What is Interstitial Cystitis or Bladder Pain Syndrome?

Interstitial cystitis (IC) or bladder pain syndrome (BPS) refers to the “unpleasant sensation—pain, pressure, or discomfort—often associated with the bladder or lower urinary tract infections (UTI) persisting for more than six weeks, without any infection or other identifiable causes”, according to the American Urological Association Guidelines.

Whilst there is not enough evidence in Singapore, studies show that up to 5% of the world population suffers from BPS, although it largely goes undiagnosed.


People with IC usually complain of pelvic pain and increased frequency and urgency to urinate. Others may also experience hip, lower back, or sacroiliac joint (SIJ) pain; pain from penetration (can be sexual or from the insertion of a PAP or tampon); and constipation. Not all IC patients suffer from the same set of symptoms, though.


There is no single test to confirm or refute the diagnosis of IC, so a diagnosis of exclusion is made. Your urologist may perform a cystoscopy to rule out Hunner’s lesions or bladder cancers.


BPS symptoms were initially thought to be caused by chronic inflammation of the bladder lining. The use of antibiotics was the common treatment plan; however, symptoms persisted. BPS is a complex thing that causes many changes in your body, such as:

  1. Changes to the parts of the brain that control movement (motor) and feelings (sensory) relating to the bladder
  2. Changes in the sensitivity of the nerves that supply the bladder and surrounding structures
  3. Changes in the amount of attention the brain pays to the bladder
  4. The brain perceives the bladder to be under threat
  5. Tension between the bladder and pelvic floor structures (muscles and fascia) due to close proximity and crosstalk


For many unknown reasons, your brain thinks your bladder is in danger. For instance, you may have already suffered from UTI, recurrent UTIs or trauma. While you might have already recovered from it, your body has a memory of these “bladder events.”

Your brain also thinks that your bladder is under threat when there is a pressure change (intercourse) or a pH change (sweat, lubricant or UTI). When this happens, protective events occur from memory. These changes in the environment would normally not bother you, but with IC, your experience is amplified.


  1. Your immune system triggers an immune reaction, causing inflammation and swelling.
  2. Surrounding nerves become vigilant to assess and process the danger thoroughly.
  3. Your muscles and fascia tighten and stop working to protect the area and prevent further damage.

This vigilance may overwhelm your brain, leading you to feel the urgency or frequency to urinate, albeit you might only have 100 to 200 mL of urine.

This IS a great defence mechanism when there is a threat!

However, if you’re in danger mode for more than six months, the brain starts to change and becomes highly attuned to any bladder activity. You will be consciously aware of how your bladder and the surrounding muscles feel every time you urinate. Tight and vigilant muscles can also worsen symptoms like pelvic pain and frequent urination.


The limbic system (brain structures involved in emotions) is activated as the brain struggles to cope with different information and threat responses. So, if you are feeling some negative emotions, the pain worsens as emotions aggravate the inflammation of the bladder lining. This is a protective response to perceived threats, real or not.


What’s real is that physiotherapy works!

Another fact is that our bodies are dynamic, so they can change no matter how long you have been experiencing symptoms.

The American Urological Association has IC treatment guidelines, and physiotherapy is the only treatment proven to help nearly 85% of patients and the only treatment with an “A” evidence grade!

Your women’s health physiotherapist will educate and guide you towards change through:

  • Identifying emotional, hormonal, and nutritional triggers
  • Self-care strategies
  • Body scanning techniques
  • Breathing and mindfulness techniques
  • Internal and external pelvic floor releases
  • Body stretches
  • Flare-up plan and referrals to other clinicians, if needed
  • Self-management

Other IC treatments:

  • Nutrition: There’s no specific IC diet, but certain foods can trigger your symptoms. I can refer you to a qualified dietitian to help you understand this.
  • Bladder treatments: Bladder instillations or electrical stimulation treatments.
  • Medication: Antihistamines, antidepressants, or anti-inflammatories may be prescribed for pain relief. Botox may be useful in some patients.
  • Acupuncture: To relieve some symptoms.


  • History taking and identifying the development of your symptoms
  • Understanding your lifestyle and attitudes towards your symptoms
  • Goal setting
  • Advice to complete a bladder diary that you can download here
  • Assessment of posture, breathing, and muscles
  • Internal or external pelvic floor exam, if needed
  • A management plan
  • Referral to other care providers who can assist in symptom relief

It’s natural for our bodies to go into defence mode when we experience pain. But as mentioned, the brain and its responses to perceived threats also change. Using the best mind-body connection, physiotherapy helps neutralise perceived threats and relieve symptoms.

If you are suffering from interstitial cystitis, please call or WhatsApp us at 9780 7274 or reach out via email to discuss how we can work together towards embracing life.

Feel free to look through our website, where you can learn about other women’s health conditions we treat. This is a safe space where we can discuss how we can help you with physiotherapy.

Note: While I am a physiotherapist, I am not your personal physiotherapist. The contents of this website are for informational purposes only and are not intended to serve as personal medical advice.


  1. https://www.embracephysio.sg/wp-content/uploads/2021/10/Bladder-Diary-FINAL.pdf
  2. https://www.embracephysio.sg/what-is-a-pelvic-floor-exam/
  3. https://www.auanet.org/guidelines-and-quality/guidelines/diagnosis-and-treatment-interstitial-of-cystitis/bladder-pain-syndrome-(2022)
  4. https://www.niddk.nih.gov/health-information/urologic-diseases/interstitial-cystitis-painful-bladder-syndrome/treatment
  5. https://www.embracephysio.sg/recurrent-urinary-tract-infection-ruti-how-womens-health-physio-can-help/#content
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