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Painful Bladder Syndrome (PBS)
Painful bladder syndrome (PBS) is a condition that causes bladder pain, pressure, or discomfort. Some people feel the need to urinate frequently or rush to get to the bathroom. The symptoms range from mild to severe, and can happen sometimes or all the time. PBS is not caused by an infection, but it can feel like a bladder infection like a urinary tract infection or UTI. Painful bladder syndrome is also referred to as bladder pain syndrome and interstitial cystitis. In the past, doctors thought PBS was rare and difficult to treat. We now know that PBS affects many women and men and treatments are helpful.
What causes PBS?
No one knows for sure, but we think PBS happens when the inner lining of the bladder is not working properly. This means that nerves in the wall of the bladder become hypersensitive so the normal feeling of the bladder filling can be painful. There may also be inflammation or allergic reaction responses in the bladder. Some people report developing PBS after an injury to the bladder such as a severe bladder infection or major trauma, but this is not always the case. PBS is more common in people who have irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, or other chronic pain conditions. It is not clear why these problems happen together.
What are the symptoms of PBS?
Frequency is when someone feels they are urinating more than expected based on how much they are drinking. The average person urinates about seven times a day and might get up once at night. A person with PBS may have to go more often both day and night. Urgency is the need to rush to get to the bathroom. Some people feel a constant urge that never goes away, even right after they urinate.
People with PBS may have bladder pain when the bladder fills. Some people feel pain in other areas, like the urethra (the opening where the urine comes out), vagina, lower abdomen, lower back, or the pelvic or perineal (sitting) area. The pain may be constant or come and go, and may change in severity.
Many people with PBS know that certain foods or drinks make their symptoms worse. Symptoms may be worse during times of physical or emotional stress or with certain activities like sitting too long. The symptoms may change with the menstrual cycle. Some women with PBS have pain during sex and/or after sex.
How is PBS diagnosed?
There are different opinions about how to diagnose PBS because no test is 100-percent accurate. Everyone agrees that an office visit is needed to discuss symptoms, do an exam and urine tests. These tests can help make sure there isn’t another problem that might be causing the symptoms.
Do I need cystoscopy?
Cystoscopy is a test that allows a doctor to look inside the bladder. This is done by inserting a camera attached to a small tube (cystoscope) inside the urethra and bladder. This test may or may not be necessary and is up to you and your doctor to discuss.
Cystoscopy can be done in the office, however someone with PBS symptoms might need a special cystoscopy known as “cystoscopy with hydrodistention” that would be done in the operating room under anesthesia so the bladder can be overfilled to look for possible changes found in PBS. It’s also possible for a person with PBS to not have these changes seen on cystoscopy. Therefore, this test may or may not be helpful, and is not necessary for every patient.
How is PBS treated?
Because there are several different causes of PBS, no single treatment works for everyone and no treatment is “the best.” Treatment must be chosen individually for each person, based on symptoms. Usually, PBS is managed by trying different treatments, or combinations of treatments, until the symptoms improve.
Simple changes to diet or routines can help some people with bladder pain. Steps might include
- Changing what you drink. Some people feel better by drinking more water to dilute the urine. Avoid foods/ drinks that can irritate the bladder (see “How does diet affect PBS” below).
- Avoiding going to the bathroom every time you feel an urge. Try to wait at least one to two hours between bathroom trips.
- Applying ice or heat to the lower abdomen or vulvar area.
- Physical therapy (PT) can also help most people with PBS. This involves working with a specialized physical therapist one-on-one to treat the muscles, tissues and nerves in the pelvis, abdomen and hips that can become painful due to PBS. The treatment includes stretching and releasing tight and tender areas inside and outside of the vagina and often reverses the changes in the body caused by PBS. PT is usually done once or twice per week for eight to 12 weeks. Your physical therapist will discuss and determine your best treatment schedule, and will also recommend home exercises.