Do you know about Painful Bladder Syndrome?
Most women have had a urinary tract infection (UTI) and can attest to how uncomfortable, unpleasant and painful it can be. Some women have enduring, recurrent and persisting urinary symptoms and a number of these will end up having Painful Bladder Syndrome (PBS).
Painful Bladder Syndrome (PBS) is a common occurrence in women and particularly in women with other types of pelvic pain (including endometriosis). It is one of the types of pain that you can’t see on laparoscopy or ultrasound. It is commonly misdiagnosed or mistreated as recurrent UTIs. Whilst many of the symptoms of an acute UTI and PBS are similar it’s important to distinguish that they are not the same condition – their causes are different and treatment is different.
What type of symptoms might I experience with Painful Bladder Syndrome (PBS)?
The key symptoms of PBS are:
Bladder pain (often gets worse with the bladder filling and is relieved with bladder emptying)
Frequency of urination (needing to pee often)
Urgency (little warning to get to the toilet in time and difficulty holding your bladder)
Nocturia (needing to get up to pee at night)
Pain with intercourse (especially in positions that put pressure on the front wall of the vagina)
Symptoms can be transient (known as flares) which is why painful bladder syndrome can be mistaken for a UTI.
I think I have some of the symptoms above, what should I do?
It is important to discuss your symptoms with your GP so that the appropriate tests can be ordered to rule out other causes. This will usually include a urine test to rule out an infection and an STI check if needed. It’s really important you don’t start antibiotics before seeing your GP as this can affect your test results.
Your GP can also discuss a trial of recommended therapies (see below). If simple treatments don’t work your GP may arrange for further testing such as an ultrasound of your bladder & pelvis, a cystoscopy (a minor procedure where a specialist looks inside your bladder with a camera) and urodynamics (bladder function tests). They may also suggest seeing a urologist (urinary tract specialist), gynaecologist or pain specialist.
How should I manage bladder pain ‘flares’?
Bladder pain flares can be caused by various factors including:
Activities: exercise, sex, prolonged sitting certain conditions
Bladder infections,
Hormone fluctuations
Stress
Food and drinks: spicy foods, citrus fruits, alcohol, coffee, artificial sweeteners
Simple steps to manage a flare include:
drinking enough water (but not too much), aim for approx. 2L per day
taking medication prescribed by your doctor
hot/cold therapy: have a warm bath or apply a heat/cold pack (whichever feels best) to the perineum
relax your pelvic muscles (there is a link to pelvic floor relaxation stretches here)
Recommendations that your treating team might make for managing your PBS:
Bladder training to slowly increase the time between needing to urinate and to increase the amount of urine the bladder can comfortably hold
Pelvic floor physiotherapy to relax tight and tender muscles in the pelvis, lower abdomen, thigh, groin and buttocks
Medications such as low-dose amitriptyline, pregabalin as well as some other specialised medications
As with all things pelvic pain, we like to take a holistic and multidisciplinary approach to managing PBS. It’s also important that you get support managing other sources of pelvic pain including endometriosis/painful periods, IBS, pain with intercourse and pelvic floor muscle dysfunction.
There are some helpful resources about Painful Bladder syndrome here:
Pelvic Pain Foundation of Australia
Urology Society of Australia
