Interstitial cystitis (IC) or Painful bladder syndrome (PBS) is pain, pressure or burning in the bladder area and/or urethra accompanied by frequency or urgency of urination.

The symptoms last greater than 6 weeks and are not caused by other factors like bacterial infection, bladder stone or kidney stone. The symptoms may mimic a urinary tract infection as the condition is caused by inflammation or sensitivity of the bladder lining. Other common symptoms are pelvic pain, pain with intercourse and hematuria. Typically, pain increases as the bladder fills and decreases temporarily after urination. IC/PBS affects both men and women but is most common in females between the ages of 30 and 60 years old. The symptoms can greatly impact quality of life.

Causes & Risk Factors

Although research has not shown any definitive cause for IC/PBS there are several conditions that are frequently associated including:

  • Irritable bowel syndrome
  • Recurrent urinary infections
  • Bladder trauma
  • Migraine headaches
  • Fibromyalgia
  • Endometriosis
  • Tight pelvic floor muscles

The symptoms of IC/PBS can be consistent or intermittent in flares. The flares can be brought on by multiple factors including certain foods, stress, infection and intercourse.


woman with bladder painDiagnosis of IC/PBS is a diagnosis of exclusion. Your provider will conduct a history and physical exam initially to rule out other conditions that could cause the symptoms of IC/PBS. This may include a pelvic examination. Your urine will be checked in the office for signs of infection and blood. You may be asked to complete a symptom score sheet to help make the diagnosis and track the progress of your symptoms. Depending on your symptoms and other variables a cystoscopy (look in the bladder with a camera) and/or bladder pressure testing may be recommended.


There is not a cure for IC/PBS. It is a chronic condition that is treated with symptom management. Therefore, there is not one treatment that can help all patients with this diagnosis. Effective symptoms control may require trials of multiple therapeutic options.

Firstline therapy

  • Education on IC/PBS and determination of bladder triggers
  • Stress management
  • Avoiding bladder irritants (link to bladder triggers / IC diet)
  • Hydration with water
  • Physical activity (walking, gentle stretching)
  • Bladder retaining

Secondline therapy

  • Pelvic floor physical therapy
  • Pain management: Nonsteroidal antiinflammatory medications (NSAIDs), painkillers that target bladder lining
  • Other oral medications
  • Elmiron
  • Certain antidepressant medications
  • Muscle relaxers
  • Medications that decrease bladder spasms
  • Bladder instillations
  • Some patients benefit from inoffice instillation of DMSO, heparin or lidocaine through a urethral catheter

Thirdline therapy

  • Bladder stretching and/or treatment of bladder ulceration

If first and secondline therapies are unsuccessful, a patient may benefit from a surgical procedure to stretch the bladder lining (hydrodistension). A scope is inserted into the bladder and the bladder is filled with fluid, stretching the bladder for several minutes. The procedure provides relief of IC/PBS symptoms for some time but typically must be repeated in the future. If ulcerations are seen in the bladder wall they are burned or injected with medication. Treatment of ulceration has been shown to provide pain relief.

Other treatments

If the above strategies fail there are several other options including Botox (botulinum toxin) injection into the bladder, neurostimulation and major bladder surgery.

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