Interstitial Cystitis (Bladder Pain Syndrome)

If you suffer from persistent pelvic pain, pressure, or an overwhelming urge to urinate throughout the day and night, you are not alone. These symptoms are key indicators of Interstitial Cystitis (IC), also referred to as Bladder Pain Syndrome (BPS).

In the past, IC was widely misunderstood and considered rare. Today, we know that IC affects millions of men and women. While living with chronic bladder pain can be frustrating and disruptive, IC is a manageable condition. At UroPartners, our board-certified urologists across Chicagoland provide empathetic care, advanced diagnostic clarity, and personalized multi-modal treatment plans designed to bring you lasting relief.

What is interstitial cystitis (IC)?

Normally, as your bladder fills with urine, the bladder muscle relaxes and expands smoothly. A specialized inner lining (the epithelium) protects the bladder wall from irritating substances in urine and prevents bacterial infections.

In patients with IC, this protective lining may be compromised or inflamed, allowing irritating urine components to reach sensitive nerves and muscles in the bladder wall. This causes non-infectious inflammation, painful spasms, and heightened pain sensitivity.

Related Conditions

IC is often associated with other chronic inflammatory or pain conditions, including irritable bowel syndrome (IBS), fibromyalgia, chronic fatigue syndrome, and pelvic floor dysfunction.

How many people in the United States have IC?

It is hard to know for certain how many people have IC, because doctors have different opinions about how exactly to diagnose IC. Current literature suggests that the disease affects well over 1 million Americans.

Recognizing the Symptoms

IC symptoms vary widely from person to person. They can range from mild to severe, fluctuate periodically, or remain constant. Key symptoms include:

• Urinary Frequency: The need to pass urine far more often than normal—sometimes 16 to 40+ times per day and multiple times throughout the night (nocturia).
• Urinary Urgency: A persistent, uncomfortable pressure or intense urge to urinate that rarely subsides, even immediately after emptying your bladder.
• Pelvic & Bladder Pain: Chronic pain, pressure, or discomfort in the bladder, lower abdomen, urethra, lower back, or perineal region.
• Pain During Intercourse: Women may experience pain during or after intercourse due to the bladder's proximity to the vaginal wall; men may experience painful ejaculation or testicular discomfort.

Note: IC symptoms closely mimic those of a severe urinary tract infection (UTI), but no bacterial infection is present.

Causes & Risk Factors

While the exact root cause of IC continues to be studied, research indicates that it is often driven by a combination of factors:

1. Bladder Wall Defects: Small breakdowns in the protective epithelium that permit urine toxins to irritate bladder tissue.
2. Nerve & Immune Responses: Heightened nerve sensitivity or mast cell activation releasing histamine and inflammatory chemicals into the bladder.
3. Genetic Factors: IC can run in families, suggesting a potential genetic predisposition.
4. Gender: Approximately 80% of diagnosed IC patients are women, though many men experiencing "prostatitis-like" symptoms may actually suffer from IC as well. 

How is IC diagnosed?

Because IC symptoms overlap with other conditions (such as UTIs, kidney stones, or bladder cancer), diagnosis begins with a process of ruling out other causes and carefully evaluating your symptom patterns.

Your evaluation at UroPartners typically includes:

• Medical History & Physical Exam: Reviewing your symptoms, pelvic health, and lifestyle factors.
• Urinalysis & Urine Culture: Ensuring there is no active bacterial infection or microscopic blood.
• In-Office Cystoscopy: A brief 10-to-15-minute examination using a thin, flexible scope to visually examine the bladder lining for inflammation, small bleeding sites, or ulcers (Hunner's lesions), while ruling out structural abnormalities.
• Bladder Biopsy or Distention (If Needed): Performed when additional tissue evaluation or therapeutic stretching of the bladder wall is beneficial.

Are there stages of IC?

IC is a disease that often starts in a subtle way, sometimes beginning with urinary frequency that the patient may not notice or recognize as a problem. In other cases, the onset is much more dramatic with severe symptoms occurring within days, weeks or months. In many cases, the symptoms become chronic but the disease does not tend to progress after the initial 12 to 18 months. In rare cases, the bladder will become progressively smaller over time to the point where there is almost no capacity to store urine.

How is IC treated?

Because IC affects each patient differently, there is no single "one-size-fits-all" treatment. The goal of therapy is to soothe inflammation, rebuild the bladder's protective lining, interrupt pain signaling, and restore normal bladder capacity.

1. Dietary & Lifestyle AdjustmentsMany patients find that certain foods exacerbate bladder irritation.

Common dietary triggers include:

• Citrus fruits and tomatoes
• Caffeinated and alcoholic beverages
• Carbonated drinks and artificial sweeteners
• Chocolate and heavily spiced foods

Your specialist can guide you through an elimination diet to pinpoint your personal dietary triggers without sacrificing balanced nutrition.

2. Oral Medications

• Pentosan Polysulfate Sodium (Elmiron®): An FDA-approved oral medication designed to help restore the protective glycosaminoglycan (GAG) layer of the bladder epithelium.
• Antihistamines (e.g., Hydroxyzine): Reduces histamine release from mast cells in the bladder wall, soothing irritation and promoting restful sleep.
• Tricyclic Agents (e.g., Amitriptyline): Calms nerve pathways, reduces muscle spasms, and minimizes chronic pelvic pain sensations.

3. Bladder Instillations (Direct Treatments)
Bladder instillation involves gently placing a therapeutic solution directly into the bladder via a small catheter for 15 to 30 minutes:

• DMSO (Dimethyl Sulfoxide): An FDA-approved treatment that reduces inflammation, relaxes bladder muscles, and desensitizes pain nerves.
• Combination Solutions ("Bladder Cocktails"): Mixing agents such as heparin, local anesthetics (lidocaine), and steroids directly to coat the bladder lining and provide immediate localized pain relief.
• 4. Physical Therapy & Pain Management
  Pelvic Floor Physical Therapy: Specialized therapy focusing on relaxing tight, spasming pelvic floor muscles (avoiding aggressive Kegel exercises, which can worsen IC symptoms).
• Targeted Pain Therapies: Collaborating with interdisciplinary pain specialists for nerve blocks or specialized nerve modulation when needed.

What can be expected after IC treatment?

The most important thing to remember is that none of the IC treatments works immediately. It usually takes weeks to months before symptoms improve. Even with successful treatment, the condition may not be "cured;" it is simply "in remission."

Most patients need to continue treatment indefinitely, or else the symptoms return. Some patients have flare-ups of symptoms even on treatment. In some patients the symptoms gradually improve and even disappear.

Although most patients will find that their symptoms improve as they are treated for IC, not all patients will become completely symptom-free. Many patients still have to urinate more frequently than normal, or have some degree of persistent discomfort and/or have to avoid certain foods or activities that make symptoms worse.

Is it possible for IC to recur after successful treatment? How can recurrences be prevented?

It is possible for IC symptoms to recur even if the disease has been in remission for a long time. It is not known what causes recurrences. Also, there is no known way to prevent recurrences for certain. Some things that patients do to try to prevent recurrence include: (1) stay on their medical treatments even after remission; (2) avoid certain foods that may irritate the bladder; and (3) avoid certain activities or stresses that may worsen IC. The specific foods or activities that affect IC are different for different patients, and so each person has to form his/her own individual plan.

Frequently Asked Questions

How does diet affect IC?

Most (but not all) people with IC find that certain foods make their symptoms worse.  There are four foods that patients most often find irritating to their bladders: citrus fruits, tomatoes, chocolate and coffee. All four of these foods are rich in potassium. Other foods that bother the bladder in many patients are alcoholic beverages, caffeinated beverages, spicy foods and some carbonated beverages. The list of  foods that have been reported to affect IC is quite long, but not all foods affect all patients the same way. For this reason, each patient must find out how foods affect his or her own bladder.

The simplest way to find out whether any foods bother your bladder is to try an "elimination diet" for one to two weeks. On an elimination diet, you stop eating all of the foods that could irritate your bladder. IC food lists are available from many sources (www.ichelp.org or www.ic-network.com). If your bladder symptoms improve while you are on the elimination diet, this means that at least one of the foods was irritating your bladder.

The next step is to find out exactly which foods cause bladder problems for you. After one to two weeks on the elimination diet, try eating one food from the IC food list. If this food does not bother your bladder within 24 hours, this food is probably safe and can be added back into your regular diet. The next day, try eating a second food from the list, and so on. In this way, you will add the foods back into your diet one at a time, and your bladder symptoms will tell you if any food causes problems for you. Be sure to add only one new food to your diet each day. If a person eats a banana, strawberries and tomatoes all in the same day, and the IC symptoms get bad that evening, he/she will not know which of the three foods caused the symptom to flare up.

Does stress cause IC?

At this time, there is no evidence that stress makes a person get IC in the first place. However, it is well known that if a person has IC, physical or mental stress can make the symptoms worse.

Is IC hereditary?

There is some research that indicates that there is a genetic pattern. It is important to discuss the symptoms of IC with the family, especially females, so that any other affected members can be screened and treated early in the disease process.