Perplexing, painful and inconvenient, the chronic condition known as interstitial cystitis/painful bladder syndrome (IC/ PBS) affects women more than nine times as often as men. Its symptoms, including bladder pain and frequent urination, often are mistaken for those of a bladder infection—yet tests reveal no bacteria, and antibiotics bring no relief.
Though IC/PBS affects up to 6% of American women, its cause is a mystery.
What is known: The bladder wall becomes inflamed and super-sensitive...pinpoints of bleeding and ulcers often appear...stiffness and scarring may develop.
Many women suffer for years without a proper diagnosis, taking antibiotics for infections that they do not actually have. This delay causes needless pain...raises the odds that resistance to antibiotics will develop...and increases the risk that an IC/PBS-triggered inflammatory reaction will spread to other organs. In severe cases, surgery may be needed to remove part or all of the bladder. IC/PBS cannot be cured—but treatment can relieve symptoms and reduce complications.
If you have symptoms that suggest IC/PBS, visit your doctor. If no infection is found or symptoms persist despite treatment, consult a urologist or urogynecologist.
- Bladder pain or pressure
- Frequent urination (more than eight times in 24 hours)
- Urgent need to urinate
- Discomfort, pain or pressure in the lower pelvis or vulva
- Pain during or after sex
- Flare-ups during menstruation.
There is no definitive test for IC/PBS. Diagnosis involves excluding other conditions, such as a bladder infection, overactive bladder or bladder cancer. Testing may include blood and urine tests, bladder biopsy and cystoscopy (exam of the bladder using a viewing instrument).
Good news: For about 70% of patients, natural remedies ease symptoms with few or no side effects.
Soothing Dietary Strategies
Your diet affects how your bladder feels. Helpful…
- Identify foods that spark symptoms. A chief culprit is cranberry juice. Yes, this juice combats bladder infections—but with IC/PBS, you aren't fighting an infection. And cranberry juice is acidic, so it irritates a sensitive bladder.
- Other top troublemakers: Alcohol.. artificial sweeteners...caffeine (coffee, soda, tea)... carbonated drinks...citrus fruits, citrus juices... spicy foods...and tomato products.
For a comprehensive list of problematic foods, visit the Web site of the Interstitial Cystitis Association (www.ichelp.org, click on "Patient Resources"). To identify your personal triggers, for one month do not eat anything on the ICA list. Then, reintroduce one food from the list every three to five days. If symptoms flare up, swear off that food.
- Drink more, not less. You may think that limiting fluids reduces your need to urinate—but skimping on water makes urine more concentrated and thus more irritating. Drink six to eight cups of water daily—and sip, don't gulp.
- Take supplements. With your doctor's approval, try the following…
- Prelief (sold at drugstores) contains calcium ghceropbosphate, which makes food less acidic.
- CystoProtek (sold at www.cysto-protek com) has antioxidants and anti-inflammatories (glucosamine, quercetin, rutin) that help repair the bladder lining.
Note: If you take a multivitamin or other supplement that contains vitamin C, choose one with ascorbate, not ascorbic acid.
Mind Over Bladder
Try any or all of the following mind-body therapies…
- Bladder retraining. Urinating temporarily relieves pain, so patients use the toilet often in some cases, up to 60 times a day—but this habit further reduces the bladder's capacity to comfortably hold urine.
Best: Try to increase your typical time between bathroom trips by 15 minutes. After two weeks, increase by another 15 minutes. Continue until you can wait at least two hours.
- Stress reduction. Practice relaxation techniques daily, such as deep breathing, meditation and yoga. Also consider craniosacral therapy (gentle head and spine massage).
Practitioner referrals: The Upledger Institute, 800-233-5880, www.upledger.com.
- Acupuncture. This reduces IC/PBS pain for some patients
Referrals: American Association of Acupuncture and Oriental Medicine, 866-455-7999, www.aadomonline.org.
Medical Treatment Options
Persistent bladder pain eventually can cause pelvic muscles to spasm, worsening IC/PBS. Helpful...
- Intravaginal Thiele massage. To relieve spasms, a physical therapist massages muscles inside the vagina and/or rectum...and patients learn to do the procedure themselves at home. In one study, this reduced symptoms for 90% of patients.
- Electrical nerve stimulation. Stimulating the sacral nerves in the back with a mild current helps pelvic floor muscles function normally. If symptoms are severe, a urologist or urogynecologist can implant a nerve stimulator under the skin near the tailbone for continuous stimulation.
- Medication. About 5% to 10% of IC/PBS patients must resort to narcotic prescription painkillers--but these can have adverse effects, including a risk for dependence.
Better: First consider one or more of the following non-narcotic prescription drugs, discussing the pros and cons with your doctor...
- Dimethyl sulfoxide (DMSO). A pain-relieving anti-inflammatory and antispasmodic, this drug is infused into the bladder through a catheter and kept in place for about 20 minutes. The procedure typically is done once a week for six weeks. Relief lasts three to 12 months...treatment is repeated as needed. Side effects may include garlic taste in the mouth, headache and dry nasal passages. DMSO is the only drug approved for this treatment, but for some patients, other anesthetics (such as lidocaine) work as well with fewer side effects.
- Pentosan (Elmiron). This oral drug helps heal the bladder lining. It can thin the blood, however, so it may be inappropriate if you use a blood thinner, such as warfarin (Coumadin).
- Potassium citrate (Urocit-K). Taken orally, this makes urine more alkaline. Possible side effects include nausea, muscle weakness and irregular heartbeat.
- Urelle. This brand name oral medication is a five-drug formulation that reduces pain and spasms. Side effects may include nausea, dizziness and blurred vision.
To make day-to-day life with IC/PBS more comfortable, try...
- Modified exercise routines. When symptoms flare up, reduce the intensity and duration of workouts—for instance, by walking instead of running, Rinse off after swimming to remove irritating chlorine.
- Bathing. Soak in bathwater mixed with colloidal oatmeal (sold at drugstores). Avoid bubble baths and bath oils—these can be irritating.
- A personal lubricant for sex. This makes intercourse more comfortable.
Try: The organic Good Clean Love line (541-344-4483, www.goodcleanlove.com).