Interstitial Cystitis (Painful Bladder)

What it is

Interstitial cystitis, or painful bladder syndrome, is a chronic condition in which the bladder hurts or feels heavy as it fills, with frequent and urgent urges to urinate, without infection on urine tests. It affects mainly women, usually appears between ages 30 and 50, and is often mistaken for recurrent urinary tract infections, which delays diagnosis and leads to unnecessary antibiotics. The pain can extend to the pelvis, worsen during intercourse and around the menstrual period, and interfere with sleep, work, and relationships. The gynecology team at Femi Saúde evaluates the condition and manages treatment, in partnership with urology and pelvic-floor physiotherapy.

Most common symptoms

• Bladder pain or pressure that worsens as it fills
• Partial pain relief after urinating
• Needing to urinate frequently, day and night
• Urgency to urinate even with a small volume
• Pelvic pain that worsens during intercourse
• Symptoms that worsen around the menstrual period
• Normal urine tests despite the symptoms

Causes and risk factors

• A defect in the protective lining of the bladder wall
• Chronic inflammation and activation of immune cells in the bladder
• Sensitization of the pelvic nerves
• Tension in the pelvic-floor muscles
• Association with endometriosis, fibromyalgia, and irritable bowel syndrome
• Previous urinary tract infections, as a trigger

How it is diagnosed

Diagnosis is clinical and based on pain associated with the bladder, along with urgency and frequency lasting more than six weeks, after other causes have been ruled out. The gynecologist assesses the history, the pattern of pain, and its relationship to diet, menstruation, and intercourse. The gynecological exam looks for tender points in the pelvic floor and bladder. Urinalysis and urine culture rule out infection; ultrasound evaluates the uterus, ovaries, and post-void residual. A voiding diary records volumes and timing. Cystoscopy, performed by urology, is indicated in selected cases to examine the bladder wall and rule out other conditions.

How we treat it at Femi Saúde

There's no definitive cure, but most women achieve symptom control with a combined plan. The gynecology team at Femi Saúde starts with dietary guidance, identifying foods and drinks that worsen the pain, and with bladder training. Pelvic-floor physiotherapy relaxes tense muscles and is one of the most effective measures. Oral medications, such as pain relievers, antihistamines, and pain modulators, and instillations of protective substances into the bladder are options depending on the response. Associated conditions, such as endometriosis, are treated jointly. Bladder procedures are reserved for refractory cases, together with urology. The plan is individualized.

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