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Interstitial Cystitis (Painful

Bladder Syndrome)
Interstitial cystitis is a chronic bladder condition that causes
discomfort and/or pain in the bladder or pelvic region. The
bladder walls become inflamed and irritated, which causes the
bladder to become very sensitive. Based on severity, treatment
can range from diet to surgery.

Symptoms and Causes

Diagnosis and Tests

Management and Treatment

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 OVERVIEW

What is interstitial cystitis (IC)?

Interstitial cystitis (IC) or painful bladder (PBS) is defined as
a pain, pressure, or discomfort in the suprapubic or bladder
area which can cause urinary frequency or the urge to
urinate that has been present for at least six weeks.

Who gets interstitial cystitis (IC)?

Men, women and children can all be diagnosed with IC. It is
estimated that approximately 83,000 men and 1.2 million
women in the US suffer from IC.

SYMPTOMS AND CAUSES

What causes interstitial cystitis (IC)?

The causes for IC are not completely understood. IC may be
related to such medical conditions as:

Autoimmune disease.
Allergies.
Defects in the lining of the bladder.
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 Vascular (blood vessel) disease.
Mast cell (cells that cause allergic symptoms)
abnormalities.
Presence of abnormal substances in the urine.
Unidentified infections.

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What are the symptoms of interstitial

cystitis (IC)?
Symptoms of IC/PBS vary from case to case, and can be
mild, severe, occasional or constant. The symptoms may be
similar to those of a bladder infection. Women’s symptoms
often get worse during menstrual periods.

Symptoms of interstitial cystitis (IC) include the following:

Suprapubic or pelvic pain.

Pressure or discomfort when the bladder is filling.
Having to urinate frequently.
Urinating small amounts.

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 DIAGNOSIS AND TESTS

How is interstitial cystitis (IC) diagnosed?

There are no definitive tests to diagnose IC/PBS. It is
important to rule out other infections and conditions so your
doctor may run different tests, including:

Urine sample and urinalysis: The patient provides a urine

sample, and the doctor examines it with a microscope to
learn if there are any organisms, germs, pus, or white
blood cells, which could mean that there is an infection.
The doctor can treat the infection with antibiotics. If the
urine is sterile for weeks or months and the symptoms
continue, doctors may make a diagnosis of IC.
Biopsy of the bladder wall and urethra: A biopsy is a
sample of tissue taken from the body in order to examine
it more closely. This procedure will be done under
anesthesia. Tissue may be taken from the bladder wall
and urethra (the tube through which urine passes out of
the body) to rule out other conditions. A biopsy can help
rule out bladder cancer.
Cystoscopy: The doctor may examine the inside of the
bladder with an instrument called a cystoscope. This is a
long, thin scope with an eyepiece on one end. The
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cystoscope is gently placed up the urethra and into the
bladder. The doctor can see into the bladder by looking
through the eyepiece. The patient is not under anesthesia
during this procedure. A cystoscopy can rule out bladder
cancer. If a bladder biopsy is also planned, the cystoscopy
may be performed at the same time, but this may require
anesthesia.
Cystoscopy under anesthesia with bladder distension: A
cystoscopy may also be done with bladder distention
(stretching). The doctor will perform a cystoscopy as
described above and will distend (stretch) the bladder to
its maximum capacity by filling it with water. This
procedure can reveal cracks in the bladder. This procedure
requires anesthesia because the stretching is painful for
people with IC. After this procedure, many IC/PBS patients
experience temporary relief of their symptoms.

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MANAGEMENT AND TREATMENT

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How is interstitial cystitis (IC) treated?
Although IC/PBS cannot be cured, there are many ways to
treat it. There is no way to predict who will respond best to
certain treatments. Symptoms of IC/PBS may become more
severe, or may disappear. Even if symptoms disappear, they
may return after days, weeks, months or years.

Treatments for IC/PBS are aimed at relieving symptoms.

Doctors will help decide the appropriate treatment for the
patient. For some patients, treatments are combined.

Interstitial cystitis/painful bladder treatments can include:

Diet: Some people with IC/PBS find that certain foods or

drinks make their symptoms worse. You may find it helpful
to keep a diary of what you eat and drink to see if any
foods or drinks cause symptoms and/or flare-ups. For
patients who have IC/PBS, acidic foods may irritate the
bladder. If this is the case, your doctor may recommend
taking an antacid with meals to reduce the amount of acid
that gets into the urine. You may also want to remove
certain foods from your diet, such as:

Alcohol
Caffeine
Carbonated beverages
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 Chocolate
Tomatoes
Artificial sweeteners

Physical activity: Exercise and physical activity may help

relieve the symptoms of IC/PBS. Exercises can include:

Walking
Biking
Gentle stretching

Reducing stress: Stress can trigger flare-ups and

symptoms in someone who has IC/PBS. Learning stress
reduction methods and setting aside time for relaxation
may make living with IC/PBS easier.
Physical therapy: The pelvic muscles hold the bladder in
place and help control urination. Exercising these muscles
may help reduce the symptoms of IC/PBS. Your doctor or
physical therapist can help you perform this exercises
correctly.
Bladder retraining: A person who has bladder pain can get
in the habit of using the bathroom as soon as he or she
feels pain or urgency, even if the bladder is not full. As a
result, his or her body may get used to going to the
bathroom often. Bladder retraining is a treatment to try to
overcome this habit by helping you hold urine for a longer
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period of time. To use bladder retraining, keep a diary of
how often you urinate, and how often you have the urge to
urinate. Use the diary to gradually increase the length of
time between bathroom breaks.
Oral medications: Pentosan polysulfate sodium
(Elmiron®) is a medication approved for treating the pain
of IC. This medication may have to be taken for up to six
months before any improvement is noticed. Medicines
that treat heartburn may help the symptoms of IC by
reducing the amount of acid made by the body. Muscle
relaxants can help relieve the symptoms by keeping the
bladder from squeezing at the wrong time.
Antidepressants can be used to relieve pain in patients
with IC. Tricyclic antidepressants such as amitriptyline
(Elavil) have been shown to improve pain and reduce
frequent urination in patients with IC. Narcotic pain
medications are not routinely used to treat pain in IC
patients.
Bladder instillations: Another treatment is to fill the
bladder with a liquid medicine. You place a small catheter
or tube in the urethra and fill the bladder with medicine.
Bladder stretching/hydrodistension: Bladder stretching or
hydrodistension is a procedure that is performed in the
operating room under anesthesia. The bladder is filled

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 with sterile water in order to distend the bladder and
increase the amount of urine you can hold.
Nerve stimulation: Nerve stimulation is a treatment that
helps regulate the bladder. These treatments are more
helpful in reducing urgency and urinary frequency but
sometimes can help with the bladder/suprapubic pain.
Surgery: Surgery to treat IC/PBS is used as a last resort.
The surgery may remove parts of the bladder or even the
entire bladder. If the patient has tried every other
treatment option and pain is unbearable, surgery may be
considered.

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Last reviewed by a Cleveland Clinic medical professional on 09/16/2019.

References

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