Be Aware of Classic Symptoms of Painful Bladder Syndrome

Do you experience pain when your bladder is full, but brush it off as just another annoying aspect of aging? This discomfort should not be ignored, as it is the primary symptom of painful bladder syndrome (PBS), also known as interstitial cystitis (IC). PBS/IC is more than an inconvenience; it is a chronic condition that can negatively affect your quality of life without proper treatment. This article will explore ways to effectively manage this challenge, including strategies to lessen the intensity of flare-ups.

Causes and Risk Factors

One of the primary possible causes of PBS/IC is the breakdown of the glycosaminoglycan (GAG), which is the protective lining of the bladder. “Most people who have PBS/IC have some disruption of the GAG layer. But, in general, the cause of this chronic pain condition is unknown,” says Katherine Husk, MD, Assistant Professor, Department of Obstetrics and Gynecology, Division of Urogynecology, Weill Cornell Medicine. Chronic inflammation, often stemming from recurrent urinary tract infections (UTIs), can erode the GAG over time. Autoimmune responses, in which the body’s immune system mistakenly attacks the bladder lining, can also lead to its deterioration. “Typically, when the GAG layer is damaged it allows certain fluids or foods to result in irritation, and these can leak out into the bladder wall muscle,” says Dr. Husk. Examples of these beverages and foods include citrus fruits, tomatoes, coffee, and alcoholic drinks.

Treatment Options

Medication, stress reduction, dietary changes, bladder Botox, and sacral neuromodulation are among the possible strategies used to reduce the pain and other symptoms associated with PBS/ IC. “Typically, people will be on some form of long-term management using multiple modes of therapy,” says Dr. Husk. However, even when a treatment strategy is effective, flares are common.

Medications commonly prescribed to manage PBS/IC pain include neuromodulators, such as gabapentin, amitriptyline, nortriptyline, Cymbalta (duloxetine), and Lyrica (pregabalin). “Some people may also benefit from medications for overactive bladder (antispasmodics) depending on their symptoms. There are also over-the-counter medications that may be beneficial, including Prelief, an acid reducer; pyridium, which may help with bladder pain; and aloe vera capsules, which a small study recently showed may help preserve the GAG layer,” says Dr. Husk.

Elmiron (pentosan polysulfate sodium) is the only prescription medicine indicated specifically for PBS/IC. While this drug is still on the market, the FDA has issued a warning indicating that there is a risk of retina damage and permanent vision loss from long-term use. Dr. Husk explains that people who are newly diagnosed with PBS/IC and opt to take Elmiron should have a baseline eye exam and serial eye exams thereafter, and those who have been taking this medication and want to continue taking it should have serial eye exams going forward.

Flare-Up Control

Lifestyle modifications can help reduce the frequency and severity of flare-ups. Maintaining a healthy diet that avoids known bladder irritants—such as citrus fruits and other acidic foods—is crucial. Staying well-hydrated with water and avoiding alcohol and caffeinated beverages can also help. Smoking cessation is also important, because smoking can irritate the bladder and exacerbate symptoms.

Living with a Sensitive Bladder

Regular physical activity and stress management techniques, such as yoga or meditation, may reduce symptom flare-ups. Support groups and counseling can also provide emotional support and advice for coping with PBS/IC.

If you are experiencing ongoing bladder pain or sensitivity, or other symptoms discussed in this article, a visit to your primary physician, gynecologist, or a urogynecologist is warranted. To find a urogynecologist and learn more about PBS/IC, go to the American Urogynecologic Society’s web site voicesforpfd.org.

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