If you have interstitial cystitis (IC), also known as bladder pain syndrome (BPS), you might dread every trip to the toilet when you’re having a flare-up. IC happens when you have chronic pain, pressure, or discomfort in your bladder area with no evidence of an infection. Along with pain, it also causes sudden urges to pee and frequent bathroom breaks (though symptoms and their severity vary from person to person).
Experts in This Article
director of women’s health in the Brady Urological Institute at Johns Hopkins Medicine
Anyone can get IC, but the following groups have a higher risk, per the Cleveland Clinic:
- People assigned female at birth (AFAB)
- People who are 30 or older
- People who have another condition that causes chronic pain
The cause of IC is still mostly a mystery, and there’s currently no cut-and-dry cure. However, there are many ways to manage it. “Most treatments are targeted at symptom control,” says Marisa M. Clifton, MD, FACS, director of women’s health in the Brady Urological Institute at Johns Hopkins Medicine.
No one treatment works for everyone, and many people with IC find that a combination of things works best. Along with medical therapies, lifestyle changes and self-care practices can make a big difference for decreasing discomfort and pain.
Read on to learn what you can do at home for greater relief when you have IC.
The best interstitial cystitis self-care tips
Stress and certain habits can trigger an IC flare (more on this later), but there are ways to manage symptoms. The following things may help keep flares in check. But keep in mind: “Different patients may find relief from different techniques,” Dr. Clifton says. So if one strategy doesn’t work for you, don’t get discouraged: Try another. Through trial and error, you’ll learn what your body responds to best.
1. Avoid triggering foods
Though there’s no concrete evidence that diet affects IC, some experts theorize that certain foods might inflame the bladder and worsen the condition, according to Johns Hopkins Medicine. If you have IC, it might be best to limit or avoid the following foods:
- Citrus fruits
- Tomatoes
- Chocolate
- Coffee
- Potassium-rich foods
- Alcoholic beverages
- Caffeinated beverages
- Spicy foods
- Spices
- High-acid foods
- Some carbonated beverages
2. Practice stress-management techniques
You might notice your IC flares up when you’re feeling super stressed. That’s no coincidence. Stress “can heighten pain sensitivity in general,” Dr. Clifton says. “Both doctors and patients should be mindful of stressors that may trigger symptoms,” she says.
Once you’ve identified your triggers, you can work on managing your stress response. Deep breathing, yoga, and meditation are known to help relieve stress. You may also find talking to a therapist a helpful tool as well, Dr. Clifton says.
By getting a better handle on your stress, you may see an improvement in your symptoms, she says.
3. Get proper sleep
Your body needs quality sleep to function at its best. And when it comes to managing IC, there’s no exception. For one, following a consistent sleep schedule can prevent fatigue. “Decreasing fatigue can help with perceived pain and bladder symptoms,” Dr. Clifton says. In fact, there seems to be a link between chronic sleep problems and urinary symptoms. When “patients have difficulty falling or remaining asleep, bladder symptoms can be heightened,” she says.
Secondly, “routine sleep practices help with overall stress,” Dr. Clifton says. And as we know, stress management is key to symptom management for people with IC.
4. Incorporate low-impact exercise
“Staying active and maintaining a healthy weight and lifestyle is imperative to symptom management,” Dr. Clifton says. Regular physical activity can help:
- Improve your sleep quality
- Reduce fatigue
- Enhance mood
- Decrease systemic stress
All of these benefits are important when managing IC symptoms.
Just stick to low-impact exercise like walking or yoga. “High-impact [exercise] or extreme weightlifting can worsen symptoms,” Dr. Clifton says. Especially if your form is off. This can put undue stress on muscles near your bladder. “Muscle and tendon injuries can result in strain to surrounding structures and aggravate muscle tension,” she says.
5. Wear loose clothing
“In patients with muscle tension or pain, tight clothing can be uncomfortable and aggravate symptoms,” Dr. Clifton says.
Moral of the story: Let your belly breathe. Try to avoid clothing that puts pressure on your abdomen, including tight pants, hosiery, tights, and girdles, according to the Cleveland Clinic.
6. Take a warm sitz bath
ICYDK, a sitz bath is a warm, shallow bath you sit in to alleviate pain. Sitz baths can “help relax tense muscles that can be contributing to symptoms,” Dr. Clifton says. Because they’re relaxing, they’re also good for reducing anxiety and stress, she says.
Not a big fan of baths? Use a warm heating pad instead. Just don’t keep it in one place for too long. “It is important to rotate locations where heating pads are applied, as prolonged high heat can result in sensation and skin changes,” Dr. Clifton says.
7. Get a massage
A relaxing rubdown can help reduce IC symptoms as well. Stress can affect your whole body, including your nerves and muscles. “Massage, and specifically myofascial release, can be incredibly important in improving symptoms,” Dr. Clifton says. “Not only does massage decrease overall stress, but it can also target specific areas of muscle tension.”
8. Try acupuncture
“Patients may also experience benefits from acupuncture,” a healing treatment based in Traditional Chinese Medicine, Dr. Clifton says. This is exactly what a small June 2022 study in the Canadian Journal of Urology1 concluded. People AFAB reported less pain and pelvic floor tenderness after six weekly treatments of electroacupuncture (which involves inserting small needles into the skin and stimulating them with electrical current).
How acupuncture relieves pain is still not fully understood. Through the lens of Traditional Chinese Medicine, pain relief is achieved by rebalancing the flow of life energy, according to the Mayo Clinic. Alternatively, Western medical providers theorize that acupuncture promotes your body’s natural painkillers.
9. See a pelvic floor therapist
Your pelvic floor muscles play a pivotal part in bladder health: not only do they keep your bladder in its proper position, but they also help control your pee, according to the Cleveland Clinic.
That’s why it’s essential that these muscles are working well. One way to do that is by seeing a pelvic floor physical therapist. “Pelvic floor physical therapists are experts in non-medical and non-surgical therapies to improve pelvic floor symptoms,” Dr. Clifton says.
They can help you reduce IC symptoms by teaching you how to properly exercise, stretch, and relax your pelvic muscles. “Having an expert physical therapist guide patients through the correct relaxation exercises is imperative,” Dr. Clifton says.
“Pelvic floor physical therapists are also trained to perform maneuvers that can improve pelvic, abdominal, and leg muscle trigger points,” Dr. Clifton says. Research shows that techniques like internal massage and myofascial release are more effective for IC symptom relief compared to regular therapeutic massage. “They can also release painful scars that may be contributing to symptoms,” she adds.
Note: “It is incredibly important that IC patients avoid pelvic floor strengthening such as Kegel exercises,” Dr. Clifton says. These types of exercise can worsen bladder symptoms.
10. Try bladder training
When you have IC, you may feel pressure or pain when your bladder is filling, and this can cause an urgent or frequent need to pee. This means you may be running to the bathroom a lot. Bladder training is a behavior therapy that aims to help you hold your pee longer.
“Bladder training can be very helpful for patients with IC,” Dr. Clifton says. The basic idea is you pee at scheduled times and use strategies (like relaxation techniques and distractions) to help keep to the timetable, according to Johns Hopkins Medicine. Eventually, the goal is to increase the amount of time between bathroom breaks.
While bladder training can be effective, you might need a little guidance along the way. “It may be best that patients visit with a pelvic floor physical therapist who has expertise in this condition to ensure an optimized outcome,” Dr. Clifton says.
11. Connect members of your care team
People with IC have the best outcomes when their providers engage other teams to help support them, Dr. Clifton says. As the saying goes, it takes a village.
This means your doctor should work with other providers who can “help with concomitant medical conditions,” Dr. Clifton says. For instance, certain health issues may exacerbate IC symptoms (including but not limited to irritable bowel syndrome, endometriosis, recurrent vaginitis/vestibulitis, fibromyalgia, and others), she says. So, say you see an OB/GYN to manage your endometriosis. Tell them about your IC symptoms and connect them with your urologist. Together, they can come up with a plan to best help you.
Other treatment options for IC
Sometimes lifestyle and self-care habits won’t cut it. In these cases, you still have many options for treating IC.
The first step is seeing your provider for a proper diagnosis. They’ll start by ruling out other infections (like urinary tract infections) or conditions (like bladder cancer). Some tests they may order to help with a IC diagnosis include, per the Cleveland Clinic:
- Urinalysis (urine test): Your provider will examine your pee sample with a microscope to look for blood in your pee (hematuria) and signs of an infection, such as organisms, germs, pus, or white blood cells.
- Biopsy: While you’re sedated, your provider uses a thin needle to take a tissue sample of your bladder wall and urethra (the tube through which pee passes out of your body) to rule out other conditions, including bladder cancer.
- Cystoscopy: Your provider will examine the inside of your bladder with a cystoscope (a thin, lighted tube with an eyepiece on one end).
Once your doctor has ruled out other medical issues, and you have a proper IC diagnosis, you can discuss treatments. “Many studies indicate that there is no one single treatment that works well over time for the majority of patients,” Dr. Clifton says. “Therefore, the approach should be tailored to specific symptoms of each patient to optimize the patient’s quality of life,” she says.
Additionally, your provider should always discuss the risks, benefits, and alternatives for each IC treatment to help you make an informed decision about your care.
Some IC treatments include, per the Cleveland Clinic, Johns Hopkins Medicine, and the Mayo Clinic:
1. Nonsteroidal anti-inflammatory drugs (NSAIDs)
Over-the-counter medicines such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) can help relieve pain.
2. Certain antidepressants
Low doses of a tricyclic antidepressant such as amitriptyline or imipramine may help relax your bladder and reduce pain and urinary frequency.
3. Antihistamines
Histamine may cause IC/BPS symptoms, so antihistamines like loratadine, hydroxyzine, and others may reduce urinary urgency and frequency and relieve other symptoms.
4. Elmiron (pentosan polysulfate sodium)
The FDA approved this medicine specifically for treating IC. While experts aren’t sure how it works, they believe it may restore the inner surface of the bladder, which protects the bladder wall from possible irritants. But the benefits of the drug aren’t instant—it can take up to six months for pain relief or to see an improvement in urinary frequency, according to the Interstitial Cystitis Association.
Note: In some people, Elmiron has been linked to macular eye disease, per a medication guide from the National Institutes of Health. Before taking this medication, see your eye doctor, who will likely monitor you for signs of eye disease during the course of treatment.
5. Transcutaneous electrical nerve stimulation (TENS) machine
This treatment involves placing wires on your lower back or just above your pubic area that deliver mild, electrical pulses. For some, TENS eases bladder pain and urinary frequency and urgency.
6. Sacral nerve stimulation
With this treatment, a thin wire is placed near the sacral nerves (which link the spinal cord and nerves in your bladder). These nerves are stimulated through electrical impulses that are sent to your bladder. While sacral nerve stimulation won’t lessen pain, it may help relieve some symptoms of urinary frequency and urgency.
7. Bladder instillation of medicine
Your provider will insert a catheter in your urethra up to your bladder. They’ll then fill your bladder with a mixture of medications to help alleviate symptoms.
8. Bladder stretching (hydrodistension)
While under anesthesia, your provider fills your bladder with sterile water to stretch it out. This increases the volume of pee your bladder can contain. The procedure may also calm or break the overactive nerve endings (which signals to your brain that your bladder is in pain).
9. Botulinum toxin injections
Your health care provider injects small amounts of botulinum toxin (Botox) into your bladder muscle through a cystoscope. This paralyzes the muscles and helps alleviate pain.
10. Surgery
If you have severe IC/BPS symptoms that don’t respond to other treatments, your doctor may recommend surgery to remove part or all of your bladder (cystectomy).
When to see a doctor
If you have bladder-related symptoms—like painful, urgent, and/or frequent urination—that are severe or fail to improve, it’s time to see your provider, Dr. Clifton says. They can do tests to rule out other conditions that may have similar symptoms.
When you already have an IC diagnosis, check in with your doctor if:
- You have blood in your urine (hematuria)
- Lifestyle changes, stress reduction, and noninvasive therapies don’t improve symptoms
While there’s no cure for IC, you don’t have to suffer. Sometimes it takes a little trial and error to find the right combination of self-care strategies and medical treatments that work for you.
Work with an IC expert, who can assess your situation and symptoms and help you figure out your best treatment options. Often, IC specialists will “recommend physical therapists who are skilled at treating patients with pelvic pain conditions,” Dr. Clifton says.
FAQs
Is drinking a lot of water good for interstitial cystitis?
It depends on the person. “Some patients have worsened bladder symptoms when they drink large volumes of fluid,” Dr. Clifton says. In these cases, more H2O means more painful bathroom trips.
On the other hand, some folks find that sipping on a lot of water may help pain since it dilutes pee, according to the Cleveland Clinic. When your pee is less concentrated, it might be less irritating to the bladder.
What aggravates interstitial cystitis?
Most people with IC notice that certain foods lead to flares, like the ones we listed above.
Along with foods, certain habits can exacerbate IC. For example, smoking can worsen IC symptoms, according to Johns Hopkins Medicine.
Other things that may trigger IC flare-ups, per the Cleveland Clinic, include:
- Stress
- Sexual intercourse
- Your monthly menstrual cycle
- Constipation
Is cranberry juice good for cystitis?
You may have heard that drinking cranberry juice can help people with recurrent UTIs. “However, there is no data demonstrating that cranberry juice will help with IC,” Dr. Clifton says. “Additionally, cranberry juice can have high sugar content or include sugar substitutes that can be irritating to the bladder.”
—reviewed by Jennifer Gilbert, MD, MPH
Bresler L, Westbay LC, Hekman L, Joyce C, Fitzgerald CM. Acupuncture for female bladder pain syndrome: a randomized controlled trial. Can J Urol. 2022 Jun;29(3):11154-11161. PMID: 35691037.
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