Bladder Pain Syndrome

Bladder pain syndrome, also known as interstitial cystitis (IC), is a chronic and painful bladder condition characterized by inflammation and irritation of the bladder wall. It is a complex and often poorly understood condition that primarily affects the urinary system. IC can significantly impact a person’s quality of life due to its persistent discomfort and urinary symptoms.

The University of Kansas Health System is dedicated to delivering quality care and employing the latest advancements in treatment. We collaborate closely with each patient to create a customized treatment strategy that considers their individual needs and objectives. Your comprehensive care team will work together to provide the most suitable combination of treatments for your specific disease and circumstances.

While bladder pain can be caused by several factors, including recurrent urinary tract infections and bladder cancer, interstitial cystitis is one of the most frequently diagnosed causes. Interstitial cystitis is a chronic inflammatory condition of the urinary bladder that leads to bladder pain, feelings of pressure on the bladder or causes other discomfort. It is often associated with significant urination problems, including urinary urgency and frequency as well as pelvic pain.

A wide range of therapies is available to treat those who are diagnosed with bladder pain syndrome, including dietary modification, medication and surgery.

• Classic interstitial cystitis: This is the most common type and is characterized by chronic pain and urinary urgency. People with classic IC often experience worsening of symptoms as their bladder fills with urine.
• Nonulcerative interstitial cystitis: In this subtype, there is no visible ulceration on the bladder wall, but patients still experience symptoms like pain, urgency and frequency.
• Ulcerative interstitial cystitis: This subtype involves visible ulcers or Hunner’s lesions on the bladder wall, which can cause severe pain and discomfort. It tends to be less common but can be particularly challenging to manage.

People with interstitial cystitis often have problems with pelvic pain, which can negatively affect daily activities like urination, exercise and sexual health. Symptoms may be similar to a urinary tract infection and can include:

• Chronic pelvic pain: A persistent, dull or sharp pain in the lower abdomen or pelvic region, which may worsen as the bladder fills.
• Urinary urgency: Frequent and urgent need to urinate, often with only small amounts of urine passed each time.
• Frequent urination: Patients may need to urinate as often as 30 times a day or night.
• Painful urination (dysuria): A burning or painful sensation during urination.
• Nocturia: Frequent nighttime urination, which disrupts sleep.
• Pain during sexual intercourse: Many individuals with IC experience discomfort or pain during sexual activity.
• Incomplete emptying: A feeling that the bladder is not completely empty after urination.

These symptoms may come and go, including experiencing times that you are pain-free. While the symptoms of interstitial cystitis may mimic those of a urinary tract infection, no underlying infection usually exists. If a urinary tract infection occurs at the same time as interstitial cystitis, symptoms get worse. Unlike a urinary tract infection, symptoms of interstitial cystitis do not go away after taking antibiotics.

The exact reason for interstitial cystitis is not known. Differences in the bladder lining, autoimmune disorders, nerve dysfunction, chronic inflammation and genetic predisposition may be contributing factors. Although interstitial cystitis occurs in both men and women, it affects a significantly larger percentage of women. Other possible risk factors for interstitial cystitis include:

• Being diagnosed with a different chronic pain disorder, like fibromyalgia or irritable bowel syndrome
• Being over 30
• Having red hair and fair skin

Diagnosing interstitial cystitis can be challenging because its symptoms can overlap with other urologic and pelvic conditions. Here are some common diagnostic methods and screening procedures:

To properly identify the cause of your bladder pain, your doctor may use one or several diagnostic tools:

• Medical history and physical examination: Your healthcare provider will start by taking a detailed medical history and performing a physical examination to understand your symptoms and rule out other potential causes.
• Symptom assessment: The diagnosis often relies on the characteristic symptoms of IC, such as chronic pelvic pain, urinary urgency and frequency.
• Urinalysis: A urinalysis is performed to rule out urinary tract infections or other urinary abnormalities that could be contributing to your symptoms.
• Cystoscopy: A cystoscopy is a procedure in which a thin, flexible tube with a camera (cystoscope) is inserted into the bladder through the urethra. It allows the doctor to visually inspect the bladder lining for signs of inflammation, ulcers or Hunner’s lesions.
• Biopsy: During a cystoscopy, a biopsy may be taken from the bladder wall to confirm the diagnosis, especially if there are visible ulcers or lesions.
• Potassium sensitivity test: In this test, a solution containing potassium chloride is instilled into the bladder to see if it worsens symptoms. A positive response can suggest IC.
• Urodynamics: These tests measure bladder function and can help identify abnormalities in how the bladder stores and empties urine.

Your doctor may also ask you to keep a bladder diary to track your fluid intake and urine volume

No standardized treatment exists for the management of interstitial cystitis symptoms. Treatment often begins with dietary modification to identify dietary triggers that could potentially impact your bladder. Caffeine is known to flare bladder symptoms. For some, tomatoes and/or citrus fruits can also have an effect, but not every person has dietary triggers.

There are several other treatment options to relieve pain from interstitial cystitis, and not every approach works for everyone. Sometimes, a combination approach is the best option for how to get rid of bladder pain. Your doctor may recommend one or several treatments for your interstitial cystitis:

• Oral medications: Nonprescription pain relievers such as acetaminophen or prescription medications like pentosan polysulfate sodium (Elmiron), tricyclic antidepressants or antihistamines may be prescribed to alleviate pain and urinary symptoms.
• Bladder instillations: Medications such as dimethyl sulfoxide or heparin are introduced directly into the bladder via a catheter to reduce inflammation and relieve symptoms.
• Physical therapy: Pelvic floor physical therapy can help relax and strengthen pelvic muscles, potentially reducing pain and urinary urgency.
• Nerve stimulation: Treatments like sacral neuromodulation (InterStim) involve implanting a device that helps regulate nerve signals to the bladder.
• Bladder hydrodistention: This procedure involves stretching the bladder under anesthesia, which may provide temporary relief for some patients.
• Surgery: In rare and severe cases, surgery may be considered, such as bladder augmentation or urinary diversion.

The right approach to managing chronic bladder pain can help you recover from the debilitating pain to improve your quality of life.