What are Interstitial Cystitis and Bladder Pain Syndrome?

If you get pelvic pressure, frequent urination, urges to void, and pain that's worse with a full bladder, you may suffer from this sneaky condition.

The typical scenario for interstitial cystitis (IC) and bladder pain syndrome (BPS) is a patient comes in feeling like they have a urinary tract infection, and despite antibiotics, the symptoms won't get better. Even more frustrating - if a urine culture is done, the urine shows "everything is normal." There's is no infection, and the patient feels invalidated. This condition may affect 2-5% of the population, and typically occurs in young adults as well as in patients over 65 years.

Patients with IC/BPS will have pain as a primary feature of their disorder, which typically differentiates it from overactive bladder. Similar to overactive bladder, BPS/IC may also involve a frequent sensation to void, or inability to suppress bladder urges. However, these symptoms are often intolerable due to associated pain or discomfort, in contrast to overactive bladder.

The symptoms of IC/BPS often come and go, which also makes it easy to confuse with UTIs. Some patients go for long stretches without symptoms, and then they'll suddenly have a symptom flare. Managing symptom triggers is key to preventing flares (see treatments below).

What causes IC/BPS

There are currently 4 major underlying causes for IC/BPS: first - patients may have a bladder-specific pathology like ulcerations or other signs of inflammation inside the bladder. We know that this is related to a loss of glycosaminoglycans (GAG), which are important for bladder health, though it's still unclear why loss of GAG happens. Secondly, symptoms may occur in the context of regional pelvic disorders. Patients with these syndromes may improve their IC/BPS through treatments that target their pelvic pain, for example, in endometriosis or vulvodynia. Thirdly, there seems to be histamine-related overactivity in patients with other allergy disorders. Histamine has an inflammatory effect in the body, and in this case can cause bladder irritability. Finally, IC/BPS may be related to global pain disorders or diseases, for example, fibromyalgia or Sjogren's Syndrome.

How is IC/BPS treated?

The first line of treatment for IC/BPS is to target underlying conditions. In addition, certain dietary modifications may be beneficial. Common culprits include alcohol, caffeine, spicy food and acidic foods or beverages. Stress management and nervous system regulation are also key in this disorder. In many patients, addressing these domains will be sufficient for their symptoms. Complimentary therapies may include pelvic physiotherapy, accupuncture, or herbal remedies.

When first line treatments aren't enough, there are medications that can help. The choice of medication often depends on the symptoms as well as associated conditions, as described under the causes stated above. There is currently only one FDA-approved medication specifically for IC/BPS, however there is an entire algorithm of medications proven to alleviate this condition. Some of these medications can be inserted directly into the bladder, called bladder instillation, which is a treatment that Dr. Zeno offers in office.

Specialists like Dr. Zeno are trained in procedural management of IC/BPS, which may be necessary when medications fail. Bladder hydrodistention, often paired with bladder instillation, as well as injection of bladder ulcers with steroid are treatments that fall into this category.

Bladder Botox is FDA-approved and typically covered through insurance for patients experiencing frequent urination and bladder urges in association with their IC/BPS. Dr. Zeno offers this treatment in-office, though it can be done in a surgery center under anesthesia for improved pain control.

Living with IC/BPS can be frustrating. It's difficult for clinicians to diagnose, it's a chronic condition, and many patients will try multiple treatment modalities before finding the regimen that meets their individual needs. As one of the premier specialists in female pelvic health, Aldene Zeno, MD, is up to date on the latest evidence-based therapies for this condition.