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Painful Bladder Syndrome

Painful bladder syndrome (Interstitial Cystitis) at a glance

  • Interstitial cystitis (IC), or painful bladder syndrome (PBS), is a painful chronic condition affecting the bladder, the organ that holds urine produced by the kidneys.
  • The cause of IC/PBS isn’t known but what happens is that the bladder sends signals to the brain to squeeze the muscles that empty the bladder more often than necessary.
  • Painful Bladder Syndrome most often occurs in people age 30–40 and affects women 10 times more frequently than men.
  • IC/painful bladder syndrome symptoms include acute or chronic pain in the bladder (sometimes in the pelvic region), as well as frequent urge to urinate.
  • Treating painful bladder syndrome typically starts with more conservative methods, such as dietary changes or physical therapy, before more invasive options, such as nerve stimulation and surgery.

What is Painful Bladder Syndrome?

Painful Bladder Syndrome (PBS), clinically referred to as interstitial cystitis, is a chronic bladder condition that causes people to feel pressure and discomfort in the bladder, as well as overall pelvic pain in some cases. The bladder is the hollow organ located in the pelvic area and behind the pubic bone that collects and stores urine created in the kidneys.

Some researchers suggest that interstitial cystitis/painful bladder syndrome is not one condition but rather a collection of diseases, which is called a syndrome. IC is more likely to affect women than men for inconclusive reasons.

Interstitial cystitis has long-term effects on a person’s quality of life. Many people with IC suffer from depression due to the pain and the impact of constant symptoms on their lifestyle.

Causes of Painful Bladder Syndrome

The precise cause of Painful Bladder Syndrome is unknown. Some potential, although unproven, factors that may contribute to painful bladder syndrome include allergies, infections in the bladder and genetics.

Risk factors that may increase the chances of the syndrome include:

  • Susceptibility to chronic pain disorders — other chronic pain syndromes, such as fibromyalgia or irritable bowel syndrome may correlate to having painful bowel syndrome.
  • Gender — woman are more likely than men to be diagnosed with painful bladder syndrome.
  • Age — people over the age of 30 are more likely to get painful bladder syndrome.

Symptoms of painful bladder/interstitial cystitis

Painful bladder syndrome symptoms may vary and differ in response to factors such as menstruation, stress, sexual activity and sitting for extended periods of time. Primary symptoms of painful bladder syndrome include:

  • Pelvic area pain (acute or chronic)
  • Mild or severe pressure or discomfort in the bladder
  • Frequent urge to urinate (up to 60 times each day in extreme cases)
  • Painful sex.

IC symptoms may flare up and even disappear for periods of time. Any person with pain or discomfort in the bladder and pelvic area, or who needs to use the bathroom with irregular frequency, should visit a urologist for diagnosis and proper treatment.

Diagnosis and treatment of Painful Bladder Syndrome

Symptoms of PBS are similar to those of other urinary disorders, so the urologist will try to first rule out the prospect of other conditions, such as urinary tract infection (UTI), sexually transmitted disease or bladder cancer. Diagnosis efforts can include:

  • Medical history evaluation
  • Pelvic exam
  • Keeping a bladder diary
  • Urine test
  • Cystoscopy to view the lining of the bladder
  • Potassium sensitivity test, as people with IC are sensitive to potassium.

There is no cure for PRBS and treatment is often challenging since each case presents in differing ways. Diet and lifestyle changes, physical therapy, medication, nerve stimulation and surgery are all treatment options that may provide relief for painful bladder syndrome.

Diet and lifestyle changes to control PBS

Some people find that certain foods or beverages can trigger bladder irritation and making dietary changes can help control symptoms of PBS. Foods and beverages known to cause flare-ups in some patients include:

  • Caffeine (coffe, tea)
  • Alcohol
  • Chocolate
  • Citrus juices
  • Carbonated beverages
  • Foods and drinks with artificial sweeteners
  • Spicy foods and hot peppers.

An elimination diet involves eliminating one food at a time from one’s diet and keeping a food diary in order to identify foods that may trigger discomfort in a person with Painful Bladder Syndrome. There are great variations among different patients as to what particular foods trigger their bladder pain.

Bladder training is another lifestyle change possible for patients with PBS/IC. This can involve training oneself to urinate at specific times to reduce urinary frequency.

Physical therapy

A physical therapist may help relieve symptoms that arise because of overly tender muscles or pelvic floor dysfunction (PFD). Many urinary, bowel and sexual-related symptoms of PBS can be caused by PFD. Physical therapy can relax and extend tightened muscles and release trigger points of pain. A physical therapist can also evaluate the posture of a person with IC, which can exacerbate symptoms due to pelvic floor disorders.


Over-the-counter medicine such as ibuprofen and naproxen should improve minor pain symptoms. Other medications such as tricyclic antidepressants aid in relaxing the bladder muscle and soothing the pain symptoms. The antihistamine hydroxyzine pamoate can reduce urinary frequency. Medications also can be placed directly into the bladder to reduce symptoms.

Nerve stimulation (InterStim)

The techniques use electrical pulses to relieve pain by increasing blood flow to the bladder. Sacral nerve stimulation works much like a pacemaker does for the heart, as it stimulates the bladder muscles with a thin wire placed close to the bladder nerves. If the symptoms decrease during the initial stimulation procedure, a permanent wire may be surgically placed for permanent use.

Bladder surgery

Surgery is a sparingly used treatment option for painful bladder syndrome because removing the bladder (a cystectomy) typically doesn’t fully relieve pain and can even lead to other complications. Those most suited for surgery include people with severe pain or those who can only hold a tiny amount of urine, and then only after other treatments have failed.