Painful Bladder Syndrome (PBS), also called Interstitial Cystitis (IC), is a chronic condition causing bladder pressure, pain, and frequent urination. Unlike infections, PBS involves bladder wall inflammation without bacteria. Symptoms vary daily and can significantly impact quality of life.
Common symptoms
- Bladder pain (burning, stabbing, or aching)
- Urinary urgency/frequency (>8 times/day, waking >2 times/night)
- Pelvic pain (vulva, vagina, lower abdomen, or rectum)
- Pain worsening with bladder filling, relieved temporarily after voiding
- Symptoms triggered by: Stress, menstruation, sex, certain foods/drinks
Causes & triggers
The exact cause is unknown, but contributing factors include:
- Damaged bladder lining: Allows urine to irritate bladder nerves.
- Nerve dysfunction: Overactive pain signals from the bladder.
- Immune system activation: Chronic inflammation.
- Common triggers:
Diet: Acidic/spicy foods, caffeine, alcohol, carbonated drinks.
Stress: Emotional/physical stress flares symptoms.
Hormonal changes: Worsening around menstruation.
Diagnosis
PBS is diagnosed by excluding other conditions (e.g., UTIs, cancer). Tests may include:
- Urine tests: Rule out infection.
- Cystoscopy: Camera exam of the bladder (may show ulcers or bleeding).
- Bladder diary: Track fluid intake/voiding patterns.
- Potassium sensitivity test: Assess bladder lining integrity.
Management Strategies
Lifestyle & behavioural changes
| Do | Avoid |
| Drink 6–8 glasses of water/day | Coffee, tea, alcohol, soda |
| Follow a low-acid diet | Spicy foods, citrus, tomatoes |
| Practice pelvic floor relaxation | Holding urine for long periods |
| Use stress-reduction (yoga, meditation) | Tight clothing around the waist |
Medications
- Oral:
- Amitriptyline (reduces nerve pain) Pentosan polysulfate (rebuilds bladder lining)
- Antihistamines (e.g., hydroxyzine)
- Bladder Instillations:
- Dimethyl sulfoxide (DMSO) or heparin/lidocaine solutions (reduce inflammation).
Procedures & therapies
- Bladder hydrodistension: Stretches the bladder under anaesthesia.
- Pelvic floor physical therapy: Relieves muscle spasms.
- Nerve stimulation: Percutaneous tibial nerve stimulation (PTNS).
Risks of untreated PBS
- Chronic pain impacting work/sleep
- Anxiety/depression
- Reduced sexual intimacy
eGynaecologist Advice
- If you suspect or have been confirmed to have PBS, you should start dietary changes to avoid citrus, tomatoes, chocolate, artificial sweeteners.
- If you suffer from PBS, you should have low acid diet including pears, blueberries, carrots, potatoes chicken, fish, eggs, olive oil, and almond milk.
- You should seek gynaecological consultation for comprehensive assessment of PBS as this may be often misdiagnosed.
Frequently Asked Questions
Is PBS the same as a UTI?
No – UTIs are bacterial and resolve with antibiotics; PBS is chronic inflammation without infection.
Can PBS be cured?
There’s no cure, but symptoms can be managed effectively. Many achieve long-term relief.
Will I need surgery?
Rarely (<5%). Reserved for severe cases unresponsive to other treatments (e.g., bladder removal).
Can stress really worsen my symptoms?
Yes – stress amplifies pain signals. Mind-body therapies are key to management.
Is PBS linked to other conditions?
Often overlaps with fibromyalgia, IBS, vulvodynia, or endometriosis.
