Managing Interstitial Cystitis & Bladder Pain Flares

IC/BPS patients often struggle with “IC flares,” a sudden and dramatic worsening of their bladder symptoms. Lasting from hours to weeks, IC flares can be unpredictable, disruptive and difficult to manage for both newly diagnosed and veteran IC patients.  Flares can be triggered in many different ways that irritate the bladder wall, tighten pelvic floor muscles and/or sensitize nerves. Food related flares may be felt within minutes or hours of eating a risk food and may last a day or longer. A sex induced flare may occur 24-48 hours after intimacy and last for several days. Hormone induced flares, such as the flare which may occur during ovulation, may last just a few hours. The good news is that many IC flares are preventable and are often predictable. 

Are you flaring right now?

Confused? Frustrated? Desperate for relief? Your first step is to try determine what kind of flare you are having. Did your flare after eating or drinking a food? Are you under intense stress?? Did you take a long car ride? Have sex?

When is your pain the worst?

  • Pain BEFORE urination (that gets worse as you bladder FILLS with urine and feels better once you have emptied your bladder) points to your bladder wall.
  • Pain AFTER urination points to your pelvic floor as the probable source of your flare.
  • If pain is intense before and after urination, you may have a combination flare that is involving the bladder, muscles and nerves.

Bladder Wall Flares

Risk Factors

Patients with Hunner’s lesions and/or bladder wall subtypes are the most at risk for bladder wall flares.  Long-term pelvic floor dysfunction can cause ischemia which damages the bladder and makes it more sensitive.

Triggers

  • DIET – Foods and drinks high in acids, alcohol and/or caffeine can trigger bladder irritation.  Patients who have just one coffee or soda a day often suffer the most because that daily acid wash is irritating the wounds on the bladder. Healing happens when you remove the irritant and protect the bladder. Learn more about the diet here!
  • VITAMINS & SUPPLEMENTS – Multivitamins contain Vitamins C and B6, both infamous for irritating the bladder and creating discomfort. Patients do better when taking individual vitamins or a low acid multivitamin (Bladder Smart Low Acid Vitamins). Supplements containing cranberry and other forms of acid (i.e. apple cider vinegar) can also irritate even though it converts to alkaline after digestion.
  • HORMONES – Drops in estrogen with birth control, Lupron use, perimenopause or menopause (Genitourinary Syndrome of Menopause) reduce the integrity of the bladder wall making it more vulnerable to irritation. Some women also struggle with an IC flare on the day that they ovulate and a few days before their period. These are usually predictable and short-term.
  • CHEMICAL EXPOSURE – Some chemicals and/or medications can trigger an IC flare, especially cigarette smoke and vaping. Even second hand exposure increases the risk of irritation and bladder cancer.
  • UTI – Infection is rare but possible, often in women struggling with recurring UTI after menopause. Start with a simple OTC UTI Test Kit to test your urine. If the test strips change color, then contact your physician so that you have your urine cultured and, if positive, receive antibiotics. If your home test kit is negative, a bladder wall flare is likely.  If you EVER seen blood in your urine, experience fever, chills and/or low back pain, you should contact your physician immediately.

Rescue Plan

0-30 Minutes After The Flare Begins

  • REST – If you’ve been in pain or discomfort for just thirty minutes, stop what you are doing, sit down, rest and use a heating pad for several minutes. Try to break the cycle of irritation and/or muscle tension before it worsens.
  • HEAT – Heat can relax your muscles. The GingerBee Microwaveable Pad provides quick relief but will hold heat for about 20 minutes before you have to heat it up again.  BodiHeat Heating Pads are one-time use pads ideal to use during work, traveling or driving. Consider soaking in a warm bathtub but do not use bubbles, fragrance or bath salts. Try putting a handful or two of baking soda in your bathwater instead.

At 30-60 Minutes: Focus on Your Urine

  • DILUTE YOUR URINE – Water helps to flush toxins out of your body.  Whenever a flare begins, take a look at your urine. It should be clear and pale yellow in color. If it’s dark or cloudy, you may be dehydrated. If so, try drinking a glass of water or, better yet, sip a glass of water over an hour. Look at the color again. If it’s still dark yellow, more water may be helpful.
  • REDUCE URINE ACID LEVELS – If you’ve eaten an acidic food (i.e. coffees, green teas, sodas, citrus, tomato products), try using some Prelief, Tums or a 1/2 teaspoon of baking soda in a glass of water to alkalinize (aka reduce the acid levels) in your urine. If you’re on a salt limited diet, please talk with your doctor before using the baking soda method.
  • HERBAL TEA – A cup of herbal chamomile or peppermint tea can be quite soothing to the bladder and bowel.

At 60 Minutes: Catching Pain Early

  • BLADDER ANALGESICS – Over The Counter AZO Bladder Pain Relief Tablets, Pyridium and Prosed are urinary anesthetics that help to numb the bladder wall. These can be very effective in patients struggling with mild bladder symptoms. The latter two require prescriptions from your physician.
  • OTC ANALGESICS – As an early intervention for MILD pain, ibuprofin (aka Advil, Motrin) or acetaminophen (Tylenol) might be worth trying though they shouldn’t be expected to control severe pain. Please note that Ibuprofin can cause stomach irritation and acetaminophen can irritate the liver if used in large amounts.
  • BLADDER SPASMS – If you’re feeling bladder spasms (unusual flip floppy sensations or a strong spasm at the end of urination), a smooth muscle antispasmodic (i.e. Ditropan, Detrol) may be helpful. These are prescription medications that must be prescribed by your physician and may cause drowsiness. Again, a cup of peppermint or chamomile herbal tea may also lessen spasms.
  • ALOE can have a soothing effect on the bladder wall, just as it can be soothing to a sunburn. There are several aloe products on the market. Looking for ones that are organic & anthraquinone free. We suggest AloePath® which combines aloe with Palmitoylethanolamide to calm nerves!
  • CBD (Hemp or Medical Marijuana) may help reduce pain and relax muscles.  Edibles or topical creams are preferred over inhalants.

At 2-4 Hours: Getting Serious About Symptoms

Pain is a message. Your bladder and/or pelvis are telling you that they are in distress. It’s important that you not push through the pain. This is the time to relax and focus on what will make you feel better.

  • PAIN MEDICATION – If the pain or discomfort is getting worse, you may need to start using a pain medication that your doctor has prescribed. Using pain medication early, before the pain gets out of control, is ideal.  Opioid medications are the mainstream of treatment for moderate to severe pain. They come in many varieties and strengths. Some are “short-acting” medications (i.e. Tylenol with codeine) that are effe tive for about four hours and can help manage short-term persistent pain. Other medications are “long- acting” time release formulas (i.e. Oxycontin) that are designed for use with chronic pain.
  • SOOTHING FOODS – A glance at the latest IC diet research shows that there are some foods which seem to be particularly sooth-ing to the bladder. Focus on mild, comfort foods like chamomile tea, rice, potatoes, chicken, fresh breads, vanilla ice cream, vanilla milkshakes, pears, carrots, mushrooms, squashes, etc. Yes, this is a very mild diet because we don’t want to create more irritation.

At 24 Hours & Longer – As you continue the strategies used previously, the following medical interventions may be considered.

  • RESCUE INSTILLATIONS – Rescie instillations (aka anesthetic cocktails) provide immediate and sustained pain relief for some patients. This simple instillation of medication into your bladder usually contains lidocaine or marcaine to numb the bladder wall, heparin as a bladder coating, a corticosteroid to help control inflammation and, perhaps, an antibiotic.
  • HUNNER’S LESION TREATMENT – Severe, persistent bladder wall pain is often the result of untreated Hunner’s lesions. The good news is that when they are