Intimate Wellness Institute

Interstitial Cystitis/Painful Bladder Syndrome

What is interstitial cystitis?

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.

Who does interstitial cystitis/bladder pain syndrome affect?

Anyone can get IC/BPS. However, you may be at a greater risk if you:

  • Are a woman
  • Are 30 or older.
  • Have another condition that causes chronic pain.
  • What are the symptoms of interstitial cystitis/bladder pain syndrome?

Symptoms include:

  • Pain in your bladder region.
  • Pressure or discomfort when your bladder is filling.
  • Urinary frequency.
  • Urinary urgency.
  • Only peeing a small amount.

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.

What does IC/BPS feel like?

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).

How do you get interstitial cystitis/bladder pain syndrome?

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:

  • Autoimmune diseases.
  • Allergies.
  • Defects in your bladder lining.
  • Vascular disease (vasculopathy).
  • Abnormalities in your mast cell (cells that cause allergic symptoms).
  • The presence of abnormal substances in your pee, including consistently high protein levels (proteinuria).
  • Unidentified infections.

How is interstitial cystitis/bladder pain syndrome diagnosed?

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.

How do you fix interstitial cystitis/bladder pain syndrome?

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.

Interstitial cystitis/bladder pain syndrome treatments may include the following:

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:

  • Alcohol.
  • Artificial sweeteners.
  • Caffeine.
  • Carbonated beverages.
  • Chocolate.
  • Tomatoes.
  • Fruit juices.
  • We may also refer you to a dietitian to help you create the best diet to reduce symptoms.

Physical activity — Exercise and physical activity may help relieve your IC/BPS symptoms. Examples of exercises include:

  • Walking.
  • Bicycling.
  • Gentle stretching or yoga.
  • Reducing stress

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.

Will interstitial cystitis/bladder pain syndrome ever go away?

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.

What is the fastest way to get rid of interstitial cystitis/bladder pain syndrome?

Bladder infusions are used to improve symptoms the fastest.

How soon after treatment will I feel better?

It may take several weeks or months before your symptoms start to improve.


How can I prevent interstitial cystitis/bladder pain syndrome?

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:

  • Keeping a food diary, identifying foods that may cause symptoms and avoiding them.
  • Maintaining your treatment even after your symptoms go away.
  • Reducing stress in your life.


What can I expect if I have IC/BPS?

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.


How do I take care of myself?

The following tips may help reduce the length and severity of your IC/BPS flare-ups:

  • Take medicines that help reduce your symptoms as soon as you feel a flare-up start.
  • Drink extra water to help dilute your pee.
  • Place an ice pack or heating pad on your abdominal area or perineum (the space between your genitals and rectum).
  • Take a warm sitz bath.
  • Help relax your pelvic floor muscles by squatting with your legs wide apart. You can also try the “happy baby” yoga pose — lie on your back, press your knees against your chest, point the soles of your feet toward the ceiling and grab the outsides of your feet.
  • Try relaxation techniques.
  • Avoid tight clothing that presses on your abdomen, including tight pants, hosiery, tights and girdles.

If intercourse triggers flare-ups, take pain-relieving medicines before sex and use lubricants during sex to reduce discomfort.

Urethral Syndrome

What is urethral syndrome?

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:

  • Abacterial cystitis.
  • Frequency-dysuria syndrome.
  • Symptomatic abacteriuria.
  • Urethral pain syndrome (UPS).

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.

Who might have urethral syndrome?

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.

How common is urethral syndrome?

Up to 25% of patients who see a healthcare provider with symptoms in their lower urinary tract may have urethral syndrome.

What is the difference between urethral syndrome and urethritis?

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.


What causes 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:

  • Abnormal narrowing of your urethra .
  • Additional irritation of your urethra.
  • Hormonal imbalances, such as low amounts of estrogen.
  • Injury to your urethra.
  • Pelvic floor dysfunction.
  • Sensitivity of your urethra after a urinary tract infection (UTI).
  • Sexually transmitted diseases and infections (STDs and STIs).
  • Spasms of your urethra.
  • Stress.

An injury to the urethra can come from:

  • Rough sexual intercourse.
  • Using a diaphragm.
  • Using a tampon.
  • Bike riding.
  • Several things may cause additional irritation to the urethra:
  • Caffeine.
  • Alcoholic drinks.
  • Spicy foods.
  • Cancer treatments, including chemotherapy and radiation therapy.
  • Condoms and contraceptive gels, including lubrication with spermicide.
  • Scented products, such as bubble baths, perfumes and soaps.

What are the symptoms of urethral syndrome?

The symptoms of urethral syndrome may include:

  • Blood in your urine (hematuria).
  • Difficulty urinating (urinary retention).
  • Feeling an immediate urge to urinate.
  • Frequent urination, especially during the day.
  • Painful intercourse (dyspareunia).
  • Painful urination (dysuria).
  • Pain in your genitals, lower abdomen and lower back.
  • Pressure in your abdomen.
  • Waking up at night needing to urinate (nocturia). In females symptoms of urethral syndrome may also include discomfort in your vulvar area (vulvodynia or vulvitis).


How is urethral syndrome diagnosed?

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:

  • Bladder cancer.
  • Cervical cancer.
  • Painful bladder syndrome (interstitial cystitis).
  • STIs.
  • Urethritis.
  • UTIs.
  • If urethral syndrome is suspected the IIW team will do a:
  • Urinalysis, to screen for common health conditions, including urinary tract infections.
  • Urine culture, to look for bacteria or yeast.

If you have blood in your urine, we may suggest tests including:

  • CT scan, to see your upper urinary tract.
  • Cystoscopy, to view the inside of your urethra or bladder.
  • As well as other tests such as:
  • Bacterial vaginosis test, to rule out bacterial vaginosis.
  • Pap smear, to rule out cervical cancer.
  • Urine cytology, to rule out bladder cancer.
  • Vaginal swabs, to rule out fungal infections and STIs.
  • Imaging studies may be suggested such as:
  • Bladder ultrasound, kidney ultrasound or pelvic ultrasound, to rule out cysts, tumors and other conditions.
  • MRI of the pelvis, to rule out interstitial cystitis.


How is urethral syndrome treated?

Treatments for urethral syndrome focus on reducing your discomfort and the frequency of urination. The IWI team may treat urethral syndrome with:

  • Biofeedback, to help your pelvis to relax.
  • Medications, to improve blood flow and relieve pain.
  • Meditation or hypnotherapy, to reduce stress.
  • Surgery, to widen your urethra.

How do I take care of myself with urethral syndrome?

Lifestyle changes can help to reduce irritation of your urethra. These changes may include:

  • Avoiding highly acidic foods.
  • Doing activities such as tai chi and yoga to help control and relax muscles.
  • Eating plenty of dairy products, fruits and vegetables.
  • Increasing the amount of water you drink (hydration).
  • Limiting the amount of alcohol you drink.
  • Reducing stress.
  • Using unscented detergents and soaps.


How can I reduce my risk of urethral syndrome?

You can reduce your risk of urethral syndrome by:

  • Avoiding scented soaps and detergents.
  • Getting tested and treated promptly for STIs.
  • Urinating as soon as you can after sexual intercourse.
  • Using protection during sexual intercourse.
  • Wearing pants that aren’t too tight-fitting.
  • Wearing underwear made from cotton instead of nylon.
  • Wiping your genitals from front to back after urinating.
  • Are there other conditions that put me at higher risk of urethral syndrome?
  • Other conditions that may put you at higher risk of urethral syndrome include:
  • Bacterial infections of your bladders or kidneys.
  • Giving birth without having an incision between your vagina and anus (episiotomy).
  • STIs.
  • Taking immunosuppressants.


What can I expect if I have urethral syndrome?

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.


How do I take care of myself with urethral syndrome?

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.