Bladder pain syndrome

Bladder pain syndrome (BPS), also called interstitial cystitis, is a condition that causes pain in the bladder or pelvis. The pain can be severe. It also causes an urgent, frequent need to urinate.

Pain from BPS can get worse the longer you wait before urinating. It's common to have more pain as the bladder fills and some relief after you urinate. Other symptoms include urinating often, feeling a constant urge to urinate, having pain during or after sex, and having pain in your belly or pelvis.

To diagnose bladder pain syndrome (BPS), your doctor may do a test called cystoscopy that uses a thin, lighted tube to see the inside of your bladder. You may also get a urine test to rule out other problems, such as a urinary tract infection.

Treatment may include:

Bladder training.

To help your bladder get used to comfortably holding more urine, you can slowly increase the time between when you urinate during the day (not while sleeping).

• If you find you are urinating every 30 minutes, for example, you can set a schedule of going every 45 minutes during the day.
• If that works for a week, you may be able to increase your time to every 60 minutes.
• Slowly work your way up to 2½ hours.

Physical therapy.

A physical therapist can teach you exercises to relax the muscles in your lower belly, groin, and buttocks. You may want to look for a physical therapist who is specially trained in pelvic floor therapy.

Medicines.

• Medicines taken by mouth (oral medicines) include amitriptyline, pentosan polysulfate, antihistamines, and anti-inflammatory medicines.
• Medicines that are put into the bladder (bladder instillations) are often combined with other medicines. These include medicines such as dimethyl sulfoxide (DMSO), lidocaine, heparin, and sodium bicarbonate.

Counseling.

A professional counselor can help you cope with pain, stress, and depression. It may also help to join a support group for people with BPS or chronic pain.

Other treatments.

These include botulinum toxin injections in the bladder and acupuncture. These have been helpful for some people.

Surgery.

If no other treatments help, surgery may be needed. It might be done to stop nerve pain or help with a problem like bladder distension. As a last resort, surgery may be done to remove the bladder.

Your doctor may have you use a bladder diary to record how often you urinate and about how much urine is released.

Your doctor will help you manage your pain, but there are also things you can do. Here are some ideas:

• Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
• Avoid any food or drink that makes your bladder pain worse, such as high-acid foods.
• See if using heat or cold helps relieve pain. Try a warm bath, a heating pad, or an ice pack.
• Find ways to relax and lower your stress, such as listening to restful music, having a massage, or meditating.
• Try bladder training. Set certain times to go to the bathroom and slowly increase the time between visits. This may help lengthen the time your bladder can hold urine.
• Talk to a counselor. Look for one who has had training in managing chronic pain.
• Smoking can irritate the bladder. If you smoke and need help quitting, talk to your doctor.