Subscribe to Our Newsletter!
By clicking Subscribe, I agree to the Pelvic Health Support Privacy Policy and understand that I may opt out of Pelvic Health Support subscriptions at any time.
Interstitial Cystitis (IC)/Bladder Pain Syndrome (BPS)
- A chronic bladder condition with lower urinary tract symptoms lasting over 6 wks with no diagnosis of infection or other clear cause
- Two types
- Hunner’s Ulcers
- Distinctive areas of inflammation on the bladder wall that characterize the classic form of IC
- 5-10% of IC patients
- Non-Ulcerative
- Pinpoint hemorrhages, also known as glomerulations, in the bladder wall
- Also referred to as Bladder Pain Syndrome
- 90% of IC patients
- Hunner’s Ulcers
- Difficult to estimate the number of people affected as a result of there being no standard diagnostic protocol
- Typically 2-3x more common in women than in men
- Risk increases with age
- What causes IC/BPS is not exactly known, but there are many theories including:
- A defect in the bladder tissue, which may allow irritating substances in the urine to penetrate the bladder
- A specific type of inflammatory cell, called a mast cell. This cell releases histamine and other chemicals that lead to IC symptoms
- An agent in the urine that causes damage to the bladder
- Changes in the nerves that carry bladder sensations so pain is caused by events that are not normally painful (ie: bladder filling)
- The immune system attacks the bladder
- Vary for each patient and range from mild to severe
- Suprapubic/pelvic pain that may worsen as the bladder fills, be constant or may come and go
- Can be felt in other areas including the urethra, lower abdomen, lower back,
pelvic/perineal area, vulva/vagina (in women) and scrotum/testicles/penis (in men)
- Can be felt in other areas including the urethra, lower abdomen, lower back,
- Pressure/discomfort when the bladder is filling
- Urinary frequency often of small amounts, upwards of 60x a day
- Average number of times a person urinates per day: 7
- Persistent urinary urgency that can be triggered by
- Certain foods/beverages
- Physical/mental stress
- Menstrual cycle
- Sexual intercourse
- Medical history to
- Address symptoms
- Past and current health problems
- Over-the-counter and prescription drugs being taken
- Diet and liquid consumption
- Tests
- Baseline Pain Evaluation: Series of questionnaires to determine your baseline pain value with the goal of finding pain location(s), intensity and characteristics and identifying factors that make pain/discomfort better or worse
- Voiding Diary: To evaluate your voiding patterns
- Urodynamic Evaluation: The bladder is filled with water through a catheter to measure bladder pressures as it fills and empties *IC patients have a low capacity and potential pain with filling
- Cystoscopy: Bladder is looked at through a cystoscope and often the bladder will be filled with water to see how much it can hold
- If Hunner’s ulcers are seen (distinctive areas of inflammation on the bladder wall), the diagnosis is fairly certain
- *All IC patients respond differently so trial and error needs to be carried out in order to determine what will work best for you
- Diet: Certain foods can worsen symptoms
- Bladder irritants for most: Alcohol, caffeine, artificial sweeteners, carbonated beverages, chocolate, citrus fruits, tomatoes and spicy food (See Diet section for a more extensive list)
- Determining which foods irritate your bladder can be discovered through an elimination diet
- Physical Activity: Walking and gentle stretching
- Stress Reduction: Learning stress reduction methods including mindfulness meditation and restorative yoga can be helpful, as stress is a major flare trigger. (See the Lifestyle section)
- Pelvic Physiotherapy: To reduce tenderness/pain/spasms in the pelvic floor area through exercise and massage
- The Canadian Urological Association (CUA) recommends that everyone diagnosed with IC has a pelvic floor exam, looking for trigger points
- Studies show that 79% of people with IC/BPS have trigger points in the pelvic floor
- Up to 83% of patients who see a pelvic floor physiotherapist have their symptoms improved/resolved
- Bladder Retraining: Helping you begin to hold more urine for longer periods of time by gradually increasing the time between each visit to the bathroom
- Track the number of times and how often you have the urge to urinate
- Use the diary to gradually increase the length of time between bathroom breaks
- Medications (Oral & Intravesical)
- Pentosan polysulfate sodium (Elmiron): Used for treating pain
- It could take up to 6 months before any improvement is noticed
- Ophthalmic screening is advised for any patient who has taken Elmiron with any vision complaints for evidence of retinal maculopathy
- ELMIRON ADVISORY
- Heartburn medications: To reduce 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
- Antihistamines: Decrease the amount of histamine in the bladder that leads to pain and other symptoms
- Tricyclic antidepressants: Amitriptyline/nortriptyline have been shown to decrease bladder spasms and slow the nerves that carry pain messaging
- Bladder Instillations: The bladder is filled with liquid medication including Dimethyl Sulfoxide (DMSO) and Heparin, through a catheter
- DMSO may block swelling, decrease pain sensation and remove free radical toxins that can cause tissue damage
- Combined with Heparin/steroids to decrease inflammation
- Bladder Stretching/Hydrodistension: The bladder is filled with sterile water in order to distend it and increase the amount of urine it can hold
- Neuromodulation Therapy
- Delivers harmless electrical impulses to nerves to change how they work
- More effective for urgency/frequency reduction, but can sometimes help with the bladder/suprapubic pain
- Sacral Neuromodulation (SNS)
- Changes how the sacral nerve works (the nerve that carries signals between the spinal cord and the bladder)
- Electrical wire is implanted under the skin in the lower back
- It’s first connected to a handheld pacemaker to send pulses to the sacral nerve
- If it helps, a permanent pacemaker that can regulate the nerve rhythm is implanted
- Cauterization/Steroid Injections: May provide long-term relief for those with Hunner’s ulcers for up to a year or more
- Injections: To relieve pain, botulism is injected through a catheter to paralyze the bladder muscle
- These often need to be repeated every 6-9 months
- Cyclosporine: Immunosuppressant therapy reserved for severe cases only
- Surgery: Bladder/parts of the bladder are removed
- Reserved for patients with severely limited bladder capacity or severe symptoms that have not responded to other treatments
- Pentosan polysulfate sodium (Elmiron): Used for treating pain
