Painful Bladder Syndrome

Painful bladder syndrome (PBS), also called interstitial cystitis (IC) and bladder pain syndrome (BPS), is a chronic (long-lasting) condition that affects the bladder and nearby areas.

Your bladder expands as it fills with urine (pee) and creates the urge you feel when you need to urinate. With painful bladder syndrome, you may have pelvic discomfort or pain and have a strong and frequent need to urinate.

Symptoms of PBS 

PBS symptoms can get in the way of your daily activities, relationships and quality of life. Understanding the condition can help you choose treatment options and strategies that may bring relief. Symptoms may be mild, moderate or severe. Not everyone with the condition has every symptom and they may come and go.

You may notice:

• Pressure, discomfort or pain in the pelvis. Pain is generally worse as your bladder fills, which is why many patients experience frequent urination as their bladder feels better when empty.
• For women, bladder and pelvic pain may also be worse during your period.
• Sudden, strong urges to urinate.
• Needing to urinate frequently - more than seven or eight times a day, possibly passing just a small amount of urine.
• Pain or pressure in the lower abdomen (belly), above the pubic bone.
• Discomfort or pain during sexual activity.
• Blood in your urine.

PBS is not the same as a urinary tract infection (UTI), even though the symptoms can be similar.  Because of the similarity in symptoms many patients with PBS may be incorrectly diagnosed as having frequent UTI’s before they receive a diagnosis of PBS. 

A UTI is a bacterial infection that can be treated with antibiotics.  A urine culture that grows bacteria is required to make the diagnosis of UTI. PBS is a chronic condition and cannot be cured, but you can manage the symptoms. 

How PBS may impact your life

PBS may create these challenges: 

• It can be hard to manage your work responsibilities because of pain and frequent restroom visits. 
• You may not want to take part in social activities.
• The chronic pain may trigger emotional problems. 
• Frequent urination during the night can interrupt your sleep, so you don’t get the rest you need.

PBS causes and risk factors 

It’s not clear exactly what causes PBS. These factors may play a role: 

• Problems with your bladder lining may lead to irritation and inflammation. 
• An autoimmune response (your immune system mistakenly attacking healthy cells) could cause bladder inflammation. 
• Allergies could trigger a response in the bladder.
• There could be problems with nerve signals communicating with the bladder. 
• Genetic factors - PBS occurs more often in people who have a family history of the condition. 

It’s important to be aware of the risk factors of PBS. They include: 

• Gender: PBS is diagnosed more often in women than in men. 
• Age: PBS most often affects people in their 30s and 40s, though it’s possible to have it at any age.
• Chronic inflammation: Conditions such as recurring UTIs may increase risk. 
• Other chronic conditions: Irritable bowel syndrome (IBS) and fibromyalgia may raise PBS risk. 
• Pelvic trauma or surgery: Past pelvic trauma or surgeries could lead to PBS. 

Diagnosing PBS

You’ll want to see a health care provider if you have any symptoms of PBS. Your provider will check your symptoms to diagnose PBS or rule out other causes. They may also: 

• Gather a detailed medical history.
• Conduct a physical examination, including a pelvic exam for women. 
• Ask for a urine sample so they can rule out infections and other urinary tract issues. 
• Ask you to keep a bladder diary where you record what you drink and how often you urinate. 
• Perform a cystoscopy, a procedure where a thin tube with a camera is inserted into the bladder to look for ulceration (“Hunner’s ulcer”) or other causes of symptoms. 
• Perform urodynamic tests, which measure pressure as your bladder fills and empties.
• Take a small tissue sample (biopsy) from the bladder lining so they can confirm PBS. Biopsies aren’t always needed.

Treating PBS

Your health care provider may recommend lifestyle changes, therapy, medication and other strategies to help control PBS.

Although it can take weeks or months before your symptoms improve, you can start feeling better with these steps: 

• Avoid triggers such as spicy foods, pickled foods, caffeine, artificial sweeteners and acidic beverages. Steer clear of alcohol, citrus fruits, tomatoes and chocolate as well, since they can irritate your bladder.
• Choose a well-balanced diet rich in fruits, vegetables, lean proteins and whole grains.
• Stay hydrated but avoid drinking too many fluids in the evening. Choose mostly water and limit drinks with caffeine or carbonation.
• Practice stress management techniques like mindfulness, deep breathing, yoga, meditation, guided imagery and stress reduction exercises. 
• Wear loose-fitting clothing that isn’t tight on your abdomen.
• Consider pelvic floor therapy to help pelvic floor muscles work better and  reduce pelvic pain. Many patients with PBS have muscle spasms, or imbalance due to their chronic pain and this can continue to make symptoms worse.  A physical therapist can help diagnose and treat these problems.
• Apply a warm compress to the lower abdomen to help relieve pain. 
• Engage in low-impact exercises such as walking, bicycling, yoga or swimming. 
• Prioritize sleep and create a relaxing bedtime routine to help minimize nighttime interruptions.
• Quit smoking, since smoking may worsen the pain.

Your provider may also recommend medication to reduce pain and inflammation and help your bladder work properly. Options include:

• Over-the-counter (OTC) or prescription pain relievers. 
• OTC supplements such as aloe vera (juice or capsules) which may help decrease inflammation and protect the bladder lining or calcium glycerophosphate (Prelief) to help reduce bladder irritation from trigger foods. 
• Medications that help repair and protect the bladder lining. 
• Antihistamines such as hydroxyzine if an allergic reaction is causing your symptoms.
• Oral medications that relax the bladder muscles, so you don’t feel the need to urinate as urgently or as often.
• Low doses of tricyclic antidepressants, which may help manage the pain of PBS and may also help with sleep and getting up less at night to urinate.
• Elmiron (pentosan polysulfate sodium), which may help repair the surface of the bladder wall.
• Cyclosporine, which suppresses the immune system.

Some people also find relief from supplements such as, glucosamine, chondroitin and quercetin complex. Talk to your provider about supplements before beginning any treatment. If you have PBS, you should not take vitamin C, L-arginine or L-citrulline since they can make your symptoms worse.

Talk to your provider if you are pregnant or planning to become pregnant, since some treatments for PBS may affect fertility or pregnancy.

Your provider may also suggest these other options:

• Transcutaneous electrical nerve stimulation: TENS uses mild electrical pulses delivered through the skin on your lower back or above your pubic area to reduce pain.
• Sacral nerve stimulation: This implanted device can help reduce how urgently and how often you need to urinate.
• Bladder hydrodistention: This method involves stretching the bladder with water while you are asleep under anesthesia. 
• Cauterization of bladder ulcerations: If Hunner’s ulcers are present cauterizing them using heat or laser therapy may improve bladder pain.
• Medications placed directly in the bladder: Called bladder instillation, these medicines stay in your bladder for a few minutes and you get rid of them when you urinate.

Managing PBS

PBS can’t be cured, but you can take steps to minimize symptoms and manage the way the condition affects your life:

• Schedule check-ups with your health care provider to monitor your progress and adjust your treatment plan. 
• Talk to your provider about complementary therapies like acupuncture or biofeedback to help relieve symptoms. 
• Consult with a dietitian to help identify the foods that trigger your symptoms. 
• Understand your triggers, symptoms and treatment plan so you can  best manage your condition. 

Coping with the emotional impact of PBS

PBS can affect your mental health. These strategies can help you cope: 

• Join support groups. Connecting with others facing the same challenges can give you a sense of community, shared experiences and practical advice. 
• Educate friends and family about PBS so they can support you. 
• Set realistic goals for yourself based on how PBS impacts your life. Break down tasks into small steps so you don’t feel overwhelmed. 
• Consider seeing a mental health provider for additional support. 

Key points 

With PBS, you feel discomfort or pain in your pelvic area and have a strong, frequent urge to urinate. If you’re diagnosed with PBS, lifestyle changes, medication and other treatments can bring relief. 

If you’re concerned about your urinary health, connect with an expert at Banner Health for comprehensive, compassionate care.