Interstitial Cystitis: Symptoms, Causes, and Treatment
Updated: 19 hours ago
Medically reviewed by Dr. Baraa Alnahhal, MD. Last reviewed October 13, 2026. This content is for educational purposes and is not medical advice.
Quick Answer: What is interstitial cystitis?
Interstitial cystitis is a chronic condition causing bladder pressure, bladder pain and sometimes pelvic pain, with persistent urgency and frequent urination of small amounts. Pain builds as the bladder fills and eases after urinating. The cause is unknown. No single treatment works for everyone, but combining diet changes, physical therapy, medications and bladder instillations often brings relief.
What the research says
No single treatment has been proven best. A systematic review of bladder pain syndrome/interstitial cystitis treatments included 13 of 356 articles screened, found no treatment with at least two randomized controlled trials suitable for meta-analysis, and concluded that existing studies could not define the best approach (Pazin et al., International Urogynecology Journal, 2016).
Some drugs lower symptom scores, but not how often you urinate. In a network meta-analysis of 23 randomized trials with 1,871 participants, the O'Leary-Sant symptom index fell significantly more than with placebo on amitriptyline (mean difference −4.9; 95% CI −9.0 to −0.76), cyclosporine A (−7.9), and certolizumab pegol (−3.6), while none of the agents significantly reduced 24-hour urination frequency (Di et al., International Urogynecology Journal, 2021).
Long-term pentosan use is linked to eye changes. A systematic review of 14 papers with primary data found no randomized trials on the question, but available data suggest an increased risk of macular disease after years of pentosan polysulfate sodium use, and the authors suggest regular eye exams for patients who stay on it (Paredes Mogica & De, Urology, 2021).
Guidelines agree on symptoms and diagnosis, but differ on treatment. A systematic review compared 10 national and international IC/BPS guidelines. All agreed on the core symptoms (pain, pressure, discomfort, frequency, urgency and nocturia), urinalysis was a prerequisite for diagnosis, cystoscopy was recommended by most and urodynamics was not part of routine assessment. The guidelines varied to a high degree on treatment recommendations, and the highest level of evidence and consensus was for oral therapies (Pape et al., International Urogynecology Journal, 2019).
Treatment works best as a multimodal, symptom-matched plan. A review of IC/BPS pharmacotherapy under the American Urological Association (AUA) and European Association of Urology (EAU) guidelines concluded that IC/BPS requires a multimodal approach, combining behavioral changes and physical therapy with medicines, and that therapy should be targeted to the patient's symptom profile (Giusto et al., Expert Opinion on Pharmacotherapy, 2018).
Hydrodistension is used less than it used to be. In a database of 69,983 outpatient cystoscopy encounters for IC/BPS (2009 to 2020), 7,502 (10.7%) included hydrodistension. The monthly rate fell from nearly 17% before the 2011 AUA guideline to under 10% by early 2020 (Whiteside et al., Urology Practice, 2021).
How the urinary system normally works
Your bladder is a hollow, muscular organ that stores urine. It expands as it fills, then signals your brain through the pelvic nerves that it is time to urinate. For most people, that signal only fires when the bladder is genuinely full.
With interstitial cystitis, these signals get mixed up. You feel the need to urinate more often, and with smaller volumes of urine, than most people ever do.
Interstitial cystitis is also called bladder pain syndrome (IC/BPS). In the United States it affects an estimated 3 to 8 million women and 1 to 4 million men [9].
What interstitial cystitis looks and feels like
The signs and symptoms vary from person to person, and they can also vary over time for the same person. Flares often respond to common triggers such as menstruation, sitting for a long time, stress, exercise, and sexual activity. Some people even experience symptom-free periods [1].
Symptom | What it looks like |
Pelvic pain (women) | Pain in the pelvis or between the vagina and anus |
Perineal pain (men) | Pain between the scrotum and anus |
Chronic pelvic pain | Ongoing, fluctuating discomfort |
Urgency | A persistent, urgent need to urinate |
Frequency | Urinating often in small amounts, day and night — up to 60 times a day |
Filling pain | Pain or discomfort while the bladder fills, with relief after urinating |
Pain during sex | Discomfort or pain with sexual activity |
One detail matters for getting the right diagnosis: although these symptoms can resemble a chronic urinary tract infection, there is usually no infection. However, symptoms may worsen if a person with interstitial cystitis gets a urinary tract infection [1].
A provider may diagnose IC/BPS if the urine is sterile after infection treatment but symptoms continue [9].
What causes interstitial cystitis?
The exact cause is not known, but it is likely that many factors contribute. The leading theory involves a defect in the protective lining of the bladder, called the epithelium. A leak in this lining may allow substances in urine that would normally be harmless to irritate the bladder wall [1].
Other possible contributors have been suggested — an autoimmune reaction, heredity, infection, or allergy — but none of these has been proven [1].
Other suspected factors include vascular disease, abnormalities in mast cells and abnormal substances in the urine, such as consistently high protein levels [9].
Risk factor | What the evidence shows |
Sex | Women are diagnosed more often than men; in men, similar symptoms are more often tied to prostate inflammation (prostatitis) |
Age | Most people are diagnosed during their 30s or older |
Other chronic pain disorders | May be associated with irritable bowel syndrome or fibromyalgia |
Why it is a spectrum, not one disease
Interstitial cystitis is part of a spectrum of diseases known as painful bladder syndrome. That framing explains two things patients often get wrong.
First, severity differs for everyone. Some people live with mild discomfort; others have severe, life-disrupting pain. Second, the condition is chronic — there is no cure — but medications and other therapies may offer real relief [1].
There are two types. Non-ulcerative IC/BPS, about 90% of cases, shows very tiny hemorrhages (glomerulations) on the bladder wall. Ulcerative IC/BPS, about 5% to 10% of people with the condition, involves Hunner's ulcers, painful sores on the bladder wall. Stage 4 means symptoms have lasted more than two years and the bladder tissue has become very hard and holds less urine [9].
The complications worth taking seriously include a reduced bladder capacity (the bladder wall can stiffen and hold less urine), a lower quality of life as frequency and pain interfere with social life and work, strain on sexual intimacy, and emotional trouble such as stress and depression from chronic pain and interrupted sleep [1].
Most people need treatment for their entire lives. The condition is not life-threatening, does not cause bladder cancer and does not affect life expectancy. Go to the nearest emergency room if symptoms are severe or do not go away after treatment [9].
How interstitial cystitis is diagnosed
Because IC mimics a chronic UTI and other conditions, diagnosis is about ruling things out and finding the pattern. The workup typically combines several steps [2].
Test or step | What it does |
Medical history and bladder diary | You record how often you urinate and the volume of fluids you drink and pass, over a few days |
Pelvic exam | External exam plus assessment of internal pelvic organs |
Urine test | Looks for signs of a urinary tract infection |
Cystoscopy | A thin camera through the urethra shows the bladder lining; liquid may be injected to measure bladder capacity (hydrodistention) |
Biopsy | A tissue sample taken during cystoscopy under anesthesia, to check for bladder cancer and other rare causes of bladder pain |
Urine cytology | Urine cells are examined to help rule out cancer |
Potassium sensitivity test | Water and a potassium chloride solution are placed into the bladder one at a time; noticeably more pain or urgency with potassium suggests IC, because people with typical bladders cannot tell the two apart |
For further testing, you may be referred to a urologist (a specialist in urinary disorders) or a urogynecologist (urinary disorders in women) [2].
How interstitial cystitis is treated
There is no simple treatment that eliminates the signs and symptoms, and no one treatment works for everyone. You may need to try several treatments — or combinations — before finding an approach that relieves your symptoms [2].
A provider will also consider other conditions that may cause part of the pain, including hormonal imbalances, endometriosis and bowel problems, and it may take several weeks or months of treatment before symptoms improve [9].
Physical therapy
Working with a physical therapist may relieve pelvic pain tied to muscle tenderness, restrictive connective tissue, or muscle abnormalities in the pelvic floor [2].
Oral medications
Several medicines taken by mouth can improve symptoms [2]:
Medicine type | Examples | What it does |
NSAIDs | Ibuprofen (Advil, Motrin IB), naproxen sodium (Aleve) | Relieves pain |
Tricyclic antidepressants | Amitriptyline, imipramine (Tofranil) | Helps relax the bladder and block pain |
Antihistamines | Loratadine (Claritin) | May reduce urinary urgency and frequency |
Pentosan polysulfate sodium (Elmiron) | FDA-approved specifically for interstitial cystitis | May restore the inner surface of the bladder; pain relief can take 2–4 months and reduced frequency up to 6 months |
One important caution on the last row: macular eye disease has been associated with pentosan polysulfate sodium in some people. A comprehensive eye exam is typically needed before starting, with additional exams to monitor while on therapy [2].
Other oral options include over-the-counter antacids, which a provider may suggest taking with meals if acidic foods trigger flare-ups, and the antihistamine hydroxyzine [9].
Nerve stimulation
Two electrical approaches target the nerves that control the bladder [2]. Transcutaneous electrical nerve stimulation (TENS) uses wires placed on the lower back or above the pubic area to send mild pulses that may relieve pelvic pain and sometimes reduce frequency. Sacral nerve stimulation places a thin wire near the sacral nerves — the main link between the spinal cord and the bladder nerves — and, if a trial works, a permanent device can be surgically implanted under the skin of the lower back. Notably, sacral stimulation does not manage pain, but it may relieve frequency and urgency.
Nerve stimulation is also described as sometimes helping to ease pain in the bladder and abdominal area [9].
Bladder treatments
Bladder distention — stretching the bladder with water during cystoscopy — gives some people temporary improvement that can be repeated [2]. Botulinum toxin A (Botox) can be injected into the bladder wall during distention, but this option carries a risk of incomplete bladder emptying, which can require self-catheterization afterward [2].
Another route is bladder instillation: the medication dimethyl sulfoxide (DMSO, Rimso-50) is placed into the bladder through a catheter, sometimes mixed with a local anesthetic, and held for about 15 minutes. Treatment is often weekly for six to eight weeks, with maintenance sessions as needed for up to a year. An alternative solution combines lidocaine, sodium bicarbonate, and either pentosan or heparin [2].
The instilled mixture may also include a steroid and a numbing medication, and repeat botulinum toxin injections may be needed every four to nine months [9].
Surgery — rarely, and only as a last resort
Doctors rarely use surgery for interstitial cystitis, because removing the bladder does not relieve pain and can create other complications. It is considered for severe pain or very small bladder capacity only after other treatments fail and symptoms seriously affect quality of life [2]. Options include fulguration (burning off ulcers through the urethra), resection (cutting around ulcers), and bladder augmentation (patching the bladder with intestine to increase capacity — rare, it does not eliminate pain, and some people must catheterize many times a day afterward) [2].
For severe symptoms that do not respond to other treatments, removing part or all of the bladder (cystectomy) is also described as an option [9].
Self-care you can start now
Many people find relief from strategies they can apply at home [2]:
Dietary changes center on the “four Cs” — carbonated beverages, caffeine in all forms (including chocolate), citrus products, and foods with high vitamin C. Tomatoes, pickled foods, alcohol, spices, and artificial sweeteners can also aggravate symptoms. The practical method is elimination followed by reintroduction: cut out suspect foods, then bring them back one at a time and watch which worsen symptoms.
Bladder training means timed urination — going by the clock rather than the urge. You start on set intervals, such as every half-hour, then gradually stretch the time between visits. Relaxation techniques like slow, deep breathing or distraction can help you ride out urges in between.
A few smaller habits round out self-care: wear loose clothing that does not press on your abdomen, reduce stress through visualization or biofeedback, quit smoking (which can worsen any painful condition and contributes to bladder cancer), and try easy stretching exercises [2].
Walking, bicycling and gentle stretching or yoga may help. During a flare-up, steps that may shorten or ease it include taking symptom-relief medicine as soon as it starts, drinking plenty of water, using an ice pack or heating pad, taking a warm sitz bath, and, if intercourse triggers symptoms, taking a pain reliever beforehand and using lubricant [9].
Complementary approaches
Two alternative therapies show some promise — guided imagery, which uses visualization and suggestion to imagine healing, and acupuncture. Neither has been well studied for interstitial cystitis, so discuss either with your provider before starting [2].
Bottom line
Interstitial cystitis is a chronic, often frustrating condition — but it is not untreatable. The realistic expectation is a journey of trial and adjustment: diet changes and bladder training form the foundation, medications and instillations add a second layer, physical therapy and nerve stimulation a third, and surgery remains a rare last resort. Because symptoms flare and recede, the best plan is one you build with a provider who treats your quality of life as seriously as the condition itself, and because pain and interrupted sleep can take an emotional toll, support from loved ones — or a support group — is genuinely part of the treatment [1] [2].
Next steps
If chronic bladder pain or urinary urgency and frequency is part of your daily life, the single most useful thing you can do this week is keep a bladder diary and book an appointment.
Frequently asked questions
Is interstitial cystitis the same as a urinary tract infection? No. Interstitial cystitis usually occurs without any infection, which is why repeated “UTI treatments” with antibiotics often fail. The symptoms look similar, but the causes and treatments are different — though a real UTI can temporarily worsen IC symptoms.
Why is interstitial cystitis called painful bladder syndrome? Painful bladder syndrome is the name of the spectrum of conditions that interstitial cystitis belongs to. Both terms describe chronic bladder pressure and pain without infection, and you will see them used interchangeably.
What are the “four Cs” to avoid with interstitial cystitis? The four Cs are carbonated beverages, caffeine in all forms (including chocolate), citrus products, and high-vitamin-C foods. These commonly irritate the bladder; tomatoes, pickled foods, alcohol, and spices can also trigger symptoms.
How long does it take for IC medicine to work? Some medicines act quickly for pain, but the FDA-approved IC drug pentosan polysulfate sodium (Elmiron) can take two to four months for pain relief and up to six months for reduced urinary frequency — and it requires eye exams because of a possible link to macular eye disease.
Can interstitial cystitis lead to bladder cancer? No. Interstitial cystitis does not cause bladder cancer. However, because bladder pain can have rare serious causes, doctors often use cystoscopy, biopsy, and urine cytology to rule cancer out during diagnosis.
Trusted External Resources
Related Reading
Learn more in our guide to Cystoscopy: Purpose, Procedure, Recovery and Risks.
References
Mayo Clinic Staff. Interstitial cystitis: Symptoms and causes. Mayo Clinic. September 29, 2021. https://www.mayoclinic.org/diseases-conditions/interstitial-cystitis/symptoms-causes/syc-20354357
Mayo Clinic Staff. Interstitial cystitis: Diagnosis and treatment. Mayo Clinic. September 29, 2021. https://www.mayoclinic.org/diseases-conditions/interstitial-cystitis/diagnosis-treatment/drc-20354362
Pazin C, et al. Treatment of bladder pain syndrome and interstitial cystitis: a systematic review. Int Urogynecol J. 2016;27(5):697-708. PMID 26272202. https://doi.org/10.1007/s00192-015-2815-5
Di XP, Luo DY, Jin X, et al. Efficacy and safety comparison of pharmacotherapies for interstitial cystitis and bladder pain syndrome: a systematic review and Bayesian network meta-analysis. Int Urogynecol J. 2021;32(5):1129-1141. PMID 33638677. https://doi.org/10.1007/s00192-020-04659-w
Paredes Mogica JA, De EJB. Pentosan Polysulfate Maculopathy: What Urologists Should Know in 2020. Urology. 2021;147:109-118. PMID 33045286. https://doi.org/10.1016/j.urology.2020.08.072
Pape J, Falconi G, De Mattos Lourenco TR, et al. Variations in bladder pain syndrome/interstitial cystitis (IC) definitions, pathogenesis, diagnostics and treatment: a systematic review and evaluation of national and international guidelines. Int Urogynecol J. 2019;30(11):1795-1805. PMID 31073635. https://doi.org/10.1007/s00192-019-03970-5
Giusto LL, Zahner PM, Shoskes DA. An evaluation of the pharmacotherapy for interstitial cystitis. Expert Opin Pharmacother. 2018;19(10):1097-1108. PMID 29972328. https://doi.org/10.1080/14656566.2018.1491968
Whiteside JL, Murillo A, Meganathan K, et al. The Practice of Cystoscopy with Hydrodistention Since the 2011 American Urological Association Clinical Guideline on Interstitial Cystitis/Bladder Pain Syndrome. Urol Pract. 2021;8(6):676-681. PMID 37145506. https://doi.org/10.1097/UPJ.0000000000000255
Cleveland Clinic. Interstitial Cystitis/Bladder Pain Syndrome. Cleveland Clinic. Last updated November 12, 2024. https://my.clevelandclinic.org/health/diseases/15735-interstitial-cystitis-painful-bladder-syndrome
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