Interstitial Cystitis / Painful Bladder Syndrome

February 2, 2017

Interstitial cystitis (IC), is a chronic pain condition that affects the bladder. Many experts now call it bladder pain syndrome (BPS). It is a feeling of pain and pressure in the bladder area. Along with this pain are lower urinary tract symptoms which have lasted for more than 6 weeks, without having an infection or other clear causes.

A normal urinary bladder should not cause pain. Pain, irritation or hypersensitivity in and around the bladder, with a frequent and often urgent need to urinate – whether sudden and acute or gradually developing and chronic – can have many different causes. It may be related to the urinary tract, the genital tract, the bowel, nervous system or muscular system. It may be due, for example, to bacterial, viral or fungal infections, infestations, stones, benign or malignant tumours, endometriosis, systemic autoimmune disease, drugs or chemicals, and including more recently ketamine abuse.

However, if a thorough investigation has revealed none of these disorders, there is another possibility, IC may be the cause. Interstitial cystitis/bladder pain syndrome, is a distressing, chronic bladder disorder of unknown cause, with persistent or recurrent symptoms of pain, irritation, pressure ordiscomfort related to the bladder and usually accompanied by a frequent and urgent need to urinate day and night. While the symptoms may resemble a urinary tract infection (cystitis), there is no infection to be seen in the urine and tests reveal no identifiable disorder that could account for the symptoms.

How the Urinary System Works ?

The bladder is relaxed, when it is not full of urine. When nerve signals in the brain let the bodies know that the bladder is getting full, the person feels the need to pass urine. If the bladder is working normally, the body can put off urination for some time. Once the body is ready to pass urine, the brain sends a signal to the bladder. Then the bladder muscles squeeze (or “contract”). This forces the urine out through the urethra, the tube that carries urine from the body. The urethra has muscles called sphincters. They help keep the urethra closed so urine doesn’t leak before the body is ready to go to the bathroom. These sphincters relax when the bladder contracts. IC/PBS is caused when this normal process is affected.

Who is at risk?

More than 1.3 million Americans haveIC/BPS, but studies suggest that,millions more may have symptoms ofIC/BPS. An estimated 3.3 million U.S. women, or 2.7 percent, who are 18 years of age or older have pelvic pain and other symptoms, such as urinary urgency or frequency, that are associated with IC/PBS.1 An estimated 1.6 million U.S. men, or 1.3 percent, who are 30 to 79 years old have persistent symptoms, such as pain with bladder filling or pain relieved by bladder emptying, that are associated with PBS. Most people with IC/BPS are diagnosed in middle age, but it may be diagnosed in teenagers and senior citizens as well.


Causes may include –

  • A defect in the bladder wall that allows substances in the urine to irritate the bladder.
  • A specific type of cell that releases histamine (chemical released during an allergic reaction) and other chemicals, which lead to symptoms of IC/BPS.
  • Something in the urine that damages the bladder.
  • Changes in the nerves that carry bladder sensations, making normal events, such as bladder filling, painful.
  • The body’s immune system attacks the bladder.

The causes of IC/BPS in some people may be different than the causes in other people with IC/BPS. Studies of people who have IC/BPS suggest that it sometimes develops after an injury to the bladder, such as an infection. Genes also may play a role in some forms of IC/BPS. In some cases, IC/BPS affects both a mother and daughter or sisters. Still, IC/BPS does not commonly run in families.

Many women with IC/PBS have other conditions such as irritable bowel syndrome and fibromyalgia. Scientists believe IC/PBS may be a bladder manifestation of a more general condition that causes inflammation in various organs and parts of the body.

IC/BPS can get in the way of the affected person’s social life, exercise and sleep, and can cause a great deal of distress. Without treatment, IC/BPS symptoms make it hard to get through the day or even be able to work. IC/BPS may affect the relationship with his/her spouse and family. It can also rob a person of a good night’s sleep. Too little sleep will leave the patient tired and unhappy.

  • Pain –
    • Pain, irritation, pressure, discomfort or other unpleasant sensation that may worsen as the bladder fills;
    • Urinating often alleviates the pain and may give a temporary sense of relief;
    • Suprapubic pain or discomfort, pelvic pain (lower abdominal pain), sometimes extending to the lower
    • Part of the back, the groin and thighs;
    • In women there may be pain in the vagina and vulva;
    • In men, pain in the penis, testicles, scrotum and perineum;
    • Both men and women may have pain in the urethra and rectum;
    • Pain with sexual intercourse in both men and women (dyspareunia); pain on ejaculation in men;
    • Pain may worsen or be triggered by specific foods or drinks or even medication;
    • A frequent need to urinate (frequency), including at night (night-time frequency or nocturia); an often urgent or overwhelming need to urinate (urgency).


  • Urinary Frequency – Means that a person needs to urinate more frequently than normal during the daytime and at night.People with severe interstitial cystitis may urinate as often as 60 times a day.Frequency is by no means always related to bladder size. While some patients have a type of IC witha shrunken bladder with a scarred, stiff wall (fibrosis) and a small capacity under anaesthesia, other IC/BPS patients with a normal-sized bladder may nevertheless have severe frequency due to hypersensitivity on filling. A typical feature of IC/BPS is the need to empty the bladder several or multiple times during the night. The amount of urine passed may be small, even just a few drops.
  • Urinary urgency – In IC/BPS is an urgent or overwhelming need to empty the bladder due to increasingpain or discomfort or other unpleasant sensation that becomes impossible to tolerate any longer, and may in some patients be accompanied by a feeling of malaise and/or nausea. Some patients find that having to postpone urination leads to retention or difficulty in getting the flow started. The nature and cause(s) of this urgency sensation in IC/BPS patients are still not fully understood.

IC/PBS & Pregnancy – IC/BPS is not thought to affect fertility or the health of the unborn baby. Some women find that their IC/BPS symptoms get better during pregnancy. Others find their symptoms get worse. If you are thinking about becoming pregnant, talk to your doctor about your IC/BPS and any medicines you might be using to treat IC/BPS or other conditions. Some medicines and treatments are not safe to use during pregnancy.


Conventional Treatment

Most conventional treatments are aimed at symptom control. IC/BPS treatment is often done in phases with constant monitoring of your pain and quality of life. It is important to talk to your health care provider about how your treatments are working so that together you can find the best treatment option for you.


The following are the different phases of IC/BPS treatment:

  • Lifestyle changes – Lifestyle changes, known as “behavioral therapy,” are often the first treatments used to manage IC/BPS. This includes – Manipulative Physical therapy, Limiting Stress, Limiting certain Foods & Drinks. There is evidence that physical therapy exercises to strengthen the pelvic floor muscles do not improve symptoms, and often make them worse, so activities such as Kegel exercises are not recommended for patients with IC/BPS.
  • Prescription Drugs -There are many types of oral drugs, and the side effects range from drowsiness to upset stomach. Intravesical prescription drugs are placed directly into the bladder with a catheter. This includes –
    • Oral PentosanPolysulphate – It builds and restores the protective coating of the bladder tissue. It may also help by decreasing swelling or by other actions. Possible side effects are not common, but may include nausea, diarrhea and gastric distress.
    • DimethylSulfoxide (DMSo) – This blocks swelling, decrease pain sensation and remove a type of toxin called “free radicals” that can damage tissue.
    • Hydroxyzine -Hydroxyzine is an antihistamine. It is thought that some patients with IC/BPS have too much histamine in the bladder that leads to pain and other symptoms. An antihistamine may be helpful in treating IC/BPS. The main side effect is drowsiness.
    • Amitriptyline – This is described as an antidepressant, but it actually has many effects that may improve IC/BPS. It has antihistamine effects, decreases bladder spasms, and slows the nerves that carry pain messages. Amitriptyline is widely used for other types of chronic pain such as cancer and nerve damage. The most common side effects are drowsiness, constipation and increased appetite.
    • Heparin -Heparin is similar to pentosanpolysulfate and probably helps the bladder by similar mechanisms. Heparin must be placed into the bladder with a catheter. Complications are rare because the heparin stays in the bladder only and does not usually affect the rest of the body.
  • Nerve Stimulation – This includes
    • Transcutaneous electrical nerve stimulation (TENS)
    • Sacral nerve stimulation
  • Sacral nerve stimulation – Bladder distention is the stretching of the bladder with water or gas. The procedure may be repeated as a treatment if the response is long lasting.


Alternative Treatment

Nutritional Supplement

  • Quercetin – It is a bioflavonoid that may have anti-inflammatory properties. A small double-blind placebo-controlled trial found that a supplement containing quercetin reduced symptoms of interstitial cystitis.
  • Arginine –The amino acid arginine helps the body make nitric oxide, a substance that relaxes smooth muscles like those found in the bladder. Based on this mechanism, arginine has been proposed as a treatment for IC.
  • Glycosaminoglycans –There is some evidence that in interstitial cystitis the surface layer of the bladder is deficient in protective natural substances called glycosaminoglycans.This in turn might allow the bladder to become inflamed; it might also initiate autoimmune reactions.
  • Calcium citrate alkalinizes the urine, which decreases irritation to the bladder.
  • Bromelain provides anti-inflammatory action.
  • Omega-3 Fatty Acids – This is known for its ability to decrease systemic inflammation in the tissue and membranes.
  • Probiotics also help restore normal flora and lessen inflammation, plus help to combat systemic yeast triggers.
  • Estrogen plays a significant role in inflammation, and during times of great hormonal imbalances your body could be more susceptible to inflammation that can lead to interstitial cystitis.
  • Calcium-Magnesium with Vitamin D


  • Gotu kola – It enhances the integrity of connective tissue by stimulating production of glycosaminoglycans, which are an integral component of the protective mucous layer in the bladder.
  • Buchu (Barosmabetulina)—A soothing diuretic and antiseptic for the urinary system.
  • Cleavers (Galiumaparine)—Traditionally used as a urinary tract tonic.
  • Corn silk (Zea mays)—Has soothing and diuretic properties.
  • Horsetail (Equisetum arvense)—An astringent and mild diuretic with tissue-healing properties.
  • Marshmallow root (Althea officinalis)—Has soothing demulcent properties. It is best taken as a cold infusion; soak the herb in cold water for several hours, strain, and drink.
  • Usnea(Usneabarbata)—Has soothing and antiseptic properties.
  • Supplemental greens – alfalfa, green barley, spirulina, kelp, chlorella, wheat grass, chlorophyll and blue-green algae. These nutrient packed greens are an excellent way to supplement a diet low in fresh greens.



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