How to Treat Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS)

What Is IC/BPS?

The American Urological Association (AUA) defines IC/BPS as “an unpleasant sensation (pain, pressure, or discomfort) perceived to be related to the urinary bladder, associated with the lower urinary tract symptoms of more than six weeks duration, in the absence of infection or other identifiable causes” (Clemens, 2022). Surprising to most people, there is an estimated 5% of people living with IC/BPS – that is 1 in 20 people! This condition is commonly underdiagnosed or misdiagnosed. While we used to think this condition was primarily only present in women, we now know that it is much more prevalent in men than we once thought (Berry et al., 2011). If you are living with IC/BPS or symptoms of this condition, we first and foremost want you to know that you are not alone – this condition is much more prevalent than we once thought and is seen across both women and men. 

IC used to only be diagnosed following a cystoscopy confirming Hunner’s lesions in the bladder. However, we now know that you can have valid symptoms and diagnosis of IC/BPS without having these lesions on the bladder. In fact, your bladder can look completely “fine” on a cystoscopy and you could still have IC/BPS if you meet the symptom criteria described above. This is the case for the majority of people with IC/BPS! Many people with this condition actually have pelvic floor dysfunction driving their symptoms and not bladder lesions or pathology. This may help you to understand why pelvic floor therapy is a primary treatment approach as listed in the AUA guidelines for IC/BPS. 

IC/BPS  is a chronic pelvic pain condition that is not degenerative in nature. In other words, symptoms do not inherently get worse over time. There is a ton of misinformation out there on this topic. Since symptoms of IC/BPS can improve and resolve, it is encouraged not to delay treatment to start feeling more like yourself again. As indicated in one of our favorite books at Bloom Pelvic Therapy, The Interstitial Cystitis Solution, “Thousands of people with IC live healthy, pain-free lives, and so can you” (Cozean & Cozean, 2016, p.7). We have already debunked a few myths already in this blog, such as IC/BPS not being a solely women’s condition and it not being a solely bladder condition. Even more myths are looming out there in the medical and patient world, and we are here to spread the word on the more updated state of the evidence when it comes to this condition. 

What Is The IC Diet? 

There is no “IC Diet” that works for everyone. You will find these to be extremely extensive and restrictive, which ends up creating and perpetuating fears and impacting our nervous systems for the worse. While there may be a few foods that could trigger symptoms for certain folks (i.e., caffeine/coffee, wine/alcohol, citrus like lemons and limes, tomatoes/sauce, and spicy food), this does not affect everyone’s symptoms. In fact, this is a list of irritants that may affect people that do not have IC/BPS. Rather than always refraining from eating or drinking these things, it can be helpful to have awareness to see if these do or do not contribute to any pain or urgency/frequency flares. 

All acidic foods are not inherently “bad” for you if you have IC/BPS. The pH of urine is actually not a factor of IC/BPS symptoms as it normally fluctuates throughout the day. Some people that have lived with IC/BPS for years may be surprised to hear that acidic foods do not directly cause symptoms. There are other categories of food to consider, as well as the gold-standard elimination diet, to ensure any dietary recommendations are tailored to you and your symptoms specifically. Interestingly, while some foods may trigger symptoms at one point on the IC/BPS journey, they may not as you progress in your treatment (Cozean & Cozean, 2016). 

Does Elmiron Work?

Certain medications like Elmiron may not be the answers to all of your IC/BPS symptoms, especially if your bladder lining is not the issue. There also can be serious side effects to consider with your prescribing physician – take a peek at the warning label on this. You should not delay essential treatment, such as pelvic floor therapy, as you are waiting to see if this medication will work for you. Consult with your medical team if you have any questions on your medication’s effectiveness, side effects, or direct impact on symptoms or contributors to your symptoms.

How to Make Interstitial Cystitis Get Better?

Pelvic floor therapy can help to champion your care as you navigate your IC/BPS or suspected IC/BPS.

First and foremost, we can help to ensure you have a comprehensive medical team familiar with this diagnosis and the most up-to-date research and treatment options. During your treatment sessions, your pelvic floor physical therapist or occupational therapist can support you with first line treatments for IC/BPS, including education, self-care & behavioral modifications, and stress management, and manual therapies. Manual pelvic therapy techniques are given an evidence Grade “A” by the AUA (Clemens et al., 2022). With pelvic floor dysfunction being common for clients with  IC/BPS (and often a driver of pain), pelvic floor therapy helps to decrease symptoms and break the pain cycle. 

You do not need a referral to start getting relief from a pelvic floor therapist. We are here for you every step of the way whether you are reading this seeking relief, wanting to know if your symptoms align with this condition, or if you have been dealing with this for 20 years and are in need of fresh eyes and support! 

References

Berry, S., Elliot, M., Suttorp, M. et al. “Prevalence of Symptoms of Bladder Pain Syndrome/Interstitial Cystitis Among Adult Females in the United States.” The Journal  of Urology 186, no. 2 (August 2011) 540-44.

Clemens JQ, Erickson DR, Varela NP, Lai HH. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome. J Urol. 2022;208(1):34-42.

Cozean, N., & Cozean, J. (2016). The Interstitial Cystitis Solution. Quarto Publishing Group USA Inc.