The Most Effective Treatment for Bladder Pain (Interstitial Cystitis)

Are you experiencing bladder pain that just won’t go away? Or maybe you frequently have to rush to pee, and yet only a small amount comes out? If so, you may have painful bladder syndrome, also known as interstitial cystitis.

Painful Bladder syndrome is a chronic condition that affects the bladder and surrounding tissues, and can feel like a giant bladder infection without the infection. It can have a significant impact on your quality of life, affecting your ability to work, go out with friends, work out, and have pleasurable sex. What can be even more frustrating is how hard it can be to get the proper diagnosis and find effective treatment options to help you manage your symptoms.

Thankfully, the American Urological Association (AUA) just examined the research and put together a report which details what's known about this condition and provides guidelines on the most effective treatment options for those with PBS/IC. At the very top of the list, is pelvic floor physical therapy. Read on for the most up-to-date information on PBS and details on how physical therapy can help you feel like yourself again.

What is Interstitial Cystitis?

The Society for Urodynamics and Female Urology defines interstitial cystitis or painful bladder syndrome as "an unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms of more than six weeks duration, in the absence of infection or other identifiable causes.”

The definition and diagnostic criteria of painful bladder syndrome can vary, however, which makes it hard to understand how many are truly impacted by this condition. According to the American Urologic Association, painful bladder syndrome affects around 1.2 million people born with vaginal anatomy in the United States, although some sources report that the prevalence is much higher, impacting 3-8 million Americans assigned female at birth.

In advanced cases of painful bladder syndrome, Hunner’s Lesions, which are inflamed ulcers in the bladder’s wall, may be present but these are very uncommon.

What are the Symptoms of Interstitial Cystitis?

There are a variety of symptoms associated with interstitial cystitis / painful bladder syndrome, and symptoms can be significantly different from person to person. Symptom intensity can also vary between people ranging from mild to completely debilitating.

Common symptoms of interstitial cystitis include:

• Urinary frequency that can occur all day and all night
• Urinary urgency
• Pain in the pelvic area including pain anywhere in the lower abdomen, low back, bladder or urethra
• Pain that worsens with bladder filling, and improves with bladder emptying
• Pelvic pressure
• Painful sex (dyspareunia)
• Food and/or beverage sensitivities

What Causes Interstitial Cystitis?

The exact cause of interstitial cystitis / painful bladder syndrome is unknown, and it is unclear if the urinary symptoms that people often experience are even the result of the bladder itself, or if the occur secondary to some other unknown cause. It is possible that painful bladder syndrome is related to a number of factors, including:

• A defect in the lining of the bladder that allows for irritation or vulnerability to injury and sore formation.
• Autoimmune disorder that may be impacting that bladder. It is also common for those with painful bladder syndrome to report other disorders that are associated with systemic dysregulation such as fibromyalgia, IBS, and Sjogren’s syndrome.
• Pudendal nerve injury or changes in the bladder nerves that causes the typically innocuous sensation of bladder filling to begin feeling painful
• Mast cell abnormalities that may lead to an allergic reaction in the bladder
• Urine abnormalities, such as chronically increased protein (proteinuria), which can damage the bladder lining.

How is Interstitial Cystitis Diagnosed?

The symptoms of interstitial cystitis / painful bladder syndrome are very similar to other bladder conditions such as urinary tract infections or overactive bladder, so it is important to check with your physician to rule out other medical conditions.

There are no specific tests to diagnose painful bladder syndrome, although a cystoscopy or urodynamics may be performed in order to assess bladder characteristics, and assess for Hunner’s Lesions if advanced painful bladder syndrome is suspected.

Painful Bladder Syndrome can be diagnosed if symptoms are present for 6 weeks or more, and all other medical conditions have been ruled out.

In their recently published recommendations for the diagnosis and treatment of painful bladder syndrome, The American Urologic Association recommends taking a full medical history and physical examination in order to rule out other medical conditions since the symptoms of painful bladder syndrome are very similar to other bladder conditions such as urinary tract infections or overactive bladder. They also recommend collecting baseline symptoms and symptom intensity in order to assess the benefit of different treatments.

What are the Best Treatments for Interstitial Cystitis?

There is no cure for interstitial cystitis / painful bladder syndrome, but there are a variety of treatment options available that can help to manage the symptoms and improve quality of life. The most appropriate treatment approach will depend on the individual and their specific symptoms.

In their report for the diagnosis and treatment of painful bladder syndrome, the American Urologic Association recommends the following treatment options:

Pelvic Floor Physical Therapy

The most effective treatment option, strongly supported by evidence, includes physical therapy with the following elements:

• Manual therapy treatments to help improve myofascial dysfunction including pelvic, abdominal and/or hip muscular trigger points, muscle tightness, and scar and other connective tissue restrictions.
• Stress management techniques to decrease stress and its impact on the body and central nervous system. Treatment options may include diaphragmatic breathing, yoga exercises, and pain management techniques.
• Education on diet and lifestyle changes that may help manage the symptoms of painful bladder syndrome. For example, you may learn to avoid certain foods and drinks that may irritate the bladder, such as caffeine, alcohol, and spicy foods. You may even learn about urge suppression techniques and bladder retraining as strategies to help improve your bladder function.

Medication

There are several medications that can help to manage the symptoms of interstitial cystitis / painful bladder syndrome. These include over the counter pain medication such as NSAIDs, urinary analgesics, and acetaminophen, prescription medications such as amitriptyline, cimetidine, hydroxyzine, or pentosan polysulfate, or oral cyclosporin A for the treatment of Hunner’s Lesions. All of these come with their own specific risk/benefit profile, so make sure to discuss all options with your physician.

Bladder Instillations

Bladder instillations involve the insertion of a medication directly into the bladder through a catheter. Medications including DMSO, heparin, or lidocaine may be helpful to reduce inflammation and irritation in the bladder, but evidence of improvement is limited.

Low Pressure Hydrodistention

Bladder hydrodistention involves the use of a catheter to fill the bladder with water to help with examination and/or easing of symptoms. Unfortunately, there is limited evidence for the benefit of this as a treatment.

Botox or Surgery

In instances where other treatments may have failed to bring relief, the AUA recommends botox injections into the bladder muscle (the detrusor), sacral or pudendal neuromodulation, or even surgery. However, surgery including cystectomy (bladder removal) is generally only considered as a last resort, as it can have risks and complications.

Don't wait to treat your bladder pain! Improving interstitial cystitis often is a process of trial and error, as what works for one person may not work for another. But for anyone experiencing bladder pain, scheduling an evaluation with a pelvic floor physical therapist is an important way to start.