Bladder Pain Syndrome (Interstitial Cystitis)

Bladder pain syndrome (previously known as interstitial cystitis) is the condition of bladder discomfort or pain associated with urinary symptoms which may include:

• Urinary urgency (feeling an urgent need to pass urine both during day and night time)
• Urinary frequency (having to go to the toilet often) 
• Pressure, pain around the bladder or pelvis that increases as the bladder fills and improves on passing urine 
• Reduced bladder holding capacity 
• Painful sex 

The symptoms of bladder pain syndrome varies vastly depending on the woman. 

What causes bladder pain syndrome?

The exact cause is unknown, but it is thought to be related to a defect in the protective bladder lining which exposes the bladder wall to toxic contents of urine. This irritates and causes inflammation of the bladder wall, with increase in nerve cells. 

In severe cases this can result in bladder scarring and stiffening such that it is unable to hold too much urine. In some cases, a cystoscopy (camera inserted into the bladder) may pick up pinpoint bleeding or ulcers in the bladder wall as the bladder is being filled; however, in many cases, no obvious abnormality is seen on cystoscopy.

What tests do I need?

You should consult a urogynaecologist, who is a gynaecologist specialising in female urinary disorders. Your doctor will take a detailed medical history and perform a pelvic examination to check for other conditions that may mimic bladder pain syndrome. 

Depending on your symptoms, you may require an ultrasound to check your uterus and ovaries, vaginal swabs to rule out sexually transmitted infections (STIs), urine tests to look for urinary tract infections or blood in the urine, bladder scan (to check the amount of urine remaining in your bladder after you have passed urine), a cystoscopy (inserting a camera into the bladder and filling it to look for abnormalities) and/or urodynamic study (this is a test to check for your bladder function and bladder muscle stability).

What is the treatment for bladder pain syndrome?

Bladder pain syndrome is a long-term condition with no definite cure. Most women will need trial and error to find a combination of treatments that improve their symptoms. Treatment options include:

• Diet

Keeping a food diary is important to find out foods that trigger your symptoms. Common foods to avoid include alcohol, acidic food like citrus (including drinks), tomatoes, artificial sweeteners, caffeine, chocolate, spicy food. You may need to eliminate these foods from your diet and try them one at a time to see which one triggers your symptoms. Smoking may worsen symptoms so try to quit smoking.

• Stress management

Relaxation techniques, meditation, music, regular exercise can help relieve symptoms of bladder pain syndrome. 

• Painkillers

Simple painkillers like panadol and non-steroidal anti-inflammatory drugs (ponstan, synflex, ibuprofen) can help manage pain as needed. Long-term chronic pain may need referral to a pain specialist. 

• Acupuncture

Some women find acupuncture relieves their symptoms of bladder pain.

• Oral medications

Your urogynaecologist may prescribe oral medications like amitriptyline or cimetidine to relieve symptoms of urinary urgency, frequency and bladder pain.

• Bladder instillation 

Certain medications e.g. local anaesthetic, drugs thought to help restore the protective lining of the bladder, Botox can be instilled into the bladder or injected into the bladder wall to provide relief from symptoms. Some of these treatments need to be done on a weekly basis while others e.g. Botox can last for a few months. 

• Nerve stimulation/ neuromodulation

This is typically a last resort measure where all the above have failed, where electrical stimulation is applied to the nerves of the bladder. Effects may last a few months.

Remember that bladder pain syndrome is a chronic, long-term condition. Although there is no single cure available, there are many good ways to keep your symptoms under control so that your life does not revolve around your bladder.