If you experience chronic UTI like symptoms but your urine is clear from bacteria, you may be suffering from another condition known as Interstitial Cystitis or Painful Bladder Syndrome. 

Painful Bladder Syndrome is a condition that is more common in women in which patients experience severe bladder pain and urinary urgency and frequency. PBS is difficult to diagnose and treat as its exact cause is unknown and it can often be confused with other urinary syndromes. Studies have shown that patients with this condition have abnormalities in the bladder wall causing the nerves to become highly sensitive to pain and pressure.  In order to diagnose PBS, women must experience symptoms of discomfort in the bladder region as well as other lower urinary tract symptoms such as burning or pain with urination for six weeks. These symptoms must occur in the absence of infection or another cause, therefore diagnosis is challenging because all other causes must be investigated and excluded. 

The symptoms of PBS include pain that is relieved at least partially by urinating. Women tend to urinate frequently and have an urgent need to urinate all day; some may even experience urinary leakage. This can be incredibly disruptive, as some women have to urinate multiple times per hour, thus greatly affecting daily routines. Most women will have pain above the pubic bone and/or pain in the urethra; pain can range anywhere from mild to debilitating. Women with PBS may have another condition in which they experience chronic pain, such as IBS, endometriosis, fibromyalgia, or pain with menses. Symptoms of PBS usually begin gradually and worsen over time, however some patients experience severe pain from the onset. 

Diagnosis is based on the patient’s symptoms and exam. Exam findings often include tenderness in the bladder region. A urine sample will be collected to rule out infection and to evaluate for bladder emptying. For certain patients, a cystoscopy may be performed in which a small camera is placed within the bladder to examine the bladder wall. 

Treatment options for PBS are geared towards improving the quality of life for patients with this syndrome. These therapies include behavioral modifications such as avoidance of certain foods and beverages that may aggravate symptoms and bladder retraining with urge suppression. Additionally, patients may benefit from pelvic floor physical therapy to help relax the pelvic floor musculature which may be spasmed secondary to chronic pain. There are also medications that patients may try, as well as bladder instillations, and a procedure known as hydrodistention during which the bladder is filled with fluid. If less invasive treatment options fail, the patient may be a candidate for bladder botox or a bladder pacemaker. 

If you are experiencing chronic bladder symptoms that don’t seem to be improving, you may be suffering from PBS. PBS can be extremely debilitating and difficult for patients, as the flares of pain and urinary symptoms can greatly affect quality of life. If you experience any of the above symptoms, you may benefit from seeing a urogynecologist or a urologist for further bladder evaluation. 

Do you have questions about PBS? Please leave them below!

With love,

Dr. Shweta Desai