Pelvic Floor Disorders Program
Women's Medicine Collaborative

Information and Treatment for Interstitial Cystitis (Painful Bladder Syndrome)

What Is Interstitial Cystitis (Painful Bladder Syndrome)?

Painful bladder syndrome (PBS), also called interstitial cystitis (IC), is irritation or inflammation of the bladder wall that can lead to scarring and stiffening of the bladder.

It is defined as having pain in the pelvic area along with lower urinary tract symptoms, such as frequent or urgent urination, that have lasted for more than six weeks without an infection or other clear cause.

The bladder can increase from about 2 inches to more than 6 inches long, depending on how much urine it is holding. The typical human bladder holds between 16 to 24 ounces.

If the bladder wall becomes scarred or stiffened, the bladder can’t hold as much urine as it did in the past.

Painful bladder syndrome/interstitial cystitis is a chronic disorder.

How Common Is Interstitial Cystitis?

Between 700,000 and one million Americans are estimated to have painful bladder syndrome, and 90 percent are women. The average age of onset is 40.

What Causes Painful Bladder Syndrome?

The cause of PBS/IC has not been identified, but research into the cause and best treatments is ongoing. Many people find that spicy foods, citrus fruits, caffeinated beverages and chocolate make symptoms worse.

Painful bladder syndrome may be combined with other health issues such as irritable bowel syndrome, fibromyalgia, and other pain syndromes, according to the American Urological Association. 

What Are the Common Signs and Symptoms of Painful Bladder Syndrome?

These are the most common symptoms:

  • frequency or urgency of urination
  • sensations of pressure, pain, and tenderness around the bladder, pelvis, and the area between the anus and vagina or anus and scrotum (perineum)
  • pain during sex
  • in men, discomfort or pain in the penis and scrotum
  • symptoms may worsen around a woman’s period

For some people, episodes of painful bladder syndrome are sporadic; for others, chronic.

Some find that stress may make symptoms worse, but stress does not cause symptoms.

The symptoms of IC may mirror those of other conditions or medical problems. Always talk with a health care provider for an accurate diagnosis.

How Is Interstitial Cystitis Diagnosed?

No single test is definitive; symptoms of IC are a lot like those of other urinary disorders. Therefore, a variety of tests may be needed to rule out other problems before arriving at a diagnosis

  • Urinalysis: Testing to look for certain cells and chemicals in the urine. This includes red and white blood cells, bacteria, or too much protein. A sample of bacteria may be grown in the lab to determine what kinds are present.
  • Cystoscopy: For this test your health care provider threads a thin, flexible tube and viewing device into the urethra to examine the urinary tract. It checks for structural changes or blockages, such as tumors or stones.
  • Bladder wall biopsy: A test in which tissue samples are removed from the bladder (with a needle or during surgery) and examined to see if cancer or other abnormal cells are present.

The symptoms of IC may mirror those of other conditions or medical problems, such as a urinary tract infection. Always talk with a health care provider for an accurate diagnosis.

What Treatment Is Available for Painful Bladder Syndrome?

No single approach works for all people who have painful bladder syndrome, so treatment must be tailored to each patient based on symptoms. Physicians will prescribe different treatments (or combinations of them) until the patient experiences good symptom relief. 

It commonly takes weeks to months before symptoms improve. Your doctor will monitor your pain and quality of life to judge how your treatments are working so that together you can find the best treatment option.

Among the treatments are:

  • patient education
  • exercise
  • reducing stress levels. There is no evidence that stress causes painful bladder syndrome; however, if a person has it, physical or mental stress can make the symptoms worse
  • phytotherapy directed to the bladder
  • eliminating foods or drinks that can trigger symptoms. Most people with IC find that certain foods make their symptoms worse, most commonly including citrus fruits, tomatoes, chocolate, coffee, and potassium-rich foods. Other foods that bother many patients are alcoholic beverages, caffeinated beverages, spicy foods, and some carbonated beverages.
  • bladder enlargement, which increases bladder capacity and interferes with pain signals being sent by nerve cells in the bladder
  • bladder wash – The bladder is filled with a solution that is held for varying times, from a few seconds to 15 minutes, then drained with a catheter.
  • medicine taken by mouth or inserted into the bladder
  • transcutaneous electrical nerve stimulation (TENS) – Mild electric pulses are administered to the body for minutes to hours, two or more times a day. The pulses are sent through wires placed on the lower back, or through special devices put into the vagina in women or into the rectum in men. For some people, TENS eases bladder pain and urinary frequency and urgency.
  • bladder training is urinating at specific times and using relaxation techniques and distractions to help maintain the schedule. The goal is to lengthen the time between scheduled voidings.
  • surgery to remove all or part of the bladder may be done in severe cases, if other treatments do not work.
  • quitting smoking

When Should I Make an Appointment with a Urologist?

If you have pain in the pelvic area along with lower urinary tract symptoms, such as frequent or urgent urination, that have lasted for more than six weeks without having an infection or other clear cause, you should seek advice from a urologist. The Women’s Medicine Collaborative has specialists who can help.

Learn more about treatment for pelvic floor disorders at Lifespan