Bladder pain, pressure, and an urgent need to urinate – these symptoms often lead to a diagnosis of a urinary tract infection (UTI). But what happens when tests show no infection? For many, the answer is Interstitial Cystitis (IC), also known as Bladder Pain Syndrome (BPS).
IC/BPS is a chronic pain condition affecting millions, yet it is frequently misdiagnosed or dismissed. Studies estimate that 3.2 to 7.9 million women in the U.S. experience symptoms of IC/BPS, yet fewer than 10% receive a formal diagnosis. Men are often mistakenly diagnosed with chronic prostatitis, leading to ineffective treatments and prolonged suffering.
Interstitial Cystitis Network. “Interstitial Cystitis Prevalence and Epidemiology.” Interstitial Cystitis Network, https://www.ic-network.com/interstitial-cystitis-prevalence-epidemiology/. Accessed 19 Mar. 2025.
“Worrying does not take away tomorrow’s troubles. It takes away today”s peace. ~ Randy Armstrong
Why Is IC/BPS Misunderstood?
Unlike conditions with clear structural damage, IC/BPS does not have a single, identifiable cause. Theories include:
– A leaky bladder lining (epithelium) – allowing toxic substances in urine to irritate the bladder wall.
– Chronic inflammation – though often present, inflammation does not fully explain persistent pain. The brain’s perception or interpretation of damage alone can cause a protective mechanism like inflammation to persist, even when bacteria or infection is no longer present.
– Links to autoimmune reactions, heredity, infection, or allergies – none of which have been definitively proven.
More importantly, IC/BPS patients have a high prevalence of comorbid functional somatic syndromes like fibromyalgia and irritable bowel syndrome (IBS). These conditions are also characterized by chronic pain in the absence of clearly identifiable peripheral pathology. This suggests that altered central pain processing could be at play. Think hyperalgesia, allodynia, or the more commonly diagnosed central sensitization – a heightened response to pain driven by the brain and nervous system. A recent study found that IC patients have reduced pain thresholds and pain tolerance compared to healthy controls because their central nervous systems have become hyperresponsive to input, even that of gentle/neutral stimuli.
Ness TJ, Lloyd LK2, Fillingim RB. An endogenous pain control system is altered in subjects with interstitial cystitis. J Urol. 2014;191:364–370. doi: 10.1016/j.juro.2013.08.024.
The Connection to Pain Reprocessing Therapy
A lack of structural damage in IC/BPS suggests that pain may be maintained by the brain rather than the bladder itself. If the bladder is damaged by a bacteria like E. coli, for example, the organ can mend itself quickly, calling upon specialized cells in its lining to repair tissue and restore a barrier against harmful materials concentrated in the urine. Our bodies are incredibly adaptable and have the capacity to heal!
Moreover, research shows that IC/BPS patients have lower pain thresholds and increased sensitivity, much like those with other centrally mediated pain conditions. Pain Reprocessing Therapy (PRT) focuses on retraining the brain’s pain response and reducing fear-based neural pathways that keep pain active. In conditions like IC/BPS, where no clear injury persists, addressing neuroplastic pain could be key to long-term relief.
The American Urology Association Guidelines suggest that IC/BPS is a hypersensitivity disorder affecting the bladder and that a dysregulated central nervous system can be the root cause of IC and related syndromes. The majority of patients who develop widespread pelvic or bladder pain have suffered adverse childhood experiences such as physical or emotional trauma or abuse, bullying that left the nervous system in perpetual fight or flight, or experienced chronic stress, which forces the nervous system to stay in a state of high alert. As such, calming the nervous system and regulating hypervigilance with mind-body medicine techniques like PRT is the best course of action.
What This Means for Healing
– Pain does not always mean damage. Many IC/BPS patients have only minor inflammation, yet experience severe pain. This suggests that the brain’s interpretation of signals plays a significant role in symptoms.
– The bladder has a natural ability to heal. If pain continues despite no ongoing injury, it may be perpetuated by the nervous system rather than a structural problem.
– Assessing for neuroplastic pain is essential. IC/BPS is often treated with medications, diet changes, or bladder procedures, but these approaches may not address the underlying cause if the pain is brain-driven.
– “Bladder pain syndrome” is a descriptive diagnosis indicating pain in a certain area of the body, but not identifying a root cause.
Take Action
Practitioners treating those with undiagnosed bladder or pelvic pain or IC/BPS can learn to help patients recover and get their lives back with our professional Pain Reprocessing Therapy Training. PRT is a two-pronged approach. As the fear or perception of danger fuels pain, PRT addresses two categories of fear: pain threats and non-pain threats. First, providers will learn to address patients’ fears around their symptoms, including the worries, preoccupations, beliefs, and behaviors toward the pain itself that reinforce danger. Second, providers will address patients’ general fears that keep danger signals activated and perpetuate the high alert state, such as anxiety, depression, stress, conflicted relationships, life transitions, and more.