Interstitial Cystitis/Bladder Pain Syndrome

What is interstitial cystitis?

Interstitial cystitis, now known as bladder pain syndrome (IC/BPS), is chronic (long-term) pain, pressure or discomfort in your bladder area (suprapubic region). In addition, it causes a frequent need to urinate (frequency) and sudden urges to urinate (urgency) for at least six weeks.

Who does interstitial cystitis/bladder pain syndrome affect?

Anyone can get IC/BPS. However, you may be at a greater risk if you:

• Are a woman or person assigned female at birth (AFAB).
• Are 30 or older.
• Have another condition that causes chronic pain.

How common is IC/BPS?

Interstitial cystitis/bladder pain syndrome is common. It affects approximately 1 to 4 million men and people assigned male at birth (AMAB) and 3 to 8 million women and people AFAB in the United States.

What are the symptoms of interstitial cystitis/bladder pain syndrome?

Symptoms include:

• Pain in your bladder region.
• Pressure or discomfort when your bladder is filling.
• Urinary frequency.
• Urinary urgency.
• Only peeing a small amount.

Interstitial cystitis/bladder pain syndrome symptoms vary among people. They may be mild or severe. They also may be constant or only appear occasionally.

If you’re a woman or person AFAB, your symptoms often get worse when you’re menstruating.

What does IC/BPS feel like?

IC/BPS may feel different from person to person. Some people only feel mild discomfort. Others feel a lot of pain and sudden, frequent urges to pee (urinate).

How do you get interstitial cystitis/bladder pain syndrome?

Healthcare providers and medical researchers don’t completely understand what causes IC/BPS. They suspect that it may be related to certain medical conditions, including:

• Autoimmune diseases.
• Allergies.
• Defects in your bladder lining.
• Vascular disease (vasculopathy).
• Abnormalities in your mast cell (cells that cause allergic symptoms).
• The presence of abnormal substances in your pee, including consistently high protein levels (proteinuria).
• Unidentified infections.

Is IC/BPS contagious?

No, IC/BPS isn’t contagious.

How is interstitial cystitis/bladder pain syndrome diagnosed?

There aren’t any specific tests to diagnose IC/BPS. However, a healthcare provider will order tests to rule out other infections or conditions. These tests may include:

• Medical history. Your provider may ask you to record your symptoms in a diary. They may also ask you to record what you drink, how much you drink and how much you pee.
• Urinalysis (urine test). You’ll provide a pee sample for your provider. They’ll examine your sample with a microscope and look for blood in your pee (hematuria) and signs of an infection, such as organisms, germs, pus or white blood cells. Your provider will prescribe antibiotics to treat any infections. If your pee is sterile weeks or months after treatment and your symptoms remain, your provider may diagnose interstitial cystitis/bladder pain syndrome.
• Biopsy. Your provider will first sedate you (put you under) with anesthesia. They’ll then use a thin needle to take a tissue sample of your bladder wall and urethra (the tube through which pee passes out of your body) to rule out other conditions, including bladder cancer.
• Cystoscopy. Your provider will examine the inside of your bladder with a cystoscope to help rule out bladder cancer. A cystoscope is a thin, lighted tube with an eyepiece on one end. Your provider will gently insert it into your urethra up to your bladder. They’ll look at your urethra and bladder through the eyepiece. You won’t be under anesthesia during the procedure. However, if your provider orders a bladder biopsy along with a cystoscopy, it may require anesthesia.
• Cystoscopy under anesthesia with hydrodistension. Your provider may perform a cystoscopy with bladder hydrodistension (stretching). They’ll perform a cystoscopy and distend (stretch) your bladder as big as possible (maximum capacity) by filling it with water. This procedure may reveal ulcers or cracks in your bladder. It requires anesthesia because bladder distension is painful. Many people have temporary relief of their interstitial cystitis/bladder pain syndrome symptoms after this procedure.

How do you fix interstitial cystitis/bladder pain syndrome?

You can’t fix or cure IC/BPS. However, there are many ways to treat it. The goal of IC/BPS treatments is to relieve your symptoms. Your healthcare provider will work with you to decide the most appropriate treatment. In some cases, they may even combine treatments.

Healthcare providers can’t predict how your body will respond to each treatment. You’ll go through a process of trial and error with various treatments to see how your body responds. Your symptoms may go away or they may become more severe. Even if your symptoms disappear, they may return later.

Interstitial cystitis/bladder pain syndrome treatments may include the following:

Diet changes

Some people who have IC/BPS report that certain foods and drinks worsen their symptoms (triggers). Keep a diary of what and how much you eat and drink each day. Noting what you eat and drink before the onset of symptoms and/or a flare-up can help you learn what foods and drinks to avoid.

If you notice that acidic foods or drinks — citrus fruits, peppers, carbonated beverages, tomatoes — cause flare-ups, your provider may recommend taking an antacid with meals. Antacids reduce the amount of acid that gets into your pee.

Common foods and drinks that may cause IC/BPS symptoms include:

• Alcohol.
• Artificial sweeteners.
• Caffeine.
• Carbonated beverages.
• Chocolate.
• Tomatoes.
• Fruit juices.

Your provider may also refer you to a dietitian to help you create the best diet to reduce symptoms.

Physical activity

Exercise and physical activity may help relieve your IC/BPS symptoms. Examples of exercises include:

• Walking.
• Bicycling.
• Gentle stretching or yoga.

Reducing stress

If you have IC/BPS, stress may trigger flare-ups. Learning to recognize and manage stress may help alleviate your symptoms. You may need to talk to a mental health professional to help with this portion of treatment.

Physical therapy

Your pelvic muscles hold your bladder in place and help control when you pee. Exercising, stretching and especially relaxing your pelvic muscles may help reduce IC/BPS symptoms. Your provider can help ensure you’re performing these exercises correctly. Many people work with a pelvic floor physical therapist to make sure they’re relaxing their pelvic floor muscles enough.

Bladder retraining

If you have bladder pain, it’s easy to get into the habit of using the bathroom as soon as you feel pain or urgency, even if your bladder isn’t full. Your body may get used to going to the bathroom often. Bladder retraining helps you overcome this habit by helping you hold your pee for longer periods.

To practice bladder retraining, keep a diary of how often you pee and how often you have the urge to pee. Use your diary to help you gradually increase the time between bathroom breaks.

Oral medications

The following oral medications may help treat IC/BPS symptoms:

• Heartburn medications. Over-the-counter antacids (Tums®, Rolaids®) may help reduce your symptoms by reducing the amount of acid in your body.
• Antidepressants. A low dose of a tricyclic antidepressants such as amitriptyline (Elavil®) may help reduce pain and reduce urinary frequency.
• Hydroxyzine. Histamine may cause IC/BPS symptoms. Hydroxyzine is an antihistamine that helps remove histamine from your bladder.

Bladder instillations

Your provider will insert a catheter in your urethra up to your bladder. They’ll then fill your bladder with a mixture of medications that may include dimethyl sulfoxide (DMSO), a steroid and a numbing medication. DMSO is a liquid medicine that helps alleviate symptoms.

Bladder stretching (hydrodistension)

Your provider fills your bladder with sterile water to stretch out your bladder to increase the amount of pee it can hold. This may also calm or break the overactive nerve endings telling your brain your bladder is in pain. They’ll give you anesthesia so you aren’t awake and won’t feel any pain.

Nerve stimulation

Nerve stimulation (neuromodulation therapy) helps regulate your bladder by reducing urgency and frequency. It sometimes helps alleviate pain in your bladder or abdominal area.

Botulinum toxin injections

Your healthcare provider injects botulinum toxin (Botox®) into your bladder muscle through a cystoscope. Small amounts of Botox paralyze the muscles and help alleviate pain. You may need Botox injections every four to nine months.

Surgery

Your provider may recommend more invasive surgery if you have severe IC/BPS symptoms and don’t respond to other treatments. They may remove part or all of your bladder (cystectomy).

Other considerations

In addition to treating the bladder and pelvic floor, your provider will consider other conditions, such as hormone imbalances, endometriosis or bowel issues that may be causing part of your pain.

Will interstitial cystitis/bladder pain syndrome ever go away?

It depends. Most people who have IC/BPS need treatment for their entire lives. If they don’t get treatment, their symptoms may return. They may even have flare-ups while they’re actively treating IC/BPS.

Some people respond well to treatment. Their symptoms slowly improve and even go away.

What is the fastest way to get rid of interstitial cystitis/bladder pain syndrome?

Talk to a healthcare provider. They can tell you what treatments may offer the fastest relief for your symptoms.

How soon after treatment will I feel better?

It may take several weeks or months before your symptoms start to improve.

How can I prevent interstitial cystitis/bladder pain syndrome?

Healthcare providers and medical researchers don’t know how to reduce your risk of developing IC/BPS or prevent symptoms from recurring. You may be able to prevent flare-ups by:

• Keeping a food diary, identifying foods that may cause symptoms and avoiding them.
• Maintaining your treatment even after your symptoms go away.
• Reducing stress in your life.

What can I expect if I have IC/BPS?

For many people, IC/BPS is a long-term condition. Your symptoms may be mild or severe. They may appear now and then or they may be persistent. Talk to a healthcare provider to help determine your outlook and the best treatment options.

How do I take care of myself?

The following tips may help reduce the length and severity of your IC/BPS flare-ups:

• Take medicines that help reduce your symptoms as soon as you feel a flare-up start.
• Drink extra water to help dilute your pee.
• Place an ice pack or heating pad on your abdominal area or perineum (the space between your genitals and rectum).
• Take a warm sitz bath.
• Help relax your pelvic floor muscles by squatting with your legs wide apart. You can also try the “happy baby” yoga pose — lie on your back, press your knees against your chest, point the soles of your feet toward the ceiling and grab the outsides of your feet.
• Try relaxation techniques.
• Avoid tight clothing that presses on your abdomen, including tight pants, hosiery, tights and girdles.
• If intercourse triggers flare-ups, take pain-relieving medicines before sex and use lubricants during sex to reduce discomfort.

When should I see a healthcare provider?

Schedule an appointment with a healthcare provider if you have symptoms of IC/BPS. A provider will order tests to rule out infections or other conditions that may cause similar symptoms. They may also recommend or prescribe medications.

See a healthcare provider if your symptoms are severe or don’t go away after treatment.

What questions should I ask a healthcare provider?

• How can you tell that I have interstitial cystitis/bladder pain syndrome?
• If I don’t have interstitial cystitis/bladder pain syndrome, what other condition might I have?
• What tests will you conduct to confirm your diagnosis?
• What treatment do you recommend?
• Are there any side effects to your recommended treatment?
• Do you recommend one treatment option or a combination of treatments?
• Are there any other foods or drinks I should avoid?
• What lifestyle changes can help manage my symptoms?
• Should I see a dietitian, urologist or another specialist?

A note from Cleveland Clinic

Interstitial cystitis/bladder pain syndrome is a common condition that causes discomfort in your bladder area and affects your frequency and urgency to use the restroom. If you notice symptoms of IC/BPS, talk to a healthcare provider. They can order tests to rule out other conditions and work with you to develop the most effective treatment plan.