Painful Bladder Syndrome/Interstitial Cystitis (PBS/IC) is a chronic condition characterized by urinary urgency, frequency, nocturia, and/or bladder pain in the absence of infection or other apparent cause. The intensity of symptoms can range from mild to debilitating. People often see several healthcare providers before they are correctly diagnosed. The National Institutes of Health estimate that 700,000 people in the United States suffer from PBS/IC and that 90% are women.
Symptoms of PBS/IC include a sudden urge to urinate (urinary urgency), a frequent need to urinate (urinary frequency), frequent nighttime urination (nocturia), and/or pain in the bladder or surrounding area. Bladder pain tends to increase as the bladder fills. Women often incorrectly attribute their symptoms to a urinary tract (bladder) infection. Symptoms of PBS/IC often occur with episodes of increased intensity called "flares" followed by a period of remission. In severe cases, urinary frequency can occur greater than 60 times per day during flares. Certain foods, beverages, and tobacco use tend to worsen symptoms. Many women with PBS/IC suffer from additional pelvic pain brought on by spasm of the pelvic floor muscles. Women with PBS/IC have a greater than normal incidence of irritable bowel syndrome, fibromyalgia, migraines, asthma, environmental allergies, lupus, rheumatoid arthritis, endometriosis, vulvodynia, and anxiety disorders.
The exact cause of PBS/IC is unknown. Researchers believe that multiple factors are involved. A current theory is that a disruption of the bladder lining leads to overactivity of pain nerves in the bladder. Risk factors for the development of PBS/IC are young age, female gender, and a family history of PBS/IC.
There is no test for the diagnosis of PBS/IC. Testing is done to rule out other possible causes of the symptoms of PBS/IC such as bladder cancer, urinary stones, and sexually transmitted diseases or other gynecological problems. Click here for information on diagnostic testing.
There is no cure for PBS/IC, but options are available to manage the symptoms. A combination of options are usually required for symptom control. Finding the combination of options that will provide optimal relief of symptoms often requires diligence and patience.
NON-SURGICAL TREATMENT OPTIONS FOR PBS/IC
Following a bladder diet is avoiding food and beverages that worsen symptoms of PBS/IC. A "bladder elimination diet" is a way to determine which particular foods and beverages worsen symptoms. Click here to learn more about bladder irritants.
Pelvic Floor Therapy
Pelvic floor therapy for PBS/IC consists of a series of visits to a physical therapist with specialized training in the treatment of pelvic floor and bladder problems. The physical therapist uses techniques to relax and re-educate the nerves and muscles of the bladder and pelvic floor. Click here for more information on pelvic floor therapy.
- Tri-cyclic antidepressants
- Nonsteroidal anti-inflammatory drugs
- Urinary analgesics
Bladder instillations are repeated instillations of lidocaine, heparin, and other substances into the bladder to decrease bladder pain. The mixture is instilled through a small catheter inserted into the bladder through the urethra two to three times per week, until the desired results are acheived.
Referral to a Mental Health Professional
These professionals can help you develop relaxation techniques and other coping mechanisms to deal with physical pain and emotional stress associated with PBS/IC.
SURGICAL TREATMENT OPTIONS FOR PBS/IC
InterStim™ Therapy is an FDA-approved treatment for urinary urgency, frequency, urge incontinence, and retention. The InterStim™ is a small device that is implanted under the skin of one of the upper buttocks. It works by gently stimulating the sacral nerves to help the bladder function more normally. Click here for more information on InterStim™ Therapy.
Spinal Nerve Blocks
Spinal nerve blocks are injections of pain medications into the nerves that are causing your pain. These are performed by a pain management specialist.