Some people spend years treating what they think are bladder infections, only to hear that the tests keep coming back clear. When the burning and the constant need to pee have no infection behind them, one possible explanation is interstitial cystitis, also called bladder pain syndrome. Part of the pain often sits in the muscles around the bladder too, which our article on pelvic floor symptoms explains.
This article covers what the condition is, what it usually feels like, how a doctor finds it, and what tends to help. It's information to bring to an appointment. Only a clinician who examines you can say what's behind your symptoms.
In this article
- What interstitial cystitis is
- What it feels like
- Why it gets mistaken for a bladder infection
- Who tends to get it
- What can set off a flare
- How a doctor finds it
- What tends to help
- The pelvic floor, and why kegels can backfire
- Sex and bladder pain
- When to see a doctor
- Comfort for the outer skin
- Frequently asked questions
What interstitial cystitis is
Interstitial cystitis (often shortened to IC) and bladder pain syndrome (BPS) are two names for the same long-term condition. The NHS describes it as a condition where the bladder wall becomes irritated and inflamed, and it notes that treatment can help manage symptoms, even though nothing makes the condition go away for good.
The US National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) calls it a chronic condition in which there is pain in the bladder, with pain that often builds as the bladder fills and eases after you pee. It estimates that between 4 and 12 million people in the United States may have it, and says the real number is hard to pin down because it can be mistaken for other conditions.
Nobody knows exactly why it starts. The NHS mentions two ideas researchers are looking at: an immune system that attacks the bladder wall, and a bladder lining that's easily irritated by what's in urine. Neither has been proven yet.
What it feels like
Symptoms vary a lot from one person to the next, and they often come and go. The NHS lists these as the usual ones.
- Pain in the bladder, lower belly or back, which may ease for a while after you pee and build again as the bladder fills.
- Urgency, the feeling that you need to go even when your bladder is nearly empty.
- Going often, usually small amounts, through the day.
- Waking at night to pee.
- Pain during sex.
- Occasional leaks if you can't reach a toilet in time.
NIDDK describes the pain as discomfort, pressure, tenderness or pain in the bladder, lower abdomen and pelvic area. Many people describe it as pressure more than sharp pain, and it can feel a lot like the start of a bladder infection.
Flares are part of the pattern. Someone can feel fine for weeks, then have several bad days in a row. That on and off rhythm is one reason it takes a while to spot.
Why it gets mistaken for a bladder infection
A bladder infection and IC can feel almost the same, with burning and a sudden need to go. The difference shows up in the tests. With an infection, a urine test usually finds bacteria, and antibiotics help. With IC, the urine test comes back clear and antibiotics don't change much.
That's why the NHS says doctors often run tests first to rule out other causes, such as a urinary tract infection. A string of treated infections where the cultures were never positive is worth mentioning at your appointment, because it changes what your doctor looks for next.
It's also why we'd never suggest skipping a urine test when symptoms start. An infection is common and easy to confirm, and it needs its own treatment. If you get a fever, chills or blood in your urine, see someone the same day (more on that at the end).
If the pain sits on the outside skin rather than deep in the pelvis, the cause may be something else entirely, such as irritation from soap or products. Our article on why soap is wrong for vulvar skin covers that side.
Who tends to get it
NIDDK says IC is more common in women than in men, and that it can start at any age but is more common in adults. The NHS adds that it usually affects people aged 40 or over, and that the risk is higher if you already live with another long-term pain condition, such as fibromyalgia.
NIDDK goes further on the links. People with IC are more likely to also have fibromyalgia, vulvodynia (long-lasting vulvar pain with no clear cause), migraine, chronic fatigue syndrome, irritable bowel syndrome, allergies, autoimmune conditions, depression and anxiety. Having one of those doesn't mean you have IC. It does mean the pain may have more than one source, and a doctor who sees the whole picture helps.
What can set off a flare
Triggers are personal, and what bothers one bladder may not bother another. NIDDK lists these as common flare triggers:
- stress, and the hormone changes around a period
- certain foods and drinks, skipping meals, and not drinking enough
- allergies, and seasonal or weather changes
- infections, or holding urine too long
- irritants such as laundry detergent, pool chemicals, toilet paper and tight clothing
- activities that load the pelvic floor, like heavy lifting, standing for a long time, bumpy rides and sex
On food, the NHS suggests keeping a food diary and cutting back on spicy and acidic foods (such as citrus), alcohol and caffeine to see if it makes a difference. Nobody needs to drop everything at once. Taking out one suspect at a time for a couple of weeks makes it much easier to see what actually matters for you.
Irritants on the skin are worth a look too. Plain toilet paper, a mild laundry detergent and breathable underwear are small changes that cost little, and the gentle routine in our vulva care routine article keeps the outside skin out of the equation.
How a doctor finds it
There's no single test for IC. NIDDK says clinicians diagnose it by first ruling out other conditions with similar symptoms, using your history, a physical exam and lab tests.
According to the NHS, that can include:
- Urine and blood tests, to rule out infection and other causes.
- A pelvic exam, which may include an internal exam.
- An ultrasound of the belly.
- A cystoscopy, where a thin tube with a camera looks inside the bladder.
- Bladder pressure tests, done with a thin catheter.
You won't necessarily need all of these. Bring a symptom diary to the first visit: when the pain comes, how often you pee in a day and at night, what you ate and drank, and where you were in your cycle. It gives your doctor a pattern to work with instead of a memory of a bad week.
What tends to help
Treatment usually starts simple and steps up only if needed. Many people end up with a mix of several things rather than one fix.
| Option | What it involves | Where it comes from |
|---|---|---|
| Food and drink diary | Spotting your own triggers, then cutting back on them | NHS, NIDDK |
| Gentle exercise and relaxation | Low-impact exercise and relaxation techniques | NHS |
| Bladder training | Slowly stretching the time between trips to hold more urine | NIDDK |
| Pelvic floor physiotherapy | Stretching and relaxing tight pelvic floor muscles | NHS, NIDDK |
| Medicines | Everyday painkillers, nerve pain medicines, bladder-calming medicines | NHS |
| Bladder instillation | A liquid medicine put into the bladder through a catheter, held, then released | NHS, NIDDK |
| Surgery or nerve stimulation | Less common, usually after other options | NHS |
NIDDK notes that bladder training can help the bladder hold more urine and reduce pain and urgency, and that quitting smoking can reduce irritation to the bladder. The NHS adds pain management, mental health support and advice on sexual health to the list. Pain that comes and goes wears people down, so that support matters as much as the rest.
A doctor or a urologist decides which medicine fits, and every medicine has side effects to weigh. We won't name doses here. It's normal to try a few things before finding what works, and a first option failing doesn't mean nothing will help.
The pelvic floor, and why kegels can backfire
The pelvic floor is the group of muscles that holds up the bladder, bowel and uterus. With bladder pain, these muscles can be tight and tense, which is why NIDDK's treatment page talks about stretching and relaxing them. Its symptom page links pain during sex in IC to spasms in the pelvic floor muscles.
That changes what kind of exercise makes sense. NIDDK's treatment page says to avoid pelvic floor strengthening exercises, such as Kegel exercises, if you have IC symptoms, unless a physical therapist is guiding you. Squeezing a muscle that's already clenched tends to add to the tension.
A pelvic floor physiotherapist can check what your muscles are doing and teach you to stretch and relax them. That might include breathing work, gentle stretches and hands-on release. If you've been doing kegels on your own because of urgency or leaks, ask before you continue. Leaks from urgency and leaks from a sneeze aren't the same problem, and our article on leaking when you sneeze explains the difference.
Sex and bladder pain
Pain during sex is one of the symptoms the NHS lists, and NIDDK names sex as a possible flare trigger. That can make people pull away from intimacy without telling anyone why.
A few things can make sex more comfortable while you work on the bigger picture with your doctor. Going slowly gives tight muscles time to relax, and a change of position can help you find one that hurts less. Enough lubricant cuts friction too, and our article on whether you need lube explains when it helps even if you don't feel dry.
Tell your doctor or physiotherapist if sex hurts. The NHS includes sexual health advice as part of treatment, so it's a normal thing to raise, and a partner who understands what's going on usually makes it easier for both of you.
When to see a doctor
The NHS suggests booking a non-urgent appointment if pain in your bladder, lower belly or back doesn't go away or keeps coming back, or if you're peeing much more often than usual.
Get an urgent appointment, or call your local health line, if:
- you see blood in your urine
- the pain comes with a fever, or you feel hot, cold or shivery, which can mean an infection
If you've had several bladder infections where the urine tests were never positive, ask about bladder pain syndrome directly. If you're seeing a family doctor who isn't sure, asking for a urologist or a pelvic floor physiotherapist is a reasonable next step. Bring your diary, and bring the list of everything you've already tried.
Comfort for the outer skin
Peeing often means wiping often, and the skin of the vulva can get dry and sore from it. Patting dry instead of rubbing helps, and a balm can soothe that outer skin.
Lips, our vulva balm, is made with organic plant oils and candelilla wax, with no fragrance, no hormones and no petroleum. It moisturizes, softens and soothes dry skin on the vulva and the skin around it. Use a pea-sized amount with clean hands, on the outside only, and patch test first. It's $36 CAD ($27 USD) and ships free on its own in Canada and the US. Lips does not treat interstitial cystitis or bladder pain. It's for the skin only, and your treatment plan stays with your doctor.
Frequently asked questions
What is the difference between interstitial cystitis and a UTI?
A urinary tract infection is caused by bacteria and shows up on a urine test, and antibiotics usually help within days. Interstitial cystitis is a long-term condition where the bladder hurts with no infection behind it, so the urine test comes back clear. The symptoms can feel almost the same, which is why doctors test for infection first.
Does interstitial cystitis ever go away?
It's a long-term condition, and the NHS says treatments can help manage the symptoms even though nothing makes it disappear for good. Symptoms often come and go, with quiet stretches between flares. Many people find a mix of diet changes, bladder training, physiotherapy and medicine that keeps symptoms low enough to live well.
What foods make interstitial cystitis worse?
Triggers differ from person to person. The NHS suggests cutting back on spicy and acidic foods such as citrus, alcohol and caffeine, and keeping a food diary to find your own triggers. Taking out one suspect at a time for a couple of weeks makes it easier to see what really affects your bladder.
Should I do kegels if I have bladder pain?
Not on your own. NIDDK advises avoiding pelvic floor strengthening exercises like kegels if you have IC symptoms, unless a physical therapist guides you. Pelvic floor muscles can be tight with bladder pain, and squeezing them more can add to the tension. A physiotherapist can show you how to relax them instead.
How is interstitial cystitis diagnosed?
There's no single test. Doctors rule out other causes first, usually with urine and blood tests and a pelvic exam. The NHS says an ultrasound, a cystoscopy (a camera that looks inside the bladder) or bladder pressure tests may follow. A diary of your symptoms, fluids and food helps your doctor see the pattern.
Can interstitial cystitis cause pain during sex?
Yes. The NHS lists pain during sex as one of the symptoms, and NIDDK links it to spasms in the pelvic floor muscles. Going slowly, using lubricant and trying a different position can make it more comfortable. Tell your doctor or physiotherapist, because sexual health is part of the treatment plan.
Sources
- Symptoms, causes, tests, treatments and when to see a GP: NHS, Bladder pain syndrome (interstitial cystitis)
- Definition, how common it is, who gets it and related conditions: NIDDK, Definition and facts for interstitial cystitis
- How it's diagnosed by ruling out other conditions: NIDDK, Diagnosis of interstitial cystitis
- Symptoms, flare triggers and pelvic floor spasms: NIDDK, Symptoms and causes of interstitial cystitis
- Lifestyle changes, bladder training, physical therapy and the kegel caution: NIDDK, Treatment for interstitial cystitis
About this article
Written by the Peach & Cream team, based in Montréal. Published October 15, 2026. Last updated October 15, 2026. Medical facts come from the NHS and the US National Institute of Diabetes and Digestive and Kidney Diseases, linked above. Product facts come from the Lips product page. This article is general information, not medical advice. Lips does not treat or prevent any condition.