Another complication of IC is the possibility of bladder ulcers. These can cause more pronounced IC symptoms. Additionally, symptoms may sometimes worsen during your period or as a result of stress. Certain foods or drinks, like spicy foods or citrus fruits, may also aggravate the symptoms.
Although signs and symptoms of IC may resemble those of urinary incontinence or a chronic urinary tract infection, there’s usually no infection. However, symptoms may worsen if a person with IC gets a urinary tract infection. The more severe cases of interstitial cystitis/painful bladder syndrome can affect your life and your loved ones.
Causes of interstitial cystitis
Painful bladder syndrome is not very well understood and may have several interacting causes. The cause of IC isn’t known, and one diagnostic test will not be able to tell you if you have it.
Doctors often run many tests to rule out other possible causes of IC symptoms. Especially because some individuals have IC with other conditions, like irritable bowel syndrome, fibromyalgia, and other chronic pain syndromes that have similar symptoms. Experts believe several conditions could cause the problem:
- Your bladder tissue is irritated or damaged by chemicals found in your urine.
- Your body reacts to the bladder’s inflammation by releasing chemicals that cause painful symptoms.
- An autoimmune disorder is causing your body to attack the bladder.
- The nerves surrounding your bladder are overly stimulated, resulting in pain during routine urinary functions.
- Some other conditions simultaneously cause inflammation in the bladder.
How is interstitial cystitis diagnosed?
Because painful bladder syndrome is so challenging to identify, Dr. Aliabadi will instead focus on ruling out other possible conditions, such as sexually transmitted infections, a urinary tract infection, bladder cancer, and kidney stones. She will also check for endometriosis – a gynecological condition that causes similar symptoms.
Your doctor may recommend these tests:
- Urinalysis. You provide a sample of urine in a cup for a urine test. A negative urine culture is a characteristic of interstitial cystitis.
- Post-void residual urine volume. An ultrasound is performed after urinating to measure the fluid remaining in your bladder.
- Biopsy. A small tissue sample is taken from your urethra or bladder for testing.
- Cystoscopy. The inside of your urethra and bladder wall is examined using a very narrow, flexible tube with a lens at the end called a cystoscope. Cystoscopy is also used to check for the presence of Hunner’s ulcer on your bladder wall if you have end-stage disease IC.
- Bladder stretching. Under anesthesia, your bladder is stretched using fluid or gas to understand the problem better. This can also serve a therapeutic purpose.
Treatment of interstitial cystitis
IC has no cure, but treatments can help most people feel better. For about half of patients, the symptoms of painful bladder syndrome disappear on their own. For others, the symptoms can be chronic, a daily and nightly struggle for comfort and relief. Fortunately, several techniques and treatment options may work for you. You may need to try a combination of methods, which may take a few weeks for the symptoms to clear up.
You and your healthcare provider may be able to treat your interstitial cystitis (IC) with lifestyle changes, bladder training, physical therapy, medicines, bladder hydrodistention, bladder instillation, surgery, or a combination of these treatments.
Treatment options can include:
- Bladder training. If you’re urinating frequently, try to extend the interval of time between bathroom trips.
- Relaxation techniques. Stress can trigger painful symptoms. Find time to relax and cut stressors from your life.
- Exercise. Regular exercise can help relieve symptoms, even low-intensity exercises like walking or stretching.
- Loose clothing. Avoid wearing tight pants that put pressure on your bladder.
- Changing eating or drinking habits. Some foods, such as spicy or acidic foods, alcohol, caffeine, artificial sweeteners, sodas, and chocolate, may trigger symptoms. Keep a food diary to track foods that may be causing symptoms.
- Quitting smoking. If lifestyle changes aren’t enough to keep your symptoms at bay, talk to your gynecologist about medical intervention options, such as:
- Physical therapy. Therapeutic exercises can train your pelvic muscles to relax. Patients experiencing IC/BPS often have tenderness and/or pain in the pelvic floor area, and sometimes, manipulative physical therapy can reduce symptoms. However, there is evidence that physical therapy exercises to strengthen the pelvic floor muscles do not improve symptoms and often worsen them, so activities such as Kegel exercises are not recommended for patients with IC/BPS.
- Medication. A few different drugs have been shown to help control painful bladder syndrome, including Pentosan, Amitriptyline, Elmiron, Heparin, and Hydroxyzine, an antihistamine. Pain medication, injectable steroids, and dimethyl sulfoxide (DMSO) can also help control pain and inflammation.
- Bladder-stretching. In this procedure, you are put under anesthesia, and your bladder is slowly filled with fluid or gas. For some patients, this can provide relief of symptoms for up to six months.
Very severe cases of painful bladder syndrome may fail to respond to any of these treatment methods. In these cases, more intensive treatments may be recommended.
- Botox injections. Botox can paralyze the bladder muscles, numbing the pain. This is usually a temporary relief.
- Neurostimulation. Your doctor can surgically implant small electric devices to control your nervous responses.
- Cyclosporine. An immunosuppressant.
- Surgery. A surgeon could re-route your urine away from your bladder, bypassing the problem altogether. This procedure can be risky and is sometimes considered a last-resort option.
Experiencing urinary symptoms? Talk to Dr. Aliabadi
Dr. Aliabadi isn’t only an expert OB/GYN but is knowledgeable in all aspects of women’s health and well-being, including UTIs. Dr. Aliabadi and her caring, supportive staff are available to support you through menopause, childbirth, infertility, or even just routine gynecological care.
We invite you to establish care with Dr. Aliabadi. Please make an appointment online or call us at (844) 863-6700.
The practice of Dr. Thais Aliabadi and the Outpatient Hysterectomy Center is conveniently located for patients throughout Southern California and the Los Angeles area. We are near Beverly Hills, West Hollywood, Santa Monica, West Los Angeles, Culver City, Hollywood, Venice, Marina del Rey, Malibu, Manhattan Beach, and Downtown Los Angeles.
Interstitial Cystitis FAQs
What calms interstitial cystitis?
Certain oral medications, including nonsteroidal anti-inflammatory drugs, tricyclic antidepressants, and antihistamines, have been found to help calm interstitial cystitis inflammation and pain. Dr. Aliabadi can help determine if these treatment options are right for you.
What triggers interstitial cystitis flare-ups?
Highly acidic foods and drinks, coffee, spicy foods, caffeinated beverages, tomatoes, soda, citrus, and MSG are all common triggers of interstitial cystitis flare-ups.
What can I drink to soothe an irritated bladder?
Water is often the recommended drink for bladder irritation. Staying hydrated can help reduce irritation, prevent kidney and bladder stones, and help reduce the burning sensation often experienced while urinating during an interstitial cystitis flare-up.
Sources:
Interstitial Cystitis Association. https://www.ichelp.org/understanding-ic/medical-treatments/bladder-instillations/#:~:text=Heparin%20is%20a%20compound%20that,syndrome%20(IC%2FBPS).
National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/urologic-diseases/interstitial-cystitis-painful-bladder-syndrome
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