Interstitial Cystitis (IC)
Hey, hi, hello, Bestie! Let’s chat bladder pain. If you’re in the majority of ladies, you’ve experienced a urinary tract infection (UTI) at some point in your life. UTIs occur when bacteria enter the urethra and cause infection to the structures of the urinary tract. This often includes the bladder but can sometimes move to the ureters and kidneys, as well. UTIs cause all sorts of symptoms, including bladder pain, a sense of urinary urgency, frequent urination, and pain with urination. They can be very uncomfortable, but fortunately, they are fairly easy to treat. Typically, a quick round of antibiotics will clear them up and using a product such as Azo will help manage symptoms while you wait for your infection to abate.
What if you have a majority of the symptoms mentioned, but you don't have a UTI? What if your physician tests your urine just to find that there are no bacteria present? If this is the case for you, you could be suffering from Interstitial Cystitis (IC), also called Painful Bladder Syndrome (PBS).
Symptoms of IC/PBS include suprapubic bladder pain, urinary frequency at day and night, and urinary urgency. If you have these symptoms, you should have your urine tested in order to rule out UTI. IC/PBS is a form of chronic pelvic pain and should be present for more than six weeks in order to receive a diagnosis. It is much more common in the female population than the male population by a ratio of about 10:1 and it is often linked to urinary dysfunction in childhood (1).
IC/PBS symptoms are the result of chronic inflammation in the bladder (2). This is why afflicted folks experience pain or discomfort during bladder filling and why they tend to urinate more frequently than is considered normal. Remember normal number of voids per day is 6-8 and per night is 0-2. Folks with IC/PBS may be urinating upwards of 10-15+ times per day and 4+ times per night. Pain improves with urination since peeing leaves the bladder emptier. Symptoms may worsen with the consumption of acidic foods (such as citrus, tomatoes, etc), physical activity, and during certain periods of the menstrual cycle (3). Remember, your urine is acidic and the more acidic it is, the more irritation it will cause the bladder. Drinking fluid often will result in more diluted urine that is less acidic and irritating.
So, how is it treated? I’m happy you asked. IC/PBS can be challenging to treat, as are most forms of chronic pain. There is no cure, but fortunately, there are lots of treatment options to try. First, and foremost, you know I have to mention pelvic floor physical therapy (PFPT). Pelvic floor muscle (PFM) overactivity and/or tension has been shown to occur in the majority of folks suffering from IC/PBS (4). This is likely due to the constant and chronic pain of the bladder causing a clenching response of the PFMs.
Imagine you sleep weirdly and wake up noticing a crick in your neck. This neck pain causes you to sort of lean your head toward the side of the pain and raise your shoulder up. Maybe this makes your pain decrease or maybe you’re not even really sure why you’re doing it. This is the body’s natural protective response. Your body recognizes a point of pain and wants you to protect that area to avoid further harm or discomfort. When one is suffering from bladder pain, the body performs a similar, often subconscious response. It clenches the PFMs in an attempt to protect the point of pain. This consistent PFM clenching over months or years can lead to PFM tension and poor ability to lengthen the PFMs. It can even cause extra irritation to the bladder, which is the opposite of what is needed in folks with IC/PBS.
PFPT can help with decreasing PFM tension, improving PFM lengthening, and improving voiding habits. Your pelvic health provider can also help with reducing hypersensitivity along the structures of the pelvis and improve bladder mobility. Your therapist will be able to give you tools for decreasing urinary urgency and improving bladder emptying. They may even talk with you about how to modify your daily activities and diet to manage your symptoms.
Another treatment option is oral medication. There is a handful of medications used to treat IC/PBS including tricyclic antidepressants, hydroxyzine, and more. Talk with your physician about whether an oral medication would be appropriate for you. Some doctors will also recommend botox injections. Botox is injected directly into the bladder muscle to decrease overactivity. Many patients with severe IC/PBS will also try something called bladder instillations. This is a treatment technique that involves filling the bladder with a medicine solution, leaving it to sit for a bit, and then draining it (5). This can help to calm the bladder and improve irritation.
If you’re looking for a less invasive way to reduce your symptoms of IC/PBS, there are a few over-the-counter options. One option is Prelief, which you can ingest before eating foods that tend to trigger your symptoms. Secondly, I have had patients tell me that Azo helps their IC/PBS symptoms. While I wouldn’t recommend this as a long-term solution to IC/PBS, it may provide some symptom relief every once in a while. Finally, there are certain teas and herbs that have been said to improve bladder pain. One such remedy is marshmallow root. This can be found in the form of a tea and it soothes the bladder wall. Other, similar options include slippery elm and aloe vera.
Lastly, let’s not underestimate the psychological effects IC/PBS can have on someone. Studies show high levels of depression among this population, so talking with a mental health specialist could be an essential part of your care (6). If you’re suffering from long-term bladder pain, talk with your family medicine physician, urologist, pelvic health specialist, dietitian, and/or psychologist. Know that you have loads of folks on your team and you can reach a care plan perfect for you. Let’s kick bladder pain’s butt!
XOXO,
Your Pelvic Bestie
References:
1. Doggweiler-Wiygul, R. (2004). Urologic myofascial pain syndromes. Current Pain and Headache Reports, 8(6), 445–451.
2. Lv, J. W., Wen, W., Jiang, C., Fu, Q. B., Gu, Y. J., Lv, T. T.,…Xue, W. (2017). Inhibition of microRNA-214 promotes epithelial mesenchymal transition process and induces interstitial cystitis in postmenopausal women by upregulating Mfn2. Experimental & molecular medicine, 49(7), e357. doi: 10.1038/emm.2017.98
3. Hanno, P. M., Erickson, D., Moldwin, R., & Faraday, M. M. (2015). Diagnosis and treatment of interstitial cystitis/bladder pain syndrome: AUA guideline amendment. Journal of Urology, 193(5), 1545–1553
4. Carrico, D. J., Peters, K. M., & Diokno, A. C. (2008). Guided imagery for women with interstitial cystitis: Results of a prospective, randomized controlled pilot study. Journal of Alternative and Complementary Medicine, 14(1), 53–60.
5. Interstitial Cystitis Association. (n.d.). Bladder Instillations | Interstitial Cystitis Association. Interstitial Cystitis Association. https://www.ichelp.org/understanding-ic/medical treatments/bladder-instillations/
6. Keller, J. J., Chen, Y. K., & Lin, H. C. (2012). Comorbidities of bladder pain syndrome/interstitial cystitis: A population‐based study. BJU International, 110(11c), E903–E909.
*The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a qualified health provider regarding any questions you may have about a medical condition or health objectives.
