By Susan Pierce Richards, DNP, ARNP, FNP-BC, ANP-BC, RN-BC
Disclaimer: This document and resource list is for information only, is not medical advice and is not a substitute for an evaluation by your healthcare provider. Interstitial cystitis/Painful bladder syndrome requires careful history and some testing to rule out other causes or concomitant causes for pelvic and urinary symptoms
Not all pelvic pain is endometriosis.
Interstitial Cystitis/Bladder Pain Syndrome – a common cause of pelvic pain in individuals with endometriosis.
Individuals with endometriosis and pelvic pain frequently have more than one condition that contributes to their pelvic pain.
What is Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS)
Definition from the American Urological Association UC/PBS Treatment Guideline:
“An unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms of more than six weeks duration, in the absence of infection or other identifiable causes.” (https://www.auanet.org/guidelines/interstitial-cystitis/bladder-pain-syndrome-(2011-amended-2014)#4)
The AUA selected this definition because it allows treatment to begin after a relatively short symptomatic period, preventing treatment delays that could occur with definitions that require longer symptom durations (i.e., six months). The AUA recommends clinicians (as opposed to researchers) against using strict definitions used in research or clinical trials because many patients may experience misdiagnosis or delays in diagnosis resulting in delays in treatment.
Symptoms
From RAND IC Epidemiology (RICE) Study:
“Pain, pressure or discomfort in the pelvic area AND daytime urinary frequency of 10+ OR urgency due to pain, pressure, or discomfort, not fear of wetting.”
Treatment
There is not a “one size fits most” treatment for IC/BPS. There are many treatment options and most individuals require more than one treatment at the same time to relieve symptoms. For example, an individual may need to avoid dietary triggers, have physical therapy, and take over counter medications. Another individual may need to avoid dietary triggers and have medications instilled in their bladder periodically. Finding the right combination of treatments requires that individuals with IC/BPS engage with their health care team and exercise patience as they and their team work through various treatment combinations. A great first step is to educate oneself about IC/BPS.
Links:
- Overview of IC/BPS from the Urology Care Foundation: Interstitial cystitis/bladder pain syndrome (IC/BPS)
- Overview of treatment from Interstitial Cystitis Association: https://www.ichelp.org/wp-content/uploads/2015/05/AUA-IC-Guideline-September-2014-Update-final.pdf
- Full guidelines from the America Urological Association: https://www.auanet.org/common/pdf/education/clinical-guidance/IC-Bladder-Pain-Syndrome-Revised.pdf
Symptom questionnaire:
Pelvic Pain and Urgency/Frequency (PUF)Patient Symptom scale: This tool assists clinicians in diagnosing IC/BPS and monitoring response to interventions. Remember that this is just one piece of information in a detailed evaluation.
Diet:
Patients with IC/BPS often have dietary triggers and can vary among patients. It is important to explore and identify your dietary triggers. Consider keeping a detailed journal to help identify dietary triggers.
Commonly reported triggers:
- Coffee, tea, soda, alcohol, citrus juices, and cranberry juice
- Foods and beverages containing artificial sweeteners
- Hot peppers and spicy foods
- Many nuts
- Carbonated beverages
- Tomatoes
- Soy
- MSG (monosodium glutamate)***
***Monosodium glutamate is frequently contained in foods and not always labeled because there are over 40 ingredients in foods can contain MSG/Free glutamic acid. MSG is highly prevalent in processed foods, even organic processed foods and restaurant foods.
Links on Nutrition:
- Hidden sources of MSG: http://www.truthinlabeling.org/hiddensources.html
- Dietary trigger avoidance from the Interstitial Cystitis Association: https://www.ichelp.org/living-with-ic/interstitial-cystitis-and-diet/foods-to-avoid/
- IC and food sensitivities by Erin Luyendyk, RHN: http://www.thenutritionista.ca/ic-and-food-sensitivities/
- Nutrition overview by Erin Luyendyk, RHN: ENDOMETRIOSIS & NUTRITION
Additional Resources
- American Urological Association guidelines for IC/BPS: https://www.auanet.org/guidelines/interstitial-cystitis-(ic/bps)-guideline
- Interstitial Cystitis Association: https://www.ichelp.org
- Urology Care Foundation: https://www.urologyhealth.org/urologic-conditions/interstitial-cystitis
- Overview of IC/BPS from an endometriosis expert: http://pacificendometriosis.com/interstitial-cystitis/
