Do you have frequent lower abdominal pain? Do you have frequent urges to go to the toilet? This is about Interstitial Cystitis (IC/BPS).

Do you also need to go to the toilet many times a day? Do you urinate only a little? Do you just have a strange heaviness or pain in your lower abdomen? Maybe you think this is a urinary tract infection (UTI), but even taking medication will not help? Then this condition that we are talking about today, Interstitial Cystitis, may also affect you. This is a bit complicated, and a topic that many people are not fully aware of. So let's talk about it simply, in a way that you can understand.

What exactly is Interstitial Cystitis (IC/BPS)?

Simply put, this is chronic pain or discomfort in your bladder . Now doctors call this Bladder Pain Syndrome (BPS). Let's break down the meaning of this name a little.

• Interstitial means "in the space between tissues."
• Cystitis means "inflammation of the bladder," which means it is a condition that causes swelling.

That is, it is a long-term inflammation and pain that occurs between the tissues of the bladder. A person with this condition needs to urinate more often than normal. And when they feel the need to urinate, it is very difficult to hold it in, and they need to go to the toilet quickly. We call this frequency (frequent urination) and urgency (urgent need) .

There are two main types of this condition.

Yes, it doesn't affect everyone the same way. It can be divided into two main types. These two types are identified through a test (Cystoscopy) where a doctor inserts a camera into your bladder to look at it.

What is Stage 4 IC/BPS?

You may have heard of the stages of the disease. Stage 4 is the most severe stage, where symptoms have been present for more than two years. At this point, the bladder tissue has become very thick and rigid. As a result, the bladder cannot hold as much urine as it used to. This condition is most common in people with Hunner's ulcers.

What are the symptoms of IC/BPS?

The symptoms can vary from person to person. For some, they may be mild, while for others, they may be excruciatingly painful. For some, symptoms are constant, while for others, they come and go.

The main features are these:

• Pain, pressure, or discomfort in the lower abdomen (where the bladder is). This pain may increase as the bladder fills.
• The need to urinate very frequently. It can be 15, 20, or even 40-50 times a day.
• When you feel the need to urinate, you feel an urgency that you can't hold back.
• A very small amount of urine is released at a time.
• For women, symptoms may worsen during menstruation.

Why does something like this happen?

This is a problem that many people have. To be honest, even doctors still can't say with 100% certainty what causes IC/BPS. But there are a few things that are suspected to contribute to it:

• Weakness in the bladder lining: Our bladder has a protective layer on the inside. This is what protects the bladder wall from harmful substances in the urine. When this layer is damaged, those harmful substances can leak into the bladder wall and cause pain and inflammation.
• Autoimmune diseases: The body's immune system may mistakenly attack its own bladder cells.
• Allergies: It is also suspected that the activity of certain cells (mast cells) in the body that cause allergies is related to this.
• Undiagnosed infections: Sometimes a previous infection that was not properly treated can damage the nerves in the bladder, causing long-term pain.
• Abnormalities in the urine: For example, persistently high levels of protein in the urine (proteinuria).

Who is at higher risk of developing this?

• Women are at greater risk than men.
• It is most common in people over the age of 30 .
• People with other chronic pain conditions, such as fibromyalgia and irritable bowel syndrome (IBS), are also more likely to develop IC/BPS.

Doctor, how do you diagnose this?

There is no single test that can confirm IC/BPS. Your doctor will rule out other conditions that could be causing your symptoms. This may require several tests. Don't worry, let's see what they are.

What are the treatments for this?

This is the most important part. First of all, there is no cure for IC/BPS yet. But don't worry. There are many effective treatments that can help you manage your symptoms and live a normal life.

Your doctor will start with one treatment, see if it works for you, and then decide if they need to switch to other treatments or combine several treatments. This is a bit of a trial-and-error process. It may take some time to find the right treatment for you.

1. Changes in diet

Many people find that certain foods and drinks make their symptoms worse. We call these 'triggers'. You can keep a diary and note what you eat and drink and when your symptoms get worse. Over time, you will learn which foods are causing your symptoms.

Foods that worsen symptoms for many people:

• Alcohol
• Caffeine (tea, coffee, chocolate)
• Carbonated beverages
• Tomato
• Citrus fruits (oranges, lemons)
• Processed foods
• Spicy food

2. Physical Exercise and Physical Therapy

• Exercise: Gentle exercises like walking and cycling can help reduce pain.
• Pelvic Floor Physical Therapy: This is very important. The muscles in the lower abdomen (pelvic floor muscles) are what hold organs like the bladder in place. Tightness in these muscles can also increase pain. A specialist physical therapist can teach you the right exercises to relax and strengthen these muscles (Kegel exercises).

3. Reducing Stress

Stress is a major factor that increases the symptoms of IC/BPS. Learning ways to manage stress can provide great relief. Things like deep breathing exercises, meditation, and yoga can help. You can also seek the help of a mental health counselor if needed.

4. Bladder Retraining

Because of the pain, you get used to going to the toilet when your bladder is a little full. This allows your bladder to gradually get used to holding a smaller amount of urine. Bladder retraining involves deliberately increasing the time between toilet visits. You start with 5-10 minutes and gradually increase the time to 2-3 hours.

5. Oral Medications

• Antidepressants: Some antidepressants, such as amitriptyline, when given in very low doses, can help reduce bladder pain and the need to urinate frequently.
• Antihistamines: Medications like Hydroxyzine can control allergies and reduce pain.
• Pentosan Polysulfate Sodium (Elmiron®): This is the only oral medication approved specifically for IC/BPS. It is believed to help rebuild the damaged protective lining of the bladder.

6. Bladder Instillations

In this, the doctor inserts a very thin tube (catheter) into your urethra and injects a mixture of medications into your bladder. The most common medication used is dimethyl sulfoxide (DMSO). This medication is left in your bladder for a while and then removed through urination.

7. Other treatments

If the above treatments are not successful, your doctor may consider the following:

• Nerve Stimulation (Neuromodulation): A method of controlling bladder pain and urgency by sending small electrical signals to certain nerves in the body.
• Botox® Injections: Botox is injected into the bladder muscles, reducing their activity and controlling pain.
• Surgery: This is done as a last resort, only for people with very severe symptoms who have not responded to other treatments. This involves removing part or all of the bladder (cystectomy).

How to live with IC/BPS?

Because this is a long-term condition, it's important to learn to live with it. These tips will help you cope with flare-ups.

• Drink plenty of water: When urine is diluted, bladder discomfort is reduced.
• Hot or cold compresses: Placing a hot water bottle or ice pack on your lower abdomen can help relieve pain.
• Wear comfortable clothes: Avoid tight pants and underwear that constrict your stomach.
• Relaxation Techniques: Yoga poses like the 'happy baby' pose can help relax the pelvic floor muscles.
• If sex is painful: Talk to your doctor about things like taking painkillers beforehand and using lubricants.

When should I see a doctor?

If you have any of the symptoms mentioned in this article, you should definitely see a doctor. You need to find out for sure if it's a urinary tract infection, IC/BPS, or something else. Also,

This is nothing to be ashamed of. It can have a major impact on your quality of life, so it's important to get the right treatment.

Lower abdominal pain, frequent urination, Interstitial Cystitis, Bladder Pain Syndrome, Bladder inflammation, Urethritis, Women's Health