Pain is the hallmark symptom of IC/BPS, including sensations of pressure and discomfort, though it does not occur in everyone. Pain can also occur in the urethra, vulva, vagina, testicles, rectum and/or throughout the pelvis. It can also be referred to the lower back, upper legs and throughout pelvic floor muscles. Men may experience referred pain at the tip of their penis.
For patients with a bladder wall injury, pain can worsen as the bladder fills with urine especially after the consumption of irritating foods. Pain during urination is rarer and could be a sign of a urinary tract infection or tension in the urethral sphincter muscles. Pain after urination is, in our experience, more often associated with pelvic floor tension.
Urinary frequency is found in 92% of patients with IC/BPS. Patients may experience mild, moderate or severe urinary frequency of up to 60 times in a 24 hour period. With an injured bladder wall, patients may urinate and then feel another need to urinate, sometimes within minutes.
An estimated 84% of IC/BPS patients struggling with urinary urgency, a sudden need to empty their bladder to relieve pain and discomfort. In contrast, overactive bladder (OAB) patients struggling with urgency run to the restroom to avoid leakage and/or becoming incontinent. Some patients may struggle to get a good nights sleep due to a constant urge to urinate (nocturia).
Some patients struggle with excessive nighttime urgency, particularly patients with Hunner’s lesions or bladder wall injury. They may feel a constant need to urinate every 30 minutes, 15 minutes or, for patients with severe symptoms, every five minutes. Sleep deprivation is a serious concern for these patients. Nocturia can also be the result of foods eaten during the day which have irritated the bladder.
Pain With Intimacy
Tight pelvic floor muscles and/or chronic pelvic floor dysfunction can cause pain with intimacy. In men, pain occurs at the moment of ejaculation. In women, pain can occur during penetration (intercourse) or in the 24 to 48 hours after sex. Female sexual dysfunction is often present and can progress over time (6) It’s not unusual for patients to avoid sex or become fearful of sex. Thankfully, pelvic floor muscle treatment can improve sexual functioning dramatically.
Prostatitis Like Symptoms
The pain and discomfort of chronic prostatitis (CP/CPPS), as well as symptoms of urinary frequency and incomplete emptying, are very similar to interstitial cystitis. In fact, some men have symptoms of both conditions. The American Urology Association encourages men who are struggling with pain perceived to be related to the bladder previously diagnosed with prostatitis be assessed for IC/BPS.