What is bladder pain?

Bladder pain¹ is a symptom that may be caused by multiple conditions—most commonly, bladder pain syndrome, urinary tract infections, and bladder stones.

Bladder pain syndrome, also called BPS or interstitial cystitis (IC), is a chronic (long-term) condition that causes feelings of pressure and pain in the bladder. BPS is often mistaken for a urinary tract infection (UTI), a bacterial infection that can occur in any part of the urinary tract (in this case, the bladder, also called bladder infection). The two are different, however, and BPS cannot be treated with antibiotics like UTIs can.

BPS can cause a myriad of symptoms, ranging from annoying and mildly uncomfortable to severe and painful. It can lead to depression and affect your sex life.

While there is no cure for bladder pain syndrome, treatment is available to help manage pain and the other symptoms associated with the condition.

Bladder pain may also be caused by bladder stones²—hard mineral deposits that form in the bladder. Some bladder stones may pass through the urinary tract without medical intervention, while some require medications or surgical removal.

How common is bladder pain syndrome?

Women are roughly five times more likely³ to have bladder pain syndrome than men. Many discussions of BPS center around women and their experiences with the condition.

According to research, between 3.3–7.9 million⁴ adult women in the United States suffer from the symptoms of bladder pain syndrome. Of these women, however, only 9.7% reported having been diagnosed with bladder pain syndrome/interstitial cystitis.

Causes of bladder pain

Two common causes of bladder pain symptoms are BPS (bladder pain syndrome, or interstitial cystitis) and bladder stones. Each of these conditions has its own underlying causes, some of which may be unidentifiable.

In some cases, urinary tract infections (UTIs) may cause bladder pain. More commonly, however, this bacterial infection causes frequent, strong urges to urinate and pain or burning upon urination.

Bladder pain syndrome causes

A common cause of bladder pain is interstitial cystitis. Cystitis⁵ refers to inflammation of the bladder, usually caused by a bacterial infection.

Interstitial cystitis⁶ (IC), commonly referred to as bladder pain syndrome (BPS), is a chronic condition that causes pain and pressure in the bladder. This pain is accompanied by lower urinary tract symptoms that have lasted for six weeks or longer⁷ without infection or another identifiable cause.

Researchers aren’t sure⁸ exactly what causes BPS. Rather, it’s likely that multiple factors contribute to an individual developing the condition. In some instances, physical defects may cause BPS. For example, a defect in the bladder’s epithelium (protective lining) may allow toxic substances in the urine to leak into the organ, irritating the bladder wall.

BPS may also result from problems with the nerve signals involved in urination.

When the bladder becomes full, it sends signals to the brain that triggers the urge to urinate. When you urinate, the muscles of the bladder contract (tighten), which pushes the urine out.

At the same time, nerve signals cause the pelvic floor and the muscles of the urethra (the opening through which urine passes) to relax, allowing the urine to exit the body.

In some people with BPS, the signals sent to the brain are confused. This causes them to urinate more frequently than normal (often in very small volumes) and can lead to the symptoms of BPS.

Other possible causes⁹ of BPS include:

• Infections
• Autoimmune conditions that cause the body’s immune system to attack the bladder
• Substances in the urine damaging the bladder
• Allergies: Occurs when inflammatory cells known as mast cells release histamine and other chemicals that lead to BPS symptoms

Your healthcare provider is the best person to help identify the underlying cause of your bladder pain syndrome.

Risk factors for bladder pain syndrome

Women are at a higher risk of bladder pain syndrome than men, and some women are more at risk than others. Multiple factors can increase your risk¹⁰ of BPS, including:

• Bladder infection: The bladder is lined with cells that protect it from the bacteria found in urine. Bladder infections can damage the organ’s lining, causing irritation.
• Family health history: If a first-degree (immediate) family member has BPS, your risk of the condition may be higher¹¹.

• Age: Most diagnoses of BPS are made in patients 30 years of age or older.
• Underlying health conditions: Chronic health conditions, including fibromyalgia, endometriosis, irritable bowel syndrome (IBS), and chronic fatigue syndrome, may be associated with BPS.
• Skin color and hair color¹²: Having fair skin and red hair has been attributed to having an increased risk of BPS.

Bladder stone causes

Another possible cause of bladder pain symptoms is bladder stones¹³. These deposits can cause pain and discomfort in the bladder.

Bladder stones can be caused by multiple different factors and conditions, including:

• Incomplete bladder emptying: The inability to completely empty the bladder causes the urine to become concentrated. Concentrated urine can then crystallize and form stones.
• Infection: Certain infections can lead to the formation of bladder stones. Generally, the presence of foreign materials in the bladder can cause bladder stones to form.
• Enlarged prostate: In men, an enlarged prostate can obstruct urine flow, preventing the bladder from emptying completely. This can cause bladder stones.
• Nerve damage: Similarly to BPS, improper functioning of the nerves from the bladder to the brain (which may be caused by a stroke, spinal cord injury, or other health problems) can prevent the bladder from fully emptying. This condition is called neurogenic bladder.
• Inflammation: Bladder inflammation, which may be caused by UTIs or radiation therapy directed at the pelvis, can cause bladder stones.
• Medical devices: The presence of foreign objects in the bladder—such as a bladder catheter or a contraceptive device (IUD) that has moved out of place to the bladder—can cause the formation of mineral crystals that later turn into stones.
• Kidney stones: Kidney stones are not the same as bladder stones—both types of stones develop differently. In some cases, however, small kidney stones may travel to the bladder and, if they remain there, can form into bladder stones.

Risk factors for bladder stones

Men, especially those aged 50 or older, have the highest likelihood of developing bladder stones.

Other factors can increase your risk¹⁴ of bladder stones, including:

• Urinary obstruction: Some conditions can block urine from flowing from the bladder to the urethra (the tube through which urine exits the body). This blockage can cause bladder stones to form.
• Nerve damage: Some conditions that can damage the nerves that control the bladder’s function include spinal cord injuries, stroke, Parkinson’s disease, diabetes, and a herniated disk.

It’s also possible to have both nerve damage and a condition that causes urinary obstruction. Having multiple such conditions increases your risk of developing bladder stones.

Bladder pain symptoms

Generally, bladder pain refers to the symptoms of pain and pressure in the bladder. Bladder pain can be caused by different conditions, which can lead to different symptoms.

See your healthcare provider if you experience any of the following signs and symptoms. They will be able to provide you with the proper diagnosis and treatment.

Bladder pain syndrome symptoms

Common signs and symptoms¹⁵ of BPS include:

• Frequent strong urges to urinate
• Frequent urination in small amounts throughout the day and night (as many as 40–60 times a day¹⁶)

• Pain or discomfort while the bladder fills that is relieved by urinating
• Chronic pelvic pain
• Pain in the lower back, lower abdomen, or muscles of the pelvic floor
• In women, pain in the pelvis or between the vulva and anus; pain, pressure, or tenderness in the bladder, urethra, vulva, vagina, or anus
• In men, pain between the scrotum and anus (perineum)
• Pain during sexual intercourse
• Increased pain during menstruation

The signs and symptoms of BPS can be similar to those of chronic urinary tract infections. While BPS is usually not caused by an infection, the condition’s symptoms may become more severe if a UTI is contracted as well.

The signs and symptoms of bladder pain syndrome can change over time, in some cases depending upon how long you’ve had BPS. They may even go away entirely for some periods of time.

The symptoms of BPS may also “flare¹⁷,” or temporarily get worse before resolving on their own. Flares may be caused by a variety of triggers, including sitting for long periods of time, stress, exercise, menstruation, and sexual activity.

Bladder pain syndrome complications

Bladder pain syndrome (interstitial cystitis) can cause certain health complications¹⁸ and affect multiple aspects of daily life, including:

• Bladder capacity: BPS can cause the bladder’s wall to become more rigid, decreasing the volume of urine the organ can hold.
• Quality of life: Frequent urges to urinate and chronic pain can affect your ability to engage in work, social activities, and other activities you enjoy.
• Emotional distress: BPS can cause chronic pain and interrupted sleep. Constant stress can cause very real emotional issues, potentially leading to depression.
• Sexual intimacy: Bladder pain and frequent urination may cause strain on sexual relationships and intimacy.

Urinary tract infection (UTI) symptoms

UTIs don’t always cause¹⁹ noticeable signs or symptoms. When they do, UTIs can range from being mildly annoying to extremely uncomfortable.

Common symptoms of urinary tract infections include:

• Feeling a strong, persistent need to urinate, even with an empty bladder
• Frequent urination (and often passing only small amounts of urine)
• Burning or pain when urinating
• Cloudy and/or strong-smelling urine
• Red, bright pink, or cola-colored urine (indicates blood in the urine)
• Pelvic pain (in women)

Urinary tract infection (UTI) complications

Complicated UTIs occur when a patient has an abnormally structured urinary tract or when the bacteria causing a UTI is not eradicated with most antibiotics. The urinary tract infections that occur in men and children are generally considered to be complicated.

Complicated UTIs are commonly treated with a longer course of antibiotics than simple ones. If the infection is severe, antibiotics may be administered intravenously (IV) in a hospital. This is followed by an oral dose of antibiotics that lasts for as long as two weeks.

Rarely, UTIs can become severe and spread to the kidneys. A kidney infection—called pyelonephritis—is serious and requires medical treatment. Kidney infections are also often treated in the same way that other complicated UTIs are.

Bladder stone symptoms

In some cases, bladder stones don’t cause any noticeable symptoms—even large ones. Symptoms may not begin until a stone obstructs urine flow or irritates the wall of the bladder. When this occurs, signs and symptoms²⁰ can include:

• Painful urination
• Frequent urination
• Difficulty urinating or interrupted urine flow
• Pain in the lower abdomen
• Blood in the urine (pink, red, or dark-colored urine)
• Cloudy urine

Bladder stone complications

Even if they don’t cause any noticeable symptoms, bladder stones that don’t pass through the urinary tract out of the body can lead to a number of health complications²¹, including:

• Urinary tract infections (UTIs): Bladder stones can cause chronic (repeated) bacterial infections in the urinary tract.
• Chronic bladder problems: Bladder stones can become stuck in the opening where urine passes from the bladder to the urethra, blocking urine from exiting the body. Untreated bladder stones can also cause chronic (long-term) difficulties with urination, including painful or frequent urination.