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Living with Incontinence

Bladder Pain: Causes and Treatment

Bladder pain can be excruciating and debilitating. Understanding the cause will identify the treatment to resolve or relieve symptoms, so don’t put up with it.
Published by Jane Granger
Bladder Pain: Causes and Treatment

What is bladder pain?

Pain experienced below the belly button and above the legs is known as pelvic pain and can occur in the uterus, bowel, bladder or muscles. If it feels central and you have continence issues, it could be bladder pain. Bladder pain can be continuous or episodic (coming and going), a dull ache or stabbing and can include pain when urinating, from a slight sting through to a burning sensation. Pain may worsen at your bladder fills, and there may be some temporary relief when it’s emptied. Some women experience bladder pain during sexual intercourse. An irritated, inflamed bladder is causing the pain.


What causes bladder pain?

Mostly affecting women, there are three main reasons the bladder experiences pain:

  • Interstitial Cystitis (IC) Also called Painful Bladder Syndrome, or PBS, this is a complex condition for which researchers are yet to find a cure. It’s considered a chronic (long-term) condition and can have a significant impact on you – from your ability to work, your sex life and even your mental health.
  • A Urinary Tract Infection (UTI) If any part of the urinary tract has an infection, including the urethra, bladder or kidneys, you may be experiencing pain. The good news is that once antibiotics have resolved the infection, the pain also stops. You can read more about UTIs, including causes, treatments and how to reduce the risk of developing one, in this article
  • Bladder cancer According to the Australian Government website, bladder cancer represents only 2.2% of all new cancer cases diagnosed. That said, it’s still a very serious disease, so if you are experiencing bladder pain, make an appointment with your doctor.

    Bladder or kidney stones can also cause bladder pain, but like UTIs, once diagnosed and treated, the pain will subside.


    How is bladder pain diagnosed?

    The doctor will begin by discussing your symptoms. They may also conduct a physical examination, pressing on the abdomen and lower back to identify areas of inflammation. They will then test a urine sample for the presence of the bacteria that causes a UTI (Urinary Tract Infection), the most common cause of bladder pain.

    They might also enquire about additional symptoms to determine the location of pain, other than the bladder, such as:

    • The bowel, for example, from a digestive issue like a food intolerance or Irritable Bowel Syndrome (IBS)
    • The reproductive organs, including the pelvic pain caused by endometritis and fibroids or ectopic pregnancy
    • Abdominal muscles like period pain and other cramping or spasms

      While there are conclusive tests for UTIs and bladder cancer, arriving at a diagnosis for Painful Bladder Syndrome can be a long, uphill road for many women. Doctors are yet to agree on precisely what PBS is, with some believing that it is in fact, a number of different diseases.

      Diagnosis is reached through the persistence of ruling out other possibilities, also called a diagnosis of exclusion. If you have urinary pain that lasts for more than six weeks and is not caused by other conditions, you may have PBS.


      Who gets Painful Bladder Syndrome?

      It’s thought that 90% of people with PBS are women, most aged over 30, with the risk increasing as we age. Because of the difficulty in reaching a diagnosis, the incidence isn’t exact but estimated at 3-6% of adult women.

      The highly respected women’s health organisation, Jean Hailes claims that painful bladder syndrome is common among women with endometritis, while the similarly regarded Mayo Clinic

      says that it often presents with other diseases such as Irritable Bowel Syndrome (IBS) or fibromyalgia (a condition that causes widespread pain and tenderness in the body) and seems to be common among people with fair skin or red hair. Exactly what causes PBS is as yet, unknown.






      Symptoms of Painful Bladder Syndrome

      Symptoms and their severity vary greatly and, coupled with the presence of other diseases, compounds the difficulty of diagnosis.

      That said, the following experiences are indicators that you may have PBS:

      • Chronic, persistent pelvic pain that can include the bladder and genitals
      • Frequent and urgent need to urinate, night and day – for some, up to 60 times
      • Urinary incontinence, with the sudden, strong need to urinate not allowing sufficient time to get to the toilet
      • Pain as the bladder fills and when passing urine
      • Passing only small volumes of urine
      • Pain during sexual intercourse

          Impacts of Painful Bladder Syndrome

          The effects of PBS on a person’s quality of life cannot be underestimated. It can negatively impact your physical, mental and emotional wellbeing in the following ways:

          • Lack of sleep. The benefits of quality sleep on our physical and emotional wellbeing are irrefutable. PBS can force people out of bed multiple times throughout the night to go to the toilet, leaving them exhausted and reducing their emotional resilience.
          • Lifestyle. The frequent urination, pain and fatigue can force people from paid employment. It can also lead to social isolation as the condition becomes all-consuming, with catch-ups and other interactions being avoided. Even daily tasks like supermarket shopping, laundry and cleaning can seem insurmountable.
          • Wellbeing. In addition to the lack of sleep, constant pain takes a heavy toll, leaving sufferers irritable and in a low mood. It’s not uncommon for people with PBS to all have mental health issues like anxiety and depression.
          • Intimacy. On top of sleep deprivation and low mood, a symptom of PBS can be pain during sexual intercourse leading to a withdrawal of affection and distancing from a partner.

            This terrible disease has no cure, but some treatments can alleviate symptoms. Don’t put up with it and persist with a diagnosis. If your doctor is dismissive, find another.

            Treatments for Painful Bladder Syndrome symptoms

            It’s usual to begin with conservative treatments and, depending on the result, move through to interventions like medication and surgery.


             Lifestyle Changes

            • Avoiding food and drink known to irritate the bladder, including caffeine, chocolate, alcohol, carbonated drinks, citrus and tomato
            • Altering the concentration of urine by drinking more or less water
            • Bladder Retraining. If you’re emptying your bladder every 30 minutes, try stretching it out to 45 minutes. A Bladder Diary can be useful when undertaking this approach
            • Stress relief. One school of thought is that PBS is triggered by stress, so try relaxation therapies, mindfulness and gentle exercise
            • Counselling. Some people find counselling developed to help cope with chronic pain useful. You can read more about it here on the Australian Pain Management Association website. In New Zealand, there are handy resources on their Navigation Pain page of the New Zealand Pain Society website
            • Physiotherapy. Exercises and manipulation to relax the pelvic muscles and reduce pain.


            • Oral medication. These can include;
              • Antidepressants,
              • Pain killers,
              • Drugs to repair the bladder’s mucosa (the lining) which like the stomach, if damaged, can cause ulcers and inflammation
              • Medication that reduces the production of stomach acid, which can move through your system and aggravate the bladder
              • Bladder instillation. This is when medication is placed directly into the bladder via a catheter.


              • Procedures may be undertaken to repair any damage or increase the capacity of the bladder. If you have had a diagnosis of PBS, discuss a treatment plan, including any medication with your doctor. Never self-medicate as without professional supervision, there can be unintended, harmful consequences.
              • Your doctor may refer you to other health care specialists like physiotherapists and pain management experts.


              Managing incontinence associated with PBS

              TENA has a range of products to manage incontinence. All have been designed to rapidly absorb the thin, fast flow of urine, locking it within the product to keep you dry and odour free.

              For daytime, TENA Pads might be suitable. These fit into your regular underwear and range from Ultra Thin Minis for a small leak through to highly absorbent Super Pads. TENA Pants are also a great option. These are soft, stretchy and breathable, looking and feeling just like your usual underwear, but with high capacity absorbency that can handle many small voids. If you’re rushing to the toilet, the pull-down/pull-up of pants could suit your needs.

              For night time, check out TENA Pads Maxi Night. It has more coverage at the back and anti-leak guards that provide security regardless of your sleeping position and is safe for sensitive skin. For an undisturbed sleep, have a look at the TENA Specialist Products including the most absorbent products as well as Bed Pads for additional leakage protection. 

              Deciding on the right product can be challenging. If you’re still uncertain, try TENA’s Product Finder Tool where you can also order free samples.


              A final word on PBS - persist
              Painful Bladder Disease is a debilitating condition that is difficult to diagnose. Some doctors can be dismissive; others can misattribute the symptoms to other disorders. If you are continuing to suffer, persist with finding a sympathetic doctor who can help develop a plan, including referrals, to help alleviate and manage the pain of this terrible disease.


              Asaleo Care makes no warranties or representations regarding the completeness or accuracy of the information. This information should be used only as a guide and should not be relied upon as a substitute for professional, medical or other health professional advice.