IBS and Painful Bladder Syndrome (Interstitial cystitis)

Painful bladder syndrome is challenging to cope with, especially if in combination with IBS. 

Studies have shown that people with both IBS and painful bladder syndrome combined have a lower quality of life than those without (1). When symptoms are present, it can affect your social life, work life, and even sleep.

This article will explain what painful bladder syndrome is, how it links with IBS, and how to manage the symptoms.

What is painful bladder syndrome?

Painful bladder syndrome is a bladder condition that causes long-term pain and problems passing urine (1). It is usually diagnosed if you have had symptoms for 6 months or longer.

It is sometimes referred to as interstitial cystitis: a subgroup of painful bladder syndrome where there are lesions or inflammation in the bladder (2).

What are the symptoms of painful bladder syndrome?

Symptoms of painful bladder syndrome can vary from person to person, much like IBS. 

The main symptoms include (2):

• Pain or discomfort in the bladder
• Pressure in the bladder
• Frequently needing to pass urine (including throughout the night)
• Urinary urgency

Diagnosis of painful bladder syndrome should be made by a medical professional or a doctor who can investigate further and exclude other bladder-related conditions such as endometriosis. 

Is painful bladder syndrome linked to IBS?

Research has shown that people with IBS are more likely to get painful bladder syndrome than people without IBS (3).

It is not clear why there is a higher prevalence of painful bladder syndrome in those with IBS. Therefore, more research is needed on this (3). 

One theory is the role of an inflammatory process called cross-sensitisation among the nerves of the bowel and the bladder. Research is currently underway to better understand the factors which may be responsible for the link between IBS and painful bladder syndrome (4). 

Interestingly, many of the recommended changes for management of painful bladder syndrome also align with recommendations for IBS management (5).

How to manage painful bladder syndrome

There is currently no cure for painful bladder syndrome, however there are ways you can improve your symptoms.

International guidelines for the management of painful bladder syndrome recommend lifestyle changes in the first instance for example stress management, gentle activities such as yoga and pelvic relaxation exercises (6). 

Stress management

Worsening symptoms of painful bladder syndrome are linked to increased stress (7). Stress can also increase symptoms in IBS. Here is our guide on how stress affects IBS. 

However, psychological support, whether professional or from social support, can improve symptoms and overall quality of life (8).

Suggestions of coping mechanisms for stress include:

• Reaching out to family or friends
• Include things in your routine that you enjoy
• Breathing techniques
• Relaxation techniques
• Regular exercise
• Cognitive behavioral therapy (CBT)

Pelvic relaxation exercises

Pelvic floor relaxation exercises and ‘bladder training’ can be useful to decrease the frequency and urgency of urination (9).

There is no research that shows pelvic floor exercises (e.g kegel exercises) to be beneficial if you have painful bladder syndrome (10). 

Physiotherapists may be able to perform manual exercises to release tension, or advise how you can do this yourself. 

Recommended exercises to do at home may include (11):

• Hugging knees to chest
• Squatting
• Reclining with spread legs  

Yoga 

Yoga has been shown to ease symptoms for those with painful bladder syndrome, specifically improving bothersome bladder symptoms and pain (12).

Other management options

Dietary changes are also one of the main first line treatments for painful bladder syndrome (more information in the section below).

Other management techniques include (11):

• Hot and cold therapy
• Medication
• Stopping smoking (the chemicals in cigarettes are a bladder irritant)
• Botulinum A injection or surgery (in severe cases)

Painful bladder syndrome and diet

Up to 90% of people with painful bladder syndrome report that they get changes in their symptoms depending on what they eat (13). However, sensitivity to foods is specific to each person.

Foods which have been reported to worsen symptoms in patients with painful bladder syndrome include (13):

• Alcohol
• Caffeinated drinks 
• Carbonated drinks
• Spicy foods
• Tomatoes
• Citrus fruits (lemon, orange, grapefruits)

It may be useful to keep a food diary to determine which foods or drinks may be contributing towards your symptoms, but it is recommended to do this in line with a registered dietitian or other medical professional to help accurately pinpoint this. 

Summary

Painful bladder syndrome often co-occurs with IBS, usually presenting with urinary symptoms such as urgency and frequency. Although there is no cure, there are multiple management techniques which can help manage your symptoms, so it is important to find out what works best for you.

Written by Annabelle Green, Student Dietitian reviewed by Serena Bansal Registered Dietitian BSc Hons