Interstitial Cystitis
Also known as Bladder pain syndrome, IC/BPS
This article is general health information for the selected condition. It is not a diagnosis and does not replace clinical judgement. If you have questions or need treatment advice, please consult a qualified healthcare professional.
What is interstitial cystitis?
Interstitial cystitis, also called bladder pain syndrome, causes chronic bladder pain or pressure with urinary urgency and frequency in the absence of infection. It is frequently misdiagnosed as recurrent urinary tract infection, and repeated antibiotic courses do not help. Diagnosis is often delayed for years.
Causes
- Defective bladder lining allowing urine irritants to penetrate
- Mast cell activation in the bladder wall
- Neurogenic inflammation and pain sensitisation
- Autoimmune mechanisms in some patients
- Pelvic floor muscle dysfunction
Symptoms
- Bladder pain or pressure that worsens as the bladder fills
- Relief immediately after passing urine
- Urinary frequency, sometimes many times an hour
- Persistent urgency
- Pelvic or perineal pain
- Pain during or after sex
- Symptom flares triggered by certain foods or stress
- Repeated negative urine cultures
Risk factors
- Female sex
- Age over 30 at onset
- Coexisting fibromyalgia or irritable bowel syndrome
- History of pelvic surgery or trauma
- Chronic pain conditions
Diagnosis
- Symptom history with characteristic filling pain
- Repeated urine cultures excluding infection
- Bladder diary recording volumes and frequency
- Cystoscopy, which may show Hunner lesions
- Exclusion of bladder cancer, stones and endometriosis
- Pelvic floor assessment
Treatment
- Dietary modification avoiding personal trigger foods
- Bladder retraining and stress management
- Pelvic floor physiotherapy, avoiding strengthening exercises
- Oral amitriptyline or antihistamines
- Bladder instillations of hyaluronic acid or similar agents
- Treatment of Hunner lesions where present
- Multidisciplinary chronic pain support
Self care
- Keep a bladder and food diary to identify personal triggers
- Reduce common irritants such as coffee, citrus and artificial sweeteners
- Practise timed voiding and gradual bladder retraining
- Use heat pads for pelvic pain
- Learn pelvic floor relaxation rather than strengthening
- Manage stress, which reliably worsens flares
- Wear loose clothing during flares
When to see a doctor
Book an appointment if:
- Bladder pain with repeatedly negative urine cultures
- Urinary frequency disrupting sleep and daily life
- Symptoms not responding to antibiotics
- Pain during or after sex
- Flares becoming more frequent
- To discuss bladder instillations or specialist referral
Some symptoms need emergency care rather than an appointment. See the warning signs listed above.
Prevention
- The condition cannot be prevented, but flares can be reduced
- Identify and avoid dietary triggers
- Manage stress and sleep
- Treat constipation, which worsens pelvic pain
- Avoid repeated unnecessary antibiotic courses
Outlook
Interstitial cystitis is chronic with a fluctuating course of flares and quieter periods. Most people achieve meaningful improvement through dietary modification, bladder retraining, pelvic floor physiotherapy and targeted medication. It does not damage the kidneys or lead to cancer, though it can significantly affect quality of life.
Common questions
How is it distinguished from recurrent urinary infection?
Urine cultures are repeatedly negative and antibiotics do not help. Pain that builds as the bladder fills and eases on emptying is characteristic, whereas infection typically causes burning throughout urination with positive cultures.
Which foods commonly trigger flares?
Frequently reported triggers include coffee, tea, alcohol, citrus, tomatoes, artificial sweeteners and spicy food. Triggers are highly individual, so a food and symptom diary is more useful than a blanket exclusion diet.
Why avoid pelvic floor strengthening?
Many people with this condition have an overactive, tight pelvic floor rather than a weak one. Kegel style strengthening can worsen pain, so physiotherapy focuses on relaxation and manual release instead.
References
Important: Dard AI is not a medical device and does not diagnose, treat, or replace clinician judgement. This article is general information only. Always consult a qualified healthcare professional about diagnosis and treatment, and seek emergency care for severe or rapidly worsening symptoms.