What is interstitial cystitis and why you might confuse it with a UTI

• Interstitial cystitis (IC) is a chronic condition that irritates the bladder causing pelvic pain.
• Certain foods, stress, UTIs, and sex can trigger IC, but there is no known cause for it.
• Lifestyle changes, certain prescriptions like antidepressants, and some surgeries can treat IC.

Interstitial cystitis (IC), sometimes referred to as painful bladder syndrome (PBS), bladder pain syndrome (BPS), or hypersensitive bladder, is a chronic bladder condition that causes bladder pressure, bladder pain, pelvic pain, and urinary urgency or frequency.

Although IC affects both men and women, the condition is more common in women. In fact, according to Wisconsin Urology, women are five times more likely to have IC when compared to men.

The Interstitial Cystitis Association (ICA) reports that three to eight million women in the US may have IC - that's about 3% - 6% of all women in the US.

Moreover, the ICA also notes that the reported number of men with IC may be lower than the actual rate as men with IC are often misdiagnosed with chronic prostatitis or chronic pelvic pain syndrome.

Here's how to tell if you have interstitial cystitis, what causes it, and what treatment options are available.

Signs and symptoms

IC isn't a "one-size-fits-all" condition, as symptoms and symptom severity can vary from person to person. For some individuals with IC, the condition can be debilitating and have a serious and negative impact on one's quality of life, whereas others may have symptoms that come and go with periodic flare-ups.

"Symptoms of IC/PBS are similar to symptoms one would have with a urinary tract infection (UTI), except there is no presence of infection," says Stacy Sutton, PT, DPT, and founder of Sutton Health Advocacy.

Common signs and symptoms of IC include:

• Bladder pain, pressure, or discomfort
• Frequent or painful urination
• Pelvic pain
• A sense of pressure, discomfort, or pain in the pelvis
• Painful sex or dyspareunia, sex-related distress, and a decline in libido and orgasm frequency
• Urinary tract symptoms of more than 6 weeks' duration, in the absence of infection or other identifiable causes
• Suprapubic pain over the area where the bladder is located
• Increasing pain as the bladder fills with liquid and reduced pain after you go to the bathroom

In addition to the symptoms listed above, men with IC may experience "perineal, groin, penile, or scrotal pain," says Kimberly Langdon, MD, and OB-GYN at Medzino. "Generally, a cystoscope, or camera attached to a tube to visualize the inside of the bladder, is needed to confirm the diagnosis (for both men and women)."

Important: Your doctor will likely do tests to rule out a UTI before doing a cystoscopy. A cystoscopy isn't necessarily needed to begin IC treatment, though one is needed to make sure you have it.

Because the signs and symptoms of IC are similar to that of a chronic UTI, it can be difficult to tell the difference between the two without a urinalysis - a test that's commonly used to detect a UTI.

"The key is to look for a change in symptoms," says Sutton. "For instance, a change in urinary frequency or location of pain could indicate that you have a UTI and not a flare in IC."

If you think you have IC or are having trouble managing it and are experiencing unusual symptoms or blood is present in your urine, you should contact your doctor immediately as an untreated UTI can lead to serious consequences, including permanent kidney damage or sepsis.

"If left untreated, the symptoms of interstitial cystitis can increase as the bladder becomes more irritated and sensitized," says Sutton. "Additionally, with no treatment or intervention, more systems in the body, such as the fascia and the bowels, can be affected."

Cause and triggers

The exact cause of IC is unknown, but there are a few factors that may contribute to or cause a flare-up, including your diet, certain medications, hormone fluctuations, or sexual intercourse, among others.

"Symptoms increase after eating or drinking bladder irritants, such as coffee, tomatoes, soybeans, high potassium-containing foods, spicy food, and citrus," says Sutton.

Other triggers for an IC flare-up may happen if you:

• Are experiencing intense emotions like you're very stressed, sad, or angry
• Have sex
• Have a UTI
• Hold your urine
• Wear tight clothing (pants or undergarments)
• Use bleached, scented, highly-processed or coarse-feeling toilet paper
• Lift or push heavy objects
• Stand for a long period of time
• Take certain medications (including specific antidepressants, sinus medications, and pain relievers)
• Are dehydrated
• Use laundry detergents with chemicals
• Swim in pool water that's loaded with chemicals (chlorine or other disinfectants, pH adjusters, or algaecides)
• Have a pap smear
• Ride in a vehicle for a long period of time

Moreover, "patients with IC have a high incidence of associated conditions," says Langdon. In other words, you may experience one or more conditions at once.

If you have one, or multiple, of the following conditions you may be at a higher risk for IC:

• Endometriosis
• Vulvodynia
• Chronic fatigue syndrome
• Allergies
• Irritable bowel syndrome
• Fibromyalgia
• Focal vulvitis (inflamed vulva)

Treatment options

Although IC is an incurable condition, it is manageable via a combination of clinical and natural therapies.

"Managing pain includes implementing behavioral modifications such as identifying and eliminating foods and beverages that are irritating to the bladder," says Sutton. "Effective pain management should also include pelvic physical therapy to treat overactive pelvic floor muscles that can be causing pain."

According to the guidelines developed by the American Urological Association (AUA), when it comes to treatment, IC recommends a "stepwise approach" - a treatment plan that's modified based on its results and ability to manage your symptoms.

Lifestyle changes or behavioral modifications

The AUA recommends starting your treatment journey with conservative and non-invasive (i.e. non-surgical) approaches, including:

• Making dietary changes: Avoid bladder irritants, such as carbonated beverages, caffeine, citrus products, and foods that contain high amounts of vitamin C and implementing an IC-friendly diet.
• Wearing loose-fitting clothing: Avoid anything that's tight on your waist or abdomen.
• Managing your stress levels: Stress plays a crucial role in bringing on an IC-flare. Learning basic relaxation techniques or using meditation could help you combat stress and relieve IC-related pain.
• Exercising: Participate in gentle or light exercise, such as easy stretching or low impact aerobics.
• Bladder training: Teaching yourself to urinate at specific times and sticking to a schedule may help you to control urinary urges.

Oral medication

For most, a combination of treatments is the best approach. If the pain-management options listed above don't work, your doctor may recommend trying a medicine as your next line of treatment.

Some oral medications that can help treat IC are TCAs which are a form of antidepressants and Elmiron (or pentosan polysulfate sodium), which is the only FDA-approved medication for IC-related pain. Your doctor may also include over the counter anti-inflammatory medication like ibuprofen to treat your symptoms.

Other options

If you're still not seeing improvement, your doctor may recommend one of the following treatment options:

• Bladder instillation
• Bladder distention
• Transcutaneous electrical nerve stimulation (TENS)
• Surgery (i.e. laser surgery, urinary diversion, or bladder augmentation)

Treatment also depends on treatment preference, symptom severity, and your specialists' - a urologist or gynecologist - judgment or recommendation.

Insider's takeaway

IC is a painful bladder condition that has the potential to impeded your quality of life, which includes your job, sex life, and mental health. If you suspect you have IC, you should contact your doctor to discuss diagnosis and potential treatment options.

You can learn more about IC by visiting one or more of the following sites:

• Interstitial Cystitis Association
• National Institute of Diabetes and Digestive and Kidney Diseases
• Urology Care Foundation
• International Painful Bladder Foundation
• The Interstitial Cystitis Network.

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