Key points about Interstitial Cystitis
- Interstitial cystitis, also known as bladder pain syndrome (BPS), is a complex, chronic bladder condition characterized by pelvic pain, pressure or discomfort linked to your bladder, accompanied by an urgent and frequent need to urinate.
- Interstitial cystitis affects millions of women, frequently misdiagnosed for years as just recurrent urinary tract infections (UTIs).
- Symptoms of BPS typically run in cycles, featuring periods of remission followed by sudden flare-ups triggered by stress, diet or hormonal changes.
- Symptoms range from mild, intermittent pressure to severe, constant and debilitating pelvic pain that impacts your quality of life.
Interstitial cystitis causes
Common causes for bladder pain syndrome can include:
- A breakdown or thinning of the protective lining of your bladder, allowing irritating substances in urine to reach your bladder wall
- An overactive response or abnormal activation of mast cells in your bladder, which can lead to chronic inflammation
- Pelvic floor muscle dysfunction or chronic pelvic floor tension
- Hypersensitivity of the nerves that transmit pain from your bladder to your brain
- Co-occurring chronic pain syndromes, like fibromyalgia, Irritable Bowel Syndrome (IBS) or endometriosis
- A family history of chronic pain and bladder issues
Interstitial cystitis symptoms
- Chronic pain, pressure or a heavy aching sensation in your pelvis, lower abdomen, or perineum that worsens as your bladder fills and temporarily gets better after emptying
- A sudden, compelling and painful need to urinate that doesn’t go away, even immediately after using the restroom
- The need to urinate frequently throughout the day and night
- Pain or pelvic pressure during or after sexual intercourse
Interstitial cystitis diagnosis
Your doctor will perform a detailed evaluation of your bladder symptoms, pain patterns, menstrual cycle influences and a careful review to rule out other conditions. They will also perform a urinalysis and urine culture to rule out active bacterial infections, and a pelvic exam to check for alternative causes of pelvic pain. You’ll fill out questionnaires and bladder diaries to track triggers, voiding volumes and baseline pain levels.
In some cases, a cystoscopy (looking inside the bladder with a small camera) may be performed to check the bladder wall for specific signs of inflammation, such as Hunner’s lesions or pinpoint bleeding (glomerulations).
Interstitial cystitis treatment
- Dietary and lifestyle changes: Identifying and eliminating personal bladder triggers using an elimination diet (common irritants include caffeine, alcohol, citrus, tomatoes, artificial sweeteners and spicy foods), alongside stress-reduction techniques.
- Pelvic floor physical therapy: Specialized therapy focusing on relaxing and lengthening tight pelvic floor muscles, rather than strengthening them.
- Oral medications: Utilizing targeted prescription medications to coat the bladder lining or reduce pain and inflammation
- Bladder instillations: Delivering therapeutic medication “cocktails” that include medications directly into your bladder through a small catheter to soothe and repair your bladder lining.
- Advanced interventions: Minimally invasive procedures like bladder hydrodistension (stretching the bladder under anesthesia to relieve pain symptoms) or treating specific bladder wall ulcers (called Hunner's lesions) using fulguration or steroid injections.
When to seek care for interstitial cystitis
- If you are experiencing persistent bladder pain or pelvic pressure that is not relieved by standard antibiotics prescribed for assumed UTIs.
- If your sleep is severely disrupted because you have to get up multiple times every night to urinate.
- If you find yourself constantly planning your daily schedule around pain flare-ups or immediate access to a bathroom.