Simple steps to control chronic bladder inflammation.

Up to two million Americans have interstitial cystitis (IC), also known as painful bladder syndrome. Those with a severe form of the disease urinate up to 60 times a day.

Even though many people assume that this chronic form of nonbacterial bladder inflammation affects only women, research shows that 10% of sufferers are men. Unfortunately, the average person with IC has symptoms for five years and sees up to five doctors before a correct diagnosis is made.

Surprising development: Researchers are now discovering that some of the symptoms of IC may originate in the colon — that is, nerve impulses from an irritated colon (perhaps due to the consumption of certain foods, such as citrus fruits or spicy dishes) may “accidentally” stimulate nerves that carry impulses to the bladder.

What Is Interstitial Cystitis?

IC occurs when the wall of the bladder becomes chronically inflamed for unknown reasons. The condition typically causes an urgent and/or frequent need to urinate and pressure or pain in the bladder and pelvic area.


Besides an urgent and/or frequent need to urinate, IC causes pelvic pain. Women also may have discomfort in the area between the vagina and anus… in men, between the scrotum and the anus.

One current theory: Research now suggests that IC is caused by an abnormality in the urothelium, the thin layer of cells that makes up the bladder’s inner lining. A breakdown in this lining allows irritating substances to penetrate the bladder.

Up to 40% of IC patients have recurrent urinary tract infections. This is consistent with the hypothesis that urothelium damage is to blame — infections can damage the bladder’s protective lining. Some researchers also speculate that IC is a form of autoimmune disorder, in which the body’s immune response attacks tissues in the bladder.


If you urinate more than eight times a day… get up repeatedly (more than two times) at night to urinate… and/or have pelvic or bladder discomfort, see your primary health-care provider. He/she may refer you to a urologist or urogynecologist specializing in IC. These symptoms are not normal — regardless of your age.

Red flag: People with IC tend to void small amounts (usually less than four ounces) at a time, which leads to more frequent urination.

IC symptoms can be similar to those caused by such conditions as a urinary tract infection, kidney stones or even bladder cancer, so you may require…

  • Urinalysis to rule out a urinary tract infection.
  • Potassium sensitivity test. A potassium solution and plain water are placed in the bladder at different times via a catheter. If you have IC, you will have more urinary urgency and pain with the potassium solution. Those without IC won’t notice a difference.
  • Cystoscopy. A doctor examines the bladder and urethra with a drinking-straw–sized tube with lenses and a light. This helps rule out bladder cancer. A bladder biopsy also may be performed to test for bladder cancer.
  • Computed tomography (CT) scan to rule out kidney stones.


Up to 91% of IC patients suffer worse, or more frequent, symptoms when they eat certain foods. These foods may irritate the bladder or irritate nerves that send impulses to both the colon and bladder. Nerves for both organs originate in the same region of the spinal cord.

This may be why 30% to 40% of those with irritable bowel syndrome (a chronic condition marked by abdominal pain with constipation and/or diarrhea) also suffer from IC. Effective strategies…

Avoid the “4 Cs” — caffeine (including chocolate)… carbonated drinks… citrus fruits… and vitamin C-rich foods. They frequently trigger flare-ups in patients with IC. Most patients also need to avoid spicy or acidic foods (such as tomatoes, lemon juice and vinegar), as well as alcohol.

Sip water every five minutes when you’re awake. Some people cut back on water to reduce urinary frequency. This doesn’t work. Drinking less water makes urine more concentrated and increases discomfort. Always carry a water bottle and drink often. Most people with IC need to drink about two quarts daily to dilute urine so that the bladder can process a constant, steady amount of urine.

Work with a pelvic-floor physiologist. This health-care professional can teach gentle stretching and strengthening of the pelvic-floor muscles to reduce urinary urgency and discomfort.

Practice bladder training. This technique involves timed urination — going to the bathroom according to the clock, not the urge. Intervals typically start at 30 minutes and gradually lengthen.

Reduce stress with guided imagery. Anything that helps you relax — yoga, Pilates, taking a walk, etc. — can help control IC. When you relax, it lowers stress hormones, which reduces pain.


If the strategies described above don’t provide adequate relief, talk to your doctor about medication. Options include…

Pentosan (Elmiron), the only FDA-approved oral medication for IC. It may help repair damage to the bladder lining. The drug, which isn’t effective for all patients, can take four months to relieve pain and six months to reduce urinary frequency. The most common side effect is minor gastrointestinal discomfort. Elmiron can affect liver function, which your doctor can monitor.

Tricyclic antidepressants, such as amitriptyline (Elavil) or imipramine (Tofranil), which help relax the bladder and reduce pain. Side effects may include dry mouth and constipation. Small doses are often effective.

In severe cases, doctors can treat discomfort by infusing the bladder with lidocaine and other agents. The treatment is repeated once a week for six weeks. It’s usually used to help patients get through a period when the disease is active.