Interstitial Cystitis: What You Need to Know

September is Interstitial Cystitis (IC) Bladder Pain Syndrome (BPS) Awareness Month.

What is IC/BPS?

IC/BPS is a chronic pain condition related to the bladder, with symptoms lasting more than 6 weeks.

It can feel like pressure in the bladder that, for some, is so strong that they are not able to sit for too long. It can also feel like a urinary tract infection, with frequent, urgent and burning urination, but when the urine is tested, there is no infection.

The pain often becomes worse as the bladder fills and may improve temporarily after urination. It can be felt not only over the bladder but also in the lower abdomen, pelvis, urethra, vagina, vulva, rectum or other surrounding areas.

The condition is very individual. Not everyone has the same symptoms, the same underlying mechanisms, or the same response to treatment.

Although IC/BPS can affect both women and men, this article is written with women in mind.

Why is it called interstitial cystitis?

The term “interstitial cystitis” can be misleading. The name sounds as though there must be inflammation of the bladder tissue, but not everyone has visible inflammatory changes. The condition is now generally understood as a broader bladder pain syndrome.

Many women with IC/BPS experience pain during sexual intercourse, and some also have vulvodynia. Both are chronic pain conditions, and the exact causes are still not fully understood.

What causes IC/BPS?

IC/BPS probably does not have one single cause. Different mechanisms may contribute in different people, and there is no single treatment that reliably works for everyone.

One important distinction is between IC/BPS with Hunner lesions and IC/BPS without them. Hunner lesions are areas of inflammation that can be seen during cystoscopy.

Women without Hunner lesions can have very different presentations. Some have pelvic-floor tightness or tenderness, while others have more widespread pain or other chronic overlapping pain conditions, such as fibromyalgia or irritable bowel syndrome.

How is it diagnosed?

There is no single test for IC/BPS. Diagnosis depends on recognising the symptom pattern and excluding infection and other conditions that can mimic it.

This usually involves a thorough history and examination, urine testing and, when appropriate, further investigations such as cystoscopy.

What can help?

Treatment is increasingly viewed as individualised and multimodal. Depending on the person, this can include self-management, dietary and behavioural changes, pelvic-floor therapy, medication, bladder-directed treatments and, for selected patients, procedures or surgery.

Some people notice that certain foods or drinks trigger a flare, such as coffee, alcohol, spicy or acidic foods.

Bladder training may be useful for some people, particularly when urgency and frequency are prominent.

Chronic pain involves the nervous system, emotions, behaviour and physical symptoms. Stress and tension can sometimes make symptoms worse. This is why relaxation, stress management and psychological support can be helpful as part of a broader approach to managing chronic pain.

What about antibiotics?

It is also important to know that the AUA guidelines recommend against long-term oral antibiotics for IC/BPS.

If there is no infection, antibiotics are not treating the condition.

Of course, someone with IC/BPS can still develop a genuine urinary tract infection, which should be treated as an infection.

Where does acupuncture fit in?

Acupuncture has been studied as a treatment for IC/BPS, with some studies reporting improvements in pain and urinary symptoms. However, the current evidence is still limited, and larger, better-designed clinical trials are needed before we can draw firm conclusions about its effectiveness.

The Chinese medicine perspective

In my practice, I follow the principles of Chinese medicine:

Different diseases, same treatment; same disease, different treatment.

This means that two women can both have IC/BPS and need completely different treatment from me. Two women with completely different diagnoses can also need the same treatment.

Another important principle is that where there is no free flow, there is pain. From a Chinese medicine perspective, pain can arise when the smooth circulation of Qi, blood and/or fluids is obstructed.

Treatment is therefore directed at the individual pattern, not the symptom alone.

I have always treated every condition as systemic. I do not look for a single cause in a single organ. I look for the pattern that exists in the person sitting in front of me, through a thorough inquiry and by checking their pulse and tongue.

From a Chinese medicine perspective, acupuncture, Chinese herbal medicine and dietary guidance aim to address the individual pattern, improve the flow of Qi and blood, and help reduce pain.

There is still much we do not understand about IC/BPS. But the pain is real, and there are ways to manage it. Chinese medicine offers another way of looking at the person behind the symptoms, and that is where I believe it can have a place.

Chinese medicine does not replace conventional diagnosis or treatment. It simply offers a different perspective, looking at the individual rather than the condition alone.

If you recognise yourself in these symptoms, you are not imagining the pain, and you do not have to put up with it.

There are ways to manage it, and there is help available.💛 This information is for educational purposes only and is not a substitute for individual medical advice. If you are experiencing persistent symptoms, please consult a qualified healthcare professional before trying any new approach.

Reference:

1. American Urological Association (AUA)

American Urological Association. Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome (2022).American Urological Association. Available at: AUA Guideline: Diagnosis and Treatment of IC/BPS

2. European Association of Urology (EAU)

European Association of Urology. EAU Guidelines on Chronic Pelvic Pain – Primary Bladder Pain Syndrome. EAU Guidelines. 2025.

Available at: EAU Guidelines on Chronic Pelvic Pain

3. Acupuncture - older review

Pang R, et al. The Chinese approach to complementary and alternative medicine treatment for interstitial cystitis/bladder pain syndrome. Translational Andrology and Urology. 2015;4(6):701–708. doi:10.3978/j.issn.2223-4683.2015.12.02.

Available at: Full article on PubMed Central

4. Acupuncture - current scoping review

Infantes Rosales MA, Mesías Pesqueira A, Castellanos Díaz A, Díaz Mohedo E. Research Methodology in Acupuncture for Managing Interstitial Cystitis/Bladder Pain Syndrome: A Scoping Review. Neurourology and Urodynamics. 2025;44(5):1054–1063. doi:10.1002/nau.70061.

Available at: Full article on PubMed Central