Per the American Urological Association, interstitial cystitis (IC) is defined as >6 weeks of bladder pain, pressure, or discomfort without infection or other etiology. Pain with bladder filling, which is better after emptying, is very characteristic of IC. Signs and symptoms of IC may include urinary frequency, urinary urgency, nocturia (getting up at night to void), suprapubic pain, perineal pain, bladder spasm, pubic pressure, painful sex, and more.

Diagnosis of IC is typically based on patient symptoms and exclusion of other possible diagnoses. Unfortunately, there is no diagnostic test, imaging, or procedure that completely confirms or eliminates IC as a potential diagnosis. A urine culture should be ordered to rule out an active urinary tract infection (UTI). Other labs that may be ordered include a complete blood count (CBC) to confirm the absence of infections and a complete metabolic panel (CMP) to assess kidney function. Cystoscopy can be considered for visual inspection of the internal bladder, but it is not required to make a diagnosis of IC. However, cystoscopy may reveal significant trabeculations or Hunner’s ulcers at the time of inspection, and these are strongly correlated with IC.

Treatment of IC starts with education. Diet is a major part of IC management. The Interstitial Cystitis Association (ICA) provides excellent guidance for understanding IC and changing dietary habits. Things that most people with IC should try to avoid include frequent coffee (caffeinated and decaffeinated), teas (caffeinated and decaffeinated), soda, alcohol, citrus juices, cranberry juice, foods and beverages containing artificial sweeteners, hot peppers, and spicy foods. However, not every patient has the same triggers, so it is recommended to try eliminating one food at a time. Many patients also avoid extreme temperatures in their drinks. Some other things that can be helpful for some patients may include voiding at the shortest, natural intervals (voiding every 1-2 hours), deep breathing and intentional relaxation practice during urges/flares, avoiding more than 2 liters of fluid intake per day, and aiming for pale yellow urine because this is often less agitating to the bladder lining.

Some complementary approaches to IC include taking pre- and probiotics to maintain a healthy natural biome. Some patients have found acupuncture to be helpful. Prelief is an over-the-counter supplement that can be taken before eating or drinking known bladder-irritating foods and drinks and is helpful for some patients. N-acetylcysteine (NAC) is a potent detoxifier that neutralizes free radicals, which can also be helpful; the dose for this supplement is typically 500mg twice per day on an empty stomach.

There are a few different prescription medication options for managing IC as well. Elmiron is the only FDA-approved medication in the treatment of IC. However, it has many possible side effects, and some are very serious, including possible permanent retinal damage and vision changes. Additionally, Elmiron is frequently not covered by health insurance policies, and it is very expensive out-of-pocket. Gabapentin, amitriptyline or nortriptyline, and hydroxyzine are more common oral prescription options for IC. Gabapentin is a non-narcotic pain medication that works very well on nerve-type pain. Amitriptyline and nortriptyline are both tricyclic antidepressant medications. They are each commonly used to treat depression, neuropathic pain, migraine headaches, fibromyalgia, and IC. Research has shown that these medications are useful in non-specific voiding dysfunctions, especially in the presence of pelvic pain. Hydroxyzine is an antihistamine medication that, with nightly use, can also calm down bladder pain in patients with IC.

Bladder instillations are another option. A bladder instillation involves learning how to perform self-catheterizations to instill a combination of lidocaine and bupivacaine for numbing pain relief, and sodium bicarbonate for comfort to reduce bladder pain. If these options are trialed and failed, Botox injections into the bladder (and possibly the pelvic floor) would be the next intervention to consider. Surgical implantation of a neuromodulator may be considered for severe refractory symptoms; it stimulates mild electrical pulses to nerves to reduce pain, urinary frequency, and urinary urgency.

IC is a chronic condition, and it frequently coexists with endometriosis. At Pacific Endometriosis and Pelvic Surgery, we are dedicated to providing patients and communities with quality education and collaborative decision-making when determining the best individual plan of care. Our goal is to help patients feel empowered to better understand their symptoms, how they are connected, and all treatment options available to them.

References

Buford, K., Peters, K.M., Riedl, C., Mishra, N.N., Jacques, W.J., Lovász, S., Pinto, R.A. and Birder, L. (2026), Global consensus on interstitial cystitis/bladder pain syndrome: An update on therapeutic treatments. Neurourology and Urodynamics, 45: 46-53. https://doi.org/10.1002/nau.70106

Clemens, J. Q., Erickson, D. R., Varela, N. P., & Lai, H. H. (2022). Diagnosis and treatment of interstitial cystitis/bladder pain syndrome. The Journal of Urology, 208(1), 34–42. https://doi.org/10.1097/JU.0000000000002756

Doiron, R. C., Tadayon, B., Violette, P. D., Locke, J., Andrews, M., Nadeau, G., Gray, G., & Cox, A. (2025). Canadian urological association guideline: Selected treatment recommendations for interstitial cystitis/bladder pain syndrome. Canadian Urological Association Journal, 19(4), 90–103. https://doi.org/10.5489/cuaj.9182