What exactly is interstitial cystitis and how does it differ from painful bladder syndrome? Is painful bladder syndrome the same thing as bladder pain syndrome? These are great questions and if you’re confused, you’re not alone. The definitions and terms used to describe these conditions have been changed many times by different organizations.
Here are some of the terms used to refer to interstitial cystitis:
- interstitial cystitis
- painful bladder syndrome
- bladder pain syndrome
- hypersensitive bladder
As you can see, there are many interchangeable terms for interstitial cystitis. Because of this, throughout the rest of this article, interstitial cystitis will be used as a catchall term to refer to any of the above terms.
So What is Interstitial Cystitis?
If you’re confused about this, don’t worry. Even professional organizations dedicated to defining this condition are unable to reach a consensus. The exact definition depends on who or what organization is defining the condition. To simplify, I will list common symptoms associated with this diagnosis/condition:
- pain, pressure or discomfort over the lower abdomen (where the bladder is located) that increases with the need to urinate and diminishes after voiding
- feeling like you have a urinary tract infection, with no presence of infection
- frequent urination during the day and the night
- strong urge to urinate with minimal output of urine
- increase in symptoms with eating or drinking bladder irritants (i.e. coffee, tomatoes, citrus, spicy foods)
How is Interstitial Cystitis Diagnosed?
Different doctors may define interstitial cystitis differently. Some require that a patient has what are called Hunner’s lesions (also called Hunner’s ulcers or Hunner’s patches). Hunner’s lesions are areas of inflammation that are seen on the bladder wall during a cystoscopy. A cystoscopy is a procedure in which a small camera views the bladder by way of the urethra.
The severity of symptoms a person has is not necessarily indicative of whether or not they have Hunner’s lesions. For instance, I have seen patients with no symptoms of interstitial cystitis who were found to have Hunner’s lesions and I have seen other patients with severe symptoms who were found to have no Hunner’s lesions.
Treatment Options for Interstitial Cystitis
Typically, the bladder is the origin of the symptoms in patients who do have Hunner’s lesions (5% to 20% of patients with interstitial cystitis) and the pelvic floor muscles are the origin of the symptoms in those without Hunner’s lesions.
Treatments can vary based on whether you have Hunner’s lesions or not, but the following treatments are a good place to start for anyone having bladder pain. This blog post will focus on treatment options that do not require physician or medical intervention. These treatment options include physical therapy and behavioral modification.
For each person with interstitial cystitis or bladder irritation, she may find that certain foods irritate her bladder more than others. There are some common bladder irritants for most people, which are listed below. However, I encourage each person to keep a bladder diary to assess which foods are most bothersome because elimination diets can be very restrictive. There is also a lot of information on which foods to avoid. Rather than cut everything out of your diet, it is helpful to identify which foods are most bothersome. Common bladder irritants can include:
- coffee or caffeine-containing beverages
- tomatoes or tomato containing products
- spicy foods
- citrus (this includes cranberry juice!)
- carbonated beverages
To read more about elimination diets for interstitial cystitis and for a comprehensive list of least and most bothersome foods, visit the Interstitial Cystitis Association website.
For some patients, it can be helpful to retrain your bladder. To clarify, this involves waiting for progressively longer periods of time between voids. However, this technique may not be appropriate for everyone and should not be performed until you have been evaluated by a physician or physical therapist. Your physical therapist can help you with coming up with a unique bladder retraining schedule that fits your needs.
Connective Tissue and Muscle Release
Stretching and mobilizing the musculature that is connected to the pelvis can help to alleviate pain from tight muscles and trigger points that can be related to interstitial cystitis. Some of the muscles that may benefit include:
- inner thighs
- low back
- pelvic floor
Your physical therapist can teach you how to release these muscles and may recommend tools to assist with soft tissue mobilization.
Gentle exercises, such as active stretching, gentle strengthening, or yoga can be effective in pain reduction. The muscles surrounding the pelvis can become overactive from guarding. This can cause them to have limited mobility and strength. A physical therapist can work with you and teach you how to retrain your muscles so that you can regain strength.
Pain Relieving Modalities
Heat Heat is an effective tool used to reduce pain from interstitial cystitis. I sometimes will instruct my patients to use two heating pads. One heating pad goes over your bladder and the other heating pad goes over your low back. This heat can sandwich the bladder and calm pain.
TENS Transcutaneous electrical nerve stimulation, also called TENS, is another effective tool to reduce pain. A TENS unit sends electrical impulses through the skin to interfere with signals going to your brain that are interpreted as painful. The TENS unit has cords coming from it that send the signals to pads placed over the abdomen or lower back. In addition, TENS may also help your body to release endorphins, which are your body’s own natural pain killers.
Biofeedback Biofeedback refers to using a machine that records and displays the amount of muscle activity occurring in the pelvic floor muscles. This is helpful because it is common in patients with IC/BPS to have muscle activity occurring in the pelvic floor muscles and not know it. A biofeedback unit uses a sensor or pads to record muscle activity. And so through visualizing pelvic floor muscle activity on a screen, patients can learn how to relax their muscles.
Vaginal Dilation Therapy
Typicially, in patients with IC, the entire pelvic floor muscle complex becomes overactive or “tight”. I don’t like to use the word tight because I think it can have a negative connotation when referencing the vagina or pelvic floor, but when I say tight people generally know what I mean versus when I saw overactive. So, basically, the pelvic floor muscles become tight.
When this happens, a person can have difficulty emptying their bladder. And also the bladder can start to get confused on when it’s supposed to be emptying urine and when its supposed to be storing urine. This can lead to eventually developing IC symptoms.
Using a vaginal trainer or dilator helps to gently release the pelvic floor muscles to ease pelvic floor muscle tension. This also helps to allow the bladder to more fully empty during voiding to decrease frequency, urgency, and pain.
There are several different types of dilators or vaginal trainers available. I really like the Milli Vaginal Trainer for use in people with IC. Sometimes, in people with IC, the urethra can be inflamed or very tender. So when a dilator is inserted, it is beneficial to stay on the bottom half of the opening. To achieve this, it is necessary to have a vaginal trainer that is small enough upon insertion so that it does not hit the urethra, but that can expand large enough to get an adequate stretch to the muscles.
Milli incrementally expands millimeter-by-millimeter inside your vaginal canal by pushing a button,. So to get a greater stretch of the muscles, it is not necessary to insert a larger dilator. Additionally, Milli has built-in vibration that may help relax the surrounding muscles and stimulate blood flow.
If you have any questions about dilators or vaginal trainers, visit my Instagram page. Look for my educational series: The Ins and Outs of Vaginal Dilators. Here, I’m discussing everything from what they are, when to use them, and common uses and additional uses for them.
My goal is to help women achieve optimal health and, most importantly, independence to manage or maintain this. Complete this form for a complimentary 15-minute coaching on getting started with vaginal dilators training session.
If you have interstitial cystitis, it is possible to regain control of your life so that you do not have to know the location of every bathroom within your vicinity. Head over to our scheduling page to set up a visit or consultation.
Han E, Nguyen L, Sirls L, Peters K. Current best practice management of interstitial cystitis/bladder pain syndrome. Ther Adv Urol. 2018;10(7):197-211. Published 2018 Mar 19.