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WOMEN'S HEALTH
Interstitial cystitis (bladder pain syndrome) in women is a chronic condition. This condition significantly impacts a woman’s quality of life.
Interstitial Cystitis (Bladder Pain Syndrome) in Women
June 17, 2024
Interstitial cystitis (IC) is a chronic condition characterized by mild to severe pain and tenderness in the bladder, lower abdomen, and pelvic area. It is often accompanied by urinary frequency and urgency. IC is also known as bladder pain syndrome (BPS). Some people equate IC to the sensation of having a urinary tract infection; however, a UTI does not cause IC. In IC, the lining of the bladder is inflamed, and this affects the amount of urine the bladder can comfortably hold.
How Common is Interstitial Cystitis or Bladder Pain Syndrome?
Although IC/BPS affects children, men, and women, women are more likely to be diagnosed with IC than men and children. According to the Interstitial Cystitis Association, about 3 to 8 million women (up to 6% of all women in the US) are affected by IC. The number is a little less for men, about 1 to 4 million, and this is most likely because symptoms of IC can be mistaken for other disorders like chronic prostatitis. Unfortunately, the exact prevalence of IC in children is unknown.
The Urinary Tract
Our urinary tract is made up of two kidneys, two ureters, one urinary bladder, and one urethra. The urinary system functions to filter waste from the body and excrete it as urine. Our two kidneys are located just below the rib cage, one on each side, and act as our primary filters. Kidneys also play other vital roles in the body, such as keeping our fluid levels constant, maintaining healthy blood pressure, and stimulating the production of red blood cells. The ureters are tubes attached to the kidneys that transport urine from the kidneys to the bladder. The bladder is a hollow, muscular organ that, in a healthy person, can hold up to two cups of urine.
When full, nerves in the bladder signal the need to urinate. Urine is excreted through a small tube called the urethra, which runs from the bladder to the outside of the body. In interstitial cystitis, the walls of the bladder are irritated and inflamed. This increases the urge to urinate more often with less volume of urine.
What Causes Interstitial Cystitis or Bladder Pain Syndrome?
Unfortunately, there is no clear-cut cause of Interstitial Cystitis (Bladder Pain Syndrome). Certain conditions are associated with developing it, but no known cause exists. According to the National Kidney Foundation, conditions that can cause IC include:
- Allergies
- Autoimmune disease
- Blood vessel (vascular) disease
- Defects in the lining of the bladder wall
- Presence of abnormal substances in the urine
- Uncommon infections not found with standard screening tests
There is also an association between IC and irritable bowel syndrome, fibromyalgia, and chronic fatigue syndrome.
What are the Symptoms of Interstitial Cystitis or Bladder Pain Syndrome?
Symptoms vary widely from person to person, but can include any or all of the following:
- Pelvic pain
- Pain in the perineum (the area between the vagina and anus)
- A persistent, urgent need to urinate
- Frequent urination, up to sixty times in a 24-hour period
- Pain when the bladder is full
- Pain during sex
- Difficulty urinating
- Waking up at night to pee
People with Interstitial Cystitis (Bladder Pain Syndrome) develop inflammation that, over time, becomes chronic. The nerves present in the urinary tract can become hypersensitized when exposed to inflammatory molecules, potentially leading to pain, urinary urgency, and urinary frequency.
How is Interstitial Cystitis (Bladder Pain Syndrome) Diagnosed?
Interstitial cystitis (IC) is a chronic condition characterized by mild to severe pain and tenderness in the bladder, lower abdomen, and pelvic area. It is often accompanied by urinary frequency and urgency. IC is also known as bladder pain syndrome (BPS). Some people equate IC to the sensation of having a urinary tract infection; however, a UTI does not cause IC. In IC, the lining of the bladder is inflamed, and this affects the amount of urine the bladder can comfortably hold.
What are the Complications of IC/BPS?
Although IC/BPS is not considered life-threatening, it can severely impact your quality of life. The frequent and urgent need to urinate can interfere with your social life, sexual life, and emotional life. It can also interrupt sleep, cause chronic pain, and lead to depression and anxiety. For instance, IC/BPS can disrupt intimacy for women who experience pain during sexual intercourse. And some people might skip recommended preventative care such as pelvic exams because of expected pain from ICP/BPS.
How is IC/BPS Treated?
While there is no current cure for IC/BPS, ongoing research is exploring new therapies, including novel drugs and advanced diagnostic techniques. Most treatment options offer symptomatic relief. Since symptoms and causes for IC/BPS vary widely, working closely with your healthcare provider to develop an effective, individualized treatment plan that works for you is important. Efficient management of IC/BPS should include the urologist, gynecologist, physical therapist, pain specialists, and mental health care professionals.
First line treatment for interstitial cystitis/painful bladder syndrome will generally be conservative and focused on making some lifestyle changes that can help reduce symptoms. Meditation, mindfulness, and cognitive-behavioral therapy can help to minimize stress. Dietary changes like avoiding coffee, alcohol, acidic and spicy foods, which can exacerbate IC/BPS, can also help. Massage and myofascial therapy can lessen pain, and bladder training can help control urinary frequency. When first line treatment options fail or are inadequate, other treatments that can be considered include:
Pharmaceutical treatments
Some medications have been found to help with IC/BPS. Medications such as ibuprofen, acetaminophen, aspirin, and urinary analgesics are often prescribed for pain management.
Amitriptyline, an antidepressant that has shown benefit in chronic pain management, can also be considered for symptom control in bladder pain syndrome. Up to 77% of patients with IC/BPS experience a reduction in pain while taking amitriptyline. However, your doctor will weigh the risks versus benefits of the amitriptyline to make sure it is a right fit for you.
Pentosan polysulfate sodium (PPS) has been shown to improve pain, urinary frequency and urgency, and nighttime urination in people with IC/BPS. There is a slight risk of developing macular degeneration after long-term use of PPS, especially when taken at high doses. PPS is, however, considered safe when taken in the dosages prescribed to treat IC/BPS.
Bladder Instillations
Medications can be instilled directly into the bladder as a treatment option when first-line therapy and over-the-counter medications fail. The doctor guides a catheter (small tube) into your bladder and slowly adds the liquid to ease the irritation of the bladder wall. Examples of medications used include heparin, lidocaine, dimethyl sulfoxide (DMSO), sodium hyaluronate and bladder cocktail (a mix of medications). Bladder instillations have been shown to improve pain, as well as urinary urgency and frequency for some people.
Bladder stretching
Your doctor can treat your bladder pain by stretching the bladder temporarily. Bladder stretching, also known as hydrodistension, occurs when the doctor fills your bladder to stretch it. Some people find temporary relief of bladder pain because stretching might block pain signals sent to the bladder.
Surgery
A very small number of people with IC/BPS benefit from surgical intervention. Usually, surgical candidates have had no improvement from other treatments and have primarily bladder-related symptoms. Surgery can help make the bladder larger (bladder augmentation), reroute the natural flow of urine (urinary diversion), or remove the bladder (cystectomy).
What are Some Natural Ways to Manage IC/BPS?
Some natural ways to manage painful bladder syndrome include:
Lifestyle changes
- Eating and Drinking – some people find that certain foods and drinks can trigger their symptoms, and thus, eliminating these culprits can ease symptoms of IC/BPS and improve quality of life. Alcohol, acidic foods, spicy foods, and foods containing high amounts of a group of chemical compounds known as arylalkylamines worsen symptoms for some people. A study showed that nearly 90% of patients reported improvement in their symptoms with a change in diet.
Unfortunately, some other people find no correlation between their diet and their symptoms. It wouldn’t hurt, however, to monitor how different foods affect you and see if making changes can make a difference. Be sure to drink adequate water to avoid dehydration, which can make things worse.
- Physical Activity – being sedentary not only causes weight issues, but it also increases our risks for many other diseases. Although you might not want to be active with interstitial cystitis/painful bladder syndrome, simple activities like walking and stretching are beneficial to symptom management.
- Manage Stress – stress is a silent killer and a risk factor in nearly every disease condition. Although stress might not directly cause IC/BPS, it does trigger symptoms in some people. Reducing stress can indirectly reduce symptoms. Engage in activities that can help you relieve stress such as listening to music, gentle breathing and enjoying nature.
- Quit Smoking – there are many health reasons to quit smoking and some people report that smoking makes their symptoms worse. Unfortunately, smoking is a major cause of bladder cancer and quitting smoking will improve your overall bladder health.
- Support Network – be sure to surround yourself with family and friends, as well as other people who suffer from painful bladder syndrome. Learn all you can about your condition, so you know what to expect and how to care for your body.
Nutraceuticals
Nutritional supplements known as nutraceuticals have successfully mitigated IC/BPS symptoms. More research is needed in this area, but some people find supplementation beneficial. Common nutraceuticals used for IC/BPS include l-arginine, quercetin, probiotics, and herbal therapy.
Bladder training
People with bladder pain are often used to going to the bathroom before the bladder is full enough to be emptied. This trains the body to urinate often, which can impact your quality of life. Bladder training helps the bladder to hold more urine before urinating. Training your bladder involves slowly increasing the interval between times to urinate. A bladder journal could help to track your times and adjust.
Gradually stretch the interval that you can wait to urinate until your body gets used to being able to hold longer before peeing. It would take some time, but once your body gets used to it, the urgency to urinate often might reduce. If your bladder becomes painful, use the bathroom and keep trying.
Bowel training
Some people report that regular bowel movements improve their symptoms. Similar to bladder training, you can also train yourself to have bowel movements at the same time every day to help you become more regular. Keep a journal for your bowel movements, and let the doctor know if you have any bowel concerns like constipation or diarrhea.
Yoga and Massage
Yoga can help relax and modulate pelvic floor muscle tone, reducing IC/BPS symptoms for some people. Massage, especially regular transvaginal massage, has also been beneficial to some patients for improving pain and urinary symptoms. These benefits can persist for months after treatment. Whole-body massage may also relieve symptoms by improving overall stress levels.
Physical Therapy
People with IC or pelvic floor muscle spasms can benefit from working with a physical therapist to help relax pelvic muscles and reduce symptoms. Myofascial physical therapy, a gentle type of constant massage that releases tightness and pain throughout the pelvic floor, has been effective in some patients with interstitial cystitis. Myofascial tissues are tough covering that wrap and support muscles.
Interstitial cystitis/painful bladder syndrome can be a disruptive and challenging health issue to live with. Although there is no cure, relief is possible by collaborating on an individualized treatment plan with your healthcare provider. Lifestyle adjustments, medical support, and self-care can lessen the impact of your symptoms and make IC/BPS more manageable.
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