Interstitial Cystitis, AKA Painful Bladder Syndrome


Dr. Colene Arnold

Oh, my Bladder, Oh, my Bladder
Oh my Bladder hurts again
I feel pain & frequency
Dreadful leakage, urgency

In a pickle, always looking
For the bathroom, once again
I won’t make it, another minute
Once the key goes in the hole

Oh, my Bladder, Oh, my Bladder
Oh my Bladder hurts again
I feel pain & frequency
Dreadful leakage & urgency

Painful bladder syndrome.jpg

Now that you’ll be humming that tune, all day, give me a few moments to try to distract you with why I’ve got you singing about your bladder. 

If you’ve opened this blog I suspect you or someone you know suffers from some form of bladder dysfunction, you are not alone! My focus today is on a syndrome that masquerades as a urinary tract infection, or UTI. You know all too well what its’ like, peeing every hour, sometimes urgently, sometimes not where you intend to go & sometimes it hurts. The pressure, the burning, it’s just got to be an infection this time. That’s what Kate thought as well.

But do you, did she? Kate saw her Doctor, she provided a urine sample again, started the antibiotics, again. Two days later she got the voicemail that she didn’t have an infection and she should stop the antibiotics, have a good day,……click.

Now what? This scenario plays over and over again. Oh my bladder, oh my bladder….Not again! Cultures all negative, no sexually transmitted infections, negative cystoscopy with the Urologist. After years of getting nowhere, Kate stumbles upon a website, Interstitial Cystitis Association,, where she finds information that suggests that 4 to 12 million other folks in the United States have the same symptoms that she has and it has a name or two or three, Interstitial Cystitis, Painful Bladder Syndrome, Bladder Pain Syndrome. She doesn’t care about what they call it, she just wants to know how to make it better. Symptoms of Interstitial Cystitis vary from person to person, and even within any one individual. They can be mild or severely debilitating. Persons with IC can have intermittent symptoms that come and go or they can remain for extended periods of time. Certain triggers can cause a flare of the disorder after long periods of quiescence. “The initial evaluation typically consists of a patient history & physical exam. The four key diagnostic clues that may indicate IC are bladder and pelvic pain or discomfort, urinary frequency and urgency, symptoms that persist for longer than six weeks, negative results of lab tests checking for urinary tract or other infection.”

Interstitial Cystitis. The paper reviews diagnostic principles, general guideline statements and statements regarding treatment. There are several helpful treatments and most clinicians tend to follow an algorithm. For the majority of patients, a combination of treatments is the best approach. As physicians we have an oath that we take upon graduation which includes “to do no harm”. This approach takes into consideration risks and benefits. The least invasive, more conservative options, should be recommended and trialled first. This should include self care practices and behavioral modifications such as the following first line treatments.

First line treatments:
-bladder retraining
-healthy sleep
-dietary modifications, avoiding triggers -stress management to improve coping techniques

Second line treatments:
-referral to a Gynecologist or Urologist who has a special interest/training in this disorder.
-referral to a Pelvic Floor Physical Therapist who has special training regarding the pelvic floor.
-Medications such as antihistamines, amitriptyline, pentosan polysulfate may relieve some of the symptoms associated with the disorder.
-Intravesical treatments, aka bladder instillations, with a variety of medications such as lidocaine, heparin, triamcinolone, DMSO have been proven to be effective in reducing symptoms utilizing an antiinflammatory approach.

Third line treatments:
-Cystoscopy under anesthesia for short duration with low pressure hydrodistension if first and second line treatments have not provided acceptable symptoms control and quality of life.

Fourth line treatments:
-Botulinum toxin A treatments
-Trial of a Neurostimulator

Fifth line treatments:
-Cyclosporin A orally

Sixth line treatments:
-Major surgery

Complementary therapies include biofeedback, diet based therapies including anti-inflammatory diets, massage, yoga, pilates, herbal remedies, acupuncture, mind body medicine.

Kate, who’s name has been changed, sought treatment at our facility after 8 years of intermittent symptoms with an increased frequency of flares. She was evaluated with a history and physical exam, found to have spasm of the pelvic floor due to misalignment of her pelvis, chronic constipation and longstanding pain associated with her bladder. She benefited from life style modifications including dietary changes with increasing her water intake, reducing carbonated beverages, artificial sweeteners and caffeine, initiated pelvic floor physical therapy, as well as bladder instillations and an antihistamine. She has reduced the stress in her life which has helped her cope more positively with her symptoms during treatment and she plans to continue with yoga and a focus on self care.

There are many options today for our patients suffering from Interstitial Cystitis. Here at Inner Balance Pelvic Health & Wellness Center we will assist you as you navigate the process and celebrate with you as you gain control over your bladder once again!