Interstitial cystitis, now known as bladder pain syndrome (IC/BPS), is chronic (long-term) pain, pressure or discomfort in your bladder area (suprapubic region). In addition, it causes a frequent need to urinate (frequency) and sudden urges to urinate (urgency) for at least six weeks.
Anyone can get IC/BPS. However, you may be at a greater risk if you:
Interstitial cystitis/bladder pain syndrome symptoms vary among people. They may be mild or severe. They also may be constant or only appear occasionally.
If you’re a woman, your symptoms often get worse when you’re menstruating.
IC/BPS may feel different from person to person. Some people only feel mild discomfort. Others feel a lot of pain and sudden, frequent urges to pee (urinate).
Healthcare providers and medical researchers don’t completely understand what causes IC/BPS. They suspect that it may be related to certain medical conditions, including:
Because IC/PBS is a chronic condition and the cause is unclear Dr. Guerette and the IWI team has strict protocol that is followed to make a diagnosis. Many places will just start treatment and while that may sound appealing, if the treatments don’t work it becomes unclear if it’s because you didn’t respond or that the issue is not IC/PBS. Dr. Guerette believes an accurate diagnosis is key to long-term improvement. The evaluation includes:
Medical history. We may ask you to record your symptoms in a diary and ask you to record what you drink, how much you drink and how much you pee.
Urinalysis (urine test). You’ll provide a pee sample. We will examine your sample with a microscope and look for blood in your pee (hematuria) and signs of an infection, such as organisms, germs, pus or white blood cells. We will prescribe antibiotics to treat any infections. The urine is sent for advanced DNA analysis to look for any difficult to diagnosis infections and to determine accurate treatment if needed.
Biopsy. A bladder biopsy is critical to diagnose IC/PBS. You will be comfortably sedated (put you under) with anesthesia. Then Dr. Guerette uses a thin needle to take a tissue sample of your bladder wall and urethra (the tube through which pee passes out of your body) to rule out other conditions, including bladder cancer.
Cystoscopy. Dr. Guerette will examine the inside of your bladder with a cystoscope to help rule out bladder cancer. A cystoscope is a thin, lighted tube with an eyepiece on one end. It will be gently inserted into your urethra up to your bladder. This procedure does not require anesthesia.
Cystoscopy under anesthesia with hydrodistension. Dr. Guerette performs a cystoscopy with bladder hydrodistension (stretching). He will perform a cystoscopy and distend (stretch) your bladder as big as possible (maximum capacity) by filling it with water. This procedure may reveal ulcers or cracks in your bladder. It requires anesthesia because bladder distension is otherwise painful. Many people have temporary relief of their interstitial cystitis/bladder pain syndrome symptoms after this procedure.
There no easy cure for IC/BPS. However, there are many ways to successfully treat it. The goal of IC/BPS treatments is to relieve your symptoms so your bladder does not impair your quality of life. The IWI team will work with you to decide the most appropriate treatment. In most cases, it’s a combination of treatments.
Diet changes — Some people who have IC/BPS report that certain foods and drinks worsen their symptoms (triggers). Keep a diary of what and how much you eat and drink each day. Noting what you eat and drink before the onset of symptoms and/or a flare-up can help you learn what foods and drinks to avoid.
If you notice that acidic foods or drinks — citrus fruits, peppers, carbonated beverages, tomatoes — cause flare-ups, your provider may recommend taking an antacid with meals. Antacids reduce the amount of acid that gets into your pee.
Common foods and drinks that may cause IC/BPS symptoms include:
Physical activity — Exercise and physical activity may help relieve your IC/BPS symptoms. Examples of exercises include:
If you have IC/BPS, stress may trigger flare-ups. Learning to recognize and manage stress may help alleviate your symptoms.
Physical therapy — Your pelvic muscles hold your bladder in place and help control when you pee. Exercising, stretching and especially relaxing your pelvic muscles may help reduce IC/BPS symptoms. Working with a pelvic floor physical therapist, using advanced pelvic floor therapy with Emsella(link), and/or advanced injection therapy(link) to make sure the muscles are functioning well and not contributing to your symptoms.
Bladder retraining — If you have bladder pain, it’s easy to get into the habit of using the bathroom as soon as you feel pain or urgency, even if your bladder isn’t full. Your body may get used to going to the bathroom often. Bladder retraining helps you overcome this habit by helping you hold your pee for longer periods.
To practice bladder retraining, keep a diary of how often you pee and how often you have the urge to pee. Use your diary to help you gradually increase the time between bathroom breaks.
Oral medications — The following oral medications may help treat IC/BPS symptoms:
Heartburn medications. Over-the-counter antacids (Tums®, Rolaids®) may help reduce your symptoms by reducing the amount of acid in your body.
Antidepressants. A low dose of a tricyclic antidepressants such as amitriptyline (Elavil®) may help reduce pain and reduce urinary frequency.
Hydroxyzine. Histamine may cause IC/BPS symptoms. Hydroxyzine is an antihistamine that helps remove histamine from your bladder.
Bladder instillations — IWI uses a mixture of medications including a steroid to reduce inflammation, numbing medication, and medications to help restore a healthy bladder lining. The IWI team will insert a catheter in your urethra to your bladder. They’ll then fill your bladder and you will hold the liquid inside for 20-30 minutes.
Bladder stretching (hydrodistension) — Your bladder if filled with sterile water to stretch out your bladder to increase the amount of urine it can hold. This may also calm or break the overactive nerve endings telling your brain your bladder is in pain. You will have anesthesia so you aren’t awake and won’t feel any pain.
Nerve stimulation — Nerve stimulation (neuromodulation therapy) helps regulate your bladder by reducing urgency and frequency. It sometimes helps alleviate pain in your bladder or abdominal area. This is done using Sacral Nerve Stimulation which is a small pacemaker technology used to control the bladder (link) or by stimulating a nerve in the ankle with a simple office procedure (link).
Botulinum toxin injections — Dr. Guerette injects botulinum toxin (Botox®) into your bladder muscle through a cystoscope. Small amounts of Botox paralyze the muscles and help alleviate pain. You may need Botox injections every four to nine months.(link)
Surgery — Very rarely we may recommend more invasive surgery if you have severe IC/BPS symptoms and don’t respond to other treatments. They may remove part or all of your bladder (cystectomy).
Other considerations such as hormone imbalances(link), endometriosis(link)or bowel issues(link) that may be causing part of your pain and will be addressed by the IWI team.
It depends. Most people who have IC/BPS need treatment for their entire lives. If they don’t get treatment, their symptoms return. They may even have flare-ups while they’re actively treating IC/BPS.
Some people respond well to treatment. Their symptoms slowly improve and even go away.
Bladder infusions are used to improve symptoms the fastest.
It may take several weeks or months before your symptoms start to improve.
Healthcare providers and medical researchers don’t know how to reduce your risk of developing IC/BPS or prevent symptoms from recurring. You may be able to prevent flare-ups by:
For many people, IC/BPS is a long-term condition. Your symptoms may be mild or severe. They may appear now and then or they may be persistent. The IWI team will work hard with you to offer you the best outcome possible.
The following tips may help reduce the length and severity of your IC/BPS flare-ups:
If intercourse triggers flare-ups, take pain-relieving medicines before sex and use lubricants during sex to reduce discomfort.
Urethral syndrome is a condition that causes irritation of your urethra. This is the tube connecting your bladder to the outside of your body. Your urethra carries urine (pee) away from your body.
Other names for urethral syndrome include:
Urethral syndrome symptoms are similar to those of other conditions. They may look the same as symptoms seen in urinary tract infections and urethritis. But unlike these conditions, viral and bacterial infections don’t cause urethral syndrome. Several factors can result in urethral syndrome, which can make it difficult to identify the exact cause.
People of any age, race or gender might have urethral syndrome. But women have this condition more commonly and it affects those ages 30 to 50 the most.
Up to 25% of patients who see a healthcare provider with symptoms in their lower urinary tract may have urethral syndrome.
Bacterial or viral infections cause urethritis, including nongonococcal urethritis. But urethral syndrome doesn’t come from an infection. If an infection isn’t causing your symptoms, we may suspect urethral syndrome.
Researchers don’t know what causes urethral syndrome. But they do know that bacterial and viral infections don’t cause it.
They suspect that several factors may contribute to urethral syndrome, including:
An injury to the urethra can come from:
The symptoms of urethral syndrome may include:
The IWI team will work with you to diagnose urethral syndrome. We will first ask about your symptoms and do a physical examination. We will need to rule out other conditions with similar symptoms, such as:
If you have blood in your urine, we may suggest tests including:
Treatments for urethral syndrome focus on reducing your discomfort and the frequency of urination. The IWI team may treat urethral syndrome with:
Lifestyle changes can help to reduce irritation of your urethra. These changes may include:
You can reduce your risk of urethral syndrome by:
You may have urethral syndrome throughout your life but working with IWI the symptoms can be successfully treated so it does not interfere with your quality of life.
Urethral syndrome can affect your sense of well-being. Symptoms can cause anxiety, depression and stress. Talking to us or a therapist about your concerns can help provide symptom relief and prevent the discomfort from returning.
Also, please tell the IWI team if you don’t notice any results from your treatments after some time. We are here to work with you and able to suggest other treatments that may help.
"I think the thing that stood out most about the office is that I really felt like, Dr. Guerette understood what I was talking about when I started talking about some of the bladder issues I had. And number two,everybody just seemed really very caring. I really appreciated that."
"I would recommend Dr. G and Jennifer because they are the best. They listen, they're very patient and they really know their stuff! I would like to add that since I have, found Dr. G and Jennifer, I have learned a lot about myself and what I'm going through, that I'm not the only one and there's help so don't have to suffer in silence any longer."
"When I was here, I felt completely heard. I felt, seen and understood. You guys really helped me. You made me not feel, you made me feel like a human. You didn't make me feel like I was a patient."
"I have a much better idea of what's going on with my body and the things that I need to do to, help be more comfortable, have a better quality of life."
