Interstitial Cystitis (Bladder Pain Syndrome)

Your healthcare provider may ask you to describe your symptoms and keep a bladder diary, noting fluid intake and urine output. During a pelvic exam, they will check your pelvic organs and floor muscles for signs of dysfunction and muscle spasms that might contribute to bladder pain.

Your provider may order a urinalysis, in which a sample of your urine is tested for bacteria and white or red blood cells. If the test shows no signs of these substances, they can rule out a bladder infection as the cause of your symptoms.

Your provider may also recommend a biopsy. For this procedure, they’ll start by administering anesthesia. Your provider will then use a thin needle to collect a tissue sample from your bladder wall and urethra to rule out other conditions, including bladder cancer.

Your provider will use a cystoscope, a thin, lighted tube with an eyepiece, to examine the inside of your bladder and rule out bladder cancer. The cystoscope is gently inserted through your urethra into your bladder. You'll be awake during the procedure, but anesthesia may be needed if a bladder biopsy is also performed.

Your provider may perform a cystoscopy with bladder hydrodistention, which involves stretching your bladder to its maximum capacity by filling it with water. This procedure can reveal ulcers or cracks in the bladder and requires anesthesia. Many people experience temporary relief of interstitial cystitis or bladder pain syndrome symptoms afterward.

With urodynamic testing, your bladder is filled with water and emptied through two small catheters. The goal is to measure bladder pressure and capacity so your provider can determine how much urine your bladder holds (people with interstitial cystitis can’t hold much urine) and whether filling your bladder causes pain.

Management of interstitial cystitis may also include:

• Diet changes: Dietary changes can help people with interstitial cystitis manage symptoms, as certain foods and beverages could trigger symptoms. Avoid trigger foods like alcohol, caffeine, chocolate, citrus fruits, soda, spicy foods and tomatoes.
• Quit smoking: Smoking can worsen symptoms of interstitial cystitis.
• Exercise: Regular physical activity may help alleviate symptoms.
• Reducing stress: Stress can worsen symptoms of interstitial cystitis. Practicing relaxation and coping techniques or talking to a counselor can help you manage stress and reduce pain and other symptoms.

Pelvic floor physical therapy relaxes the pelvic floor muscles through stretching, helping to manage symptoms. A physical therapist can show you specific exercises that can heal damaged tissue and provide relief.

Interstitial cystitis medications include:

• Antidepressants: These can help relax the bladder and address pain and inflammation caused by neurochemicals.
• Antihistamines: If your provider suspects your symptoms are caused by inflammation, antihistamines may help.
• Narcotic pain medicines: Codeine and hydrocodone can manage severe discomfort.
• Over-the-counter medications: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin can help with mild to moderate pain.

Nerve stimulation techniques include:

• Transcutaneous electrical nerve stimulation (TENS): Mild electrical pulses relieve pelvic pain and may reduce urinary frequency. Wires are placed on your lower back or pubic area to deliver pulses to increase blood flow, strengthen bladder muscles or trigger pain-blocking substances.
• Sacral nerve stimulation: A wire near the sacral nerves sends electrical impulses to reduce urinary urgency. If effective, a permanent device may be implanted. This technique primarily addresses urinary symptoms, not pain.

Bladder instillations are liquid medications injected directly into the bladder through a catheter. The installations may include a single medication or a combination and are intended to reduce inflammation in your bladder walls. Bladder installation treatments span up to two months, and you may need to receive treatment weekly or every other week.

Procedures that your provider may recommend include:

• Bladder distention: Some people experience temporary symptom relief after a cystoscopy with bladder distention, in which the bladder is stretched with water. If symptoms improve long-term, the procedure may be repeated.
• Botulinum toxin injections: Small doses of botulinum toxin injected directly into the bladder can paralyze bladder muscles, relieving any pain. This treatment may need to be repeated after six to nine months.

Surgery is rarely used to treat interstitial cystitis, as removing the bladder often doesn’t relieve pain and can cause complications. However, for those with severe pain or very limited bladder capacity, surgical options may be considered after other treatments fail:

• Fulguration: Minimally invasive procedure that uses heat to destroy ulcers through the urethra
• Resection: Minimally invasive removal of ulcers through the urethra
• Bladder augmentation: Rarely, a surgeon increases bladder capacity with an intestinal patch, though it doesn’t eliminate pain and may require catheter use