Interstitial cystitis: causes, symptoms, and treatment for bladder pain syndrome

How do you know if you have interstitial cystitis? You might have to pee many times a day and multiple times at night. Trips to the bathroom often feel urgent, and it may hurt when you urinate. You might feel like there is pressure or pain in your lower belly. These symptoms can seem like the beginnings of a urinary tract infection (UTI), but they can also be signs of interstitial cystitis, also known as bladder pain syndrome (IC/BPS). (In this article, we will use these names interchangeably.) Often mistaken for other urinary and bladder issues, interstitial cystitis is more common than once thought, affecting up to 8 million women in the United States. IC/BPS is generally considered a chronic condition, which means symptoms may come and go over time rather than being treated and disappearing completely. But with the right combination of treatments, many people find relief from these painful bladder symptoms.

Here, learn more about possible causes of interstitial cystitis/bladder pain syndrome in women, common symptoms, and how to treat it — with lifestyle changes and exercises from our Hinge Health physical therapists.

What is interstitial cystitis?

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic condition that can cause pain or pressure in the bladder and pelvic area. Although anyone can develop IC/BPS, it’s more common in women — especially those ages 40 to 60. With interstitial cystitis/bladder pain syndrome, the walls of your bladder become irritated and inflamed. (This is also called bladder inflammation.) For some, it can lead to mild discomfort or tenderness in the pelvic area. Others may experience intense bladder pain, along with urinary urgency (the sudden and strong need to go) and urinary frequency (needing to go often). There are two types of IC/BPS:

• Non-ulcerative. With this type of interstitial cystitis/bladder pain syndrome, very tiny hemorrhages (called glomerulations) form on the wall of your bladder. About 90% of IC/BPS cases are non-ulcerative.

• Ulcerative. Painful, bleeding sores known as Hunner’s ulcers develop on the bladder wall. About 5% to 10% of people with IC/BPS have this form.

Causes of interstitial cystitis

Researchers don’t know exactly what causes bladder pain syndrome. Interstitial cystitis is thought to result from a combination of factors, which can include issues with the bladder lining, abnormal immune or allergic responses, nerve issues, and pelvic floor muscle problems, all of which may contribute to bladder inflammation, irritation, and pain. The exact cause is not known, but these mechanisms together are believed to play a role in the development of the condition. Here is more information about these common causes:

• Issues with the lining of the bladder wall: The bladder’s protective lining may be damaged or “leaky,” allowing urine to irritate the bladder wall and cause bladder inflammation and pain.

• Substances in urine: Certain chemicals may be present in higher amounts or may be especially irritating to the bladder lining in people with IC/BPS.

• Allergies: Some people with IC/BPS may have a history of allergies, suggesting an immune system link.

• Inflammatory cells (called mast cells): An increased number of these allergy-related cells can trigger bladder inflammation and bladder symptoms.

• Changes in nerves that affect bladder sensation: Altered nerve signals may make the bladder feel fuller or more painful than it actually is.

• Autoimmune disorders: The body’s immune system may mistakenly attack bladder tissue, causing ongoing bladder inflammation.

• Pelvic floor muscle dysfunction: Tight or spastic pelvic floor muscles can contribute to bladder pain and urinary symptoms.

Having a family member with interstitial cystitis may increase your risk. You may also be more likely to get painful bladder syndrome after an injury or trauma to the bladder, such as from an infection or pelvic surgery.

Symptoms of interstitial cystitis

Interstitial cystitis symptoms vary from person to person. Common symptoms include pelvic discomfort or pain, an urgent and frequent need to urinate, pain that worsens as the bladder fills and improves after urination, and sometimes pain during sex. These symptoms can be mild or severe, and can change over time. Here is more information about these common symptoms:

• Pelvic discomfort, pressure, or tenderness

• Urinary frequency, or needing to pee more often than normal

• Urinary urgency, or the sudden, uncontrollable need to pee

• Pain or discomfort while the bladder fills and relief after urinating

• Pain during sex

For some, symptoms are constant; in others, they come and go. Certain things — such as menstruation, certain foods or beverages, stress, or even sexual activity — can trigger symptom flares in many people with painful bladder syndrome. Recognizing and tracking your triggers is a key step in managing flare-ups and finding strategies that bring relief.

Treatments for interstitial cystitis

If you think you might have interstitial cystitis, it’s important to talk with your healthcare provider about your symptoms. There isn’t a single test for IC/BPS. Instead, your provider will try to rule out other conditions that cause similar symptoms. This usually means talking with you about your health history and symptoms, doing a physical exam, and running some tests to check for things like infections or other bladder problems. If other causes are ruled out and your symptoms match bladder pain syndrome, your doctor may diagnose you with this condition so you can start exploring treatment options.

There isn’t a cure for IC/BPS yet, but there are many ways to help manage symptoms and find relief. Your healthcare provider may suggest different treatments, like physical therapy and exercise, bladder training, lifestyle changes, medications, nerve stimulation, or bladder procedures. You may need to try a few treatments or use them together to find what works best for you.

Pelvic floor physical therapy for interstitial cystitis

Pelvic floor physical therapy can help when problems with your pelvic floor contribute to bladder pain syndrome. Your pelvic floor is a group of muscles and tissue that stretch like a hammock from your pubic bone in the front to your tailbone in the back. 

Your bladder sits directly on top of your pelvic floor, and the two are connected by fascia (connective tissue). If you have interstitial cystitis, your pelvic floor muscles may be tight or in spasm, which can affect the nerves and blood flow in the area. This can lead to bladder irritation and contribute to other interstitial cystitis symptoms, including pain and urinary urgency and frequency.

Pelvic floor physical therapy (PT) can provide exercises to stretch and relax tense muscles, and improve the coordination of your pelvic floor to help relieve symptoms, says Renee Bullis, PT, DPT, a Hinge Health physical therapist. One study found that pelvic floor physical therapy with myofascial release (also known as trigger point therapy) and relaxation exercises led to significant symptom relief in 70% of patients with IC/BPS. If painful bladder syndrome is limiting your ability to do daily activities, a physical therapist can assess you, rule out any serious causes of your symptoms, help you modify your activities, empower you with tools and tips to help you hurt less, and personalize your exercise program. You can see one a physical therapist in person or use a program like Hinge Health to access a PT via a telehealth video visit.

These exercises are designed to target the muscles and nerves surrounding your bladder and pelvic floor, which can ease many of the common symptoms of interstitial cystitis/bladder pain syndrome. For example, diaphragmatic breathing and reverse Kegels promote relaxation and reduce tension in the pelvic floor, while gentle stretches like happy baby, child’s pose, and cat cow improve mobility and help release tight muscles. Lower body nerve glides and back rotation stretches support healthy nerve function and flexibility, further relieving pain and discomfort. By practicing these movements regularly, you can help your pelvic floor and surrounding muscles function more smoothly, making it easier to manage pain, urinary urgency and frequency, and other symptoms of interstitial cystitis/bladder pain syndrome in your daily life.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Lifestyle changes for interstitial cystitis

Because painful bladder syndrome affects everyone differently, you may need to try several treatments — or a combination of them — to find what works best for you. Along with pelvic floor physical therapy and exercise, the following lifestyle tips and strategies may help reduce or prevent symptoms:

• Track and limit bladder irritants. Try keeping a diary of your foods and drinks to see if certain ones make your symptoms worse. If you notice a pattern, consider reducing or avoiding things like coffee, tea, soda, alcohol, citrus fruits, tomatoes, artificial sweeteners, and spicy foods, which are common bladder irritants.

• Stay hydrated. Proper hydration helps keep your urine less concentrated, which can make it less irritating to your bladder lining and help prevent urinary symptoms. Aim for about half your body weight in ounces of water daily (e.g., 75 oz. for a 150-pound person). Your needs may vary with the weather, your activity level, medications, or medications. Check your urine color — if it’s pale yellow or lighter, you’re likely well hydrated.

• Reduce stress. Stress may trigger flare-ups of interstitial cystitis. Deep breathing, meditation and yoga, or even a short walk can help keep stress levels in check.

• Choose comfortable clothing. Tight clothing around your pelvic or abdominal area can contribute to symptoms for some people. Switching to looser-fitting clothing may help reduce pressure and ease discomfort.

• Try bladder training, which helps you wait longer between bathroom trips by teaching your bladder to hold urine for gradually longer periods. Start by choosing a set time between bathroom visits, such as two hours. Follow your schedule, and if you feel the urge before your set time, try to wait a few extra minutes. Gradually increase the interval between trips until you can comfortably go three to four hours between bathroom visits.

If physical therapy, exercise, lifestyle strategies, and other conservative approaches don’t provide relief, your healthcare provider may prescribe medications or recommend nerve stimulation or bladder procedures as part of your interstitial cystitis treatment plan. 

How to calm an interstitial cystitis flare

If you’re experiencing a symptom flare, gentle self-care can help bring some relief. Deep breathing, resting, using heat packs on your lower belly, avoiding food or drink triggers, and practicing relaxation techniques may all help calm your symptoms. Over time, you’ll learn which strategies work best for you during a flare.

PT tip: Finding the right treatment takes time

Managing interstitial cystitis or bladder pain syndrome is different for everyone, says Dr. Bullis. “You might have to try different things to find out what works best for you.” Pelvic floor exercises can be an important part of managing symptoms. “It can take time and regular practice to see results,” says Dr. Bullis. “Try to do these exercises every day or a few times a week, and be patient with your progress as your body adjusts.”

How Hinge Health can help you

If you have pelvic pain, bladder, bowel, or other pelvic symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Anger, J. T., Dallas, K. B., Bresee, C., De Hoedt, A. M., Barbour, K. E., Hoggatt, K. J., Goodman, M. T., Kim, J., & Freedland, S. J. (2022). National prevalence of IC/BPS in women and men utilizing veterans health administration data. Frontiers in pain research (Lausanne, Switzerland), 3, 925834.doi:10.3389/fpain.2022.925834 

2. Clemens, J. Q., Erickson, D. R., Varela, N. P., & Lai, H. H. (2022). Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome. Journal of Urology, 208(1), 34–42. doi:10.1097/ju.0000000000002756

3. FitzGerald, M. P., Payne, C. K., Lukacz, E. S., Yang, C. C., Peters, K. M., Chai, T. C., … & Chu, J. (2012). Randomized Multicenter Clinical Trial of Myofascial Physical Therapy in Women With Interstitial Cystitis/Painful Bladder Syndrome and Pelvic Floor Tenderness. Journal of Urology, 187(6), 2113–2118. doi:10.1016/j.juro.2012.01.123

4. Hanno, P., Cervigni, M., Choo, M. S., Clemens, J. Q., Lee, M.-H., Malde, S., … & Gold, D. (2023). Summary of the 2023 report of the international consultation on incontinence interstitial cystitis/bladder pain syndrome (IC/BPS) committee. Continence, 8, 101056.doi:10.1016/j.cont.2023.101056

5. Interstitial Cystitis (Bladder Pain Syndrome) - NIDDK. (2024, November). National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/urologic-diseases/interstitial-cystitis-bladder-pain-syndrome

6. Interstitial Cystitis Association. (2021, October 7). Understanding IC/BPS | Interstitial Cystitis Association. Interstitial Cystitis Association |. https://www.ichelp.org/understanding-ic/

7. Lim, Y., & O’Rourke, S. (2021). Interstitial Cystitis. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK570588/