Nurture Integrative Health

What is IC? 

Interstitial Cystitis, also known as Bladder Pain Syndrome is a condition in which people have bladder pain, often associated with symptoms of urinary urgency and frequency.

IC/BPS is an unpleasant sensation of pain, pressure or discomfort perceived to be related to the urinary bladder and associated with lower urinary tract symptoms of more than six weeks duration. These symptoms are in the absence of infection or other identifiable causes.  It is more common in biological females compared to biological males (9:1) and is commonly diagnosed in the 4th decade of life or later, although symptoms can be recognized in children as well.

Symptoms can vary from mild to severe and some patients experience pain every day while some experience intermittent pain or “flare-ups” that are commonly worsened by a variety of triggers. Usually it is gradual in onset and worsen over a period of months. However, some patients describe symptoms that are abrupt or severe from their onset.  Symptoms may include:

  • Frequent feelings of UTI , that either resolve on their own or are negative when cultured
  • Sensations such as pressure, discomfort or bladder spasming
  • Urinary Urgency
  • Urinary Frequency
  • Nocturia (waking up more than once in the middle of the night to urinate)
  • Incontinence
  • Suprapubic (above pelvis and below belly button)  pain
  • Urethral pain
  • Lower abdominal pain or low back pain, especially with bladder filling
  • Clothes with contact to pubic area feel bothersome and worsen symptoms
  • Patients may describe sitting on the toilet for hours at a time in order to let urine dribble from  their bladders so that the bladder remains as empty as possible and pain is minimized
  • Exacerbation of symptoms may occur
    • after intake of certain food or drinks, (e.g. strawberries,  oranges, beer/wine, coffee)
    • during the luteal phase of the menstrual cycle
    • stressful times

Causes: Diagnosis and treatment are controversial because the true cause is still theoretical and therefore it can be difficult to treat.

  • Bladder lining (epithelium) is deficient and therefore permeable to urinary irritants. Surveys of patients with IC/BPS suggest that certain foods and beverages, such as  caffeine, alcoholic beverages, citrus fruits, tomatoes, and spicy foods, may worsen  symptoms. The irritant can be highly variable from patient to patient.
  • Change in hormones. This can be a lack of local estrogen, perimenopause or those on prolonged oral contraceptives.
  • Mast cell activation and release of histamine. This can be stimulated by stress and hormonal fluctuations, which may play a role in the flares and seasonal symptoms that often occur with IC/PBS.
  • Pelvic Floor Dysfunction or Structural Abnormalities
  • Increased Stress
  • Lack of movement
  • Chronic hidden infections

How is it Diagnosed? 

There is no specific test for IC. The diagnosis is based on the presence of characteristic symptoms as described above. However, it is important that your doctor rules out any other conditions that may have an overlap of symptoms with IC such as bladder or urethral cancer , bladder stones, infection or pelvic masses. This should be done by taking a careful medical history, completing a thorough exam and ordering labs. In some cases, a cystoscopy may be performed. This is a procedure done to look at the inside of the bladder and urethra. It is usually completed when there is blood in the urine that is not resolved with standard treatment or if there is a history of use of synthetic mesh. During a cystoscopy, Hunner lesions may be visualized. These are reddened lesions on the bladder mucosa. However, only 5-10% of IC patients present with Hunner’s lesions. Actually, there is no bladder lining pathology in more than 90 % of IC/BPS patients, leading researchers to believe that there is a deeper root cause.

Here are some lifestyle modifications that would be a good place to start until you can receive an individualized assessment and care plan:

  • Stress Management: Stress can exacerbate IC symptoms. Practice relaxation techniques like deep breathing, meditation, or yoga to help manage stress.
  • Bladder Training: Gradually extend the time between bathroom visits to increase bladder capacity. This can help reduce the frequency of urination.
  • Heat Therapy: Applying heat to the pelvic area can provide relief from pain and muscle tension. Try using a heating pad or warm baths as needed.
  • Clothing Choices: Opt for loose-fitting, breathable clothing to reduce pressure on the bladder and minimize discomfort.
  • Smoking Cessation: Smoking can worsen IC symptoms. If you smoke (anything), consider quitting to improve your overall bladder health.
  • Avoid Trigger Foods: Some foods may exacerbate IC symptoms. Common triggers include caffeine, alcohol, citrus fruits, spicy foods, artificial sweeteners, and carbonated beverages. Keep a food diary to identify your personal triggers and minimize their consumption.
  • Moderate Your Diet: Overeating can put extra pressure on your bladder. Try eating smaller, more frequent meals throughout the day to reduce bladder stress.

Pelvic Floor Therapy:

Did you know that Pelvic Floor Therapy is recommended by the American Urological Association as a first-line medical treatment in their IC Guidelines. It is the only treatment given an evidence grade of ‘A’. This is because we are finding that IC is more of a “pelvic pain” condition rather than a true bladder condition. Stay tuned to find out how the pelvic floor and Interstitial Cystitis and bladder pain relate.

Dr. Courtney Coile is an IC expert in Oregon.  She would love to help you get relief.  Schedule an appointment to begin today!


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