Changes in lifestyle

Diet

There is evidence to show that diet triggers BPS/IC flares, though this may vary from patient to patient.^1,51,53

• Foods include: citrus fruits, tomatoes, vinegar and other high-acid foods, spices, hot pepper and chocolate^1,51,53
• Drinks include: juices and anything that contains citrus, alcohol, coffee, tea, carbonated drinks/soda and artificial sweeteners^1,51,53

Eliminating items from the diet, then reintroducing them one at a time may help determine if this is the case. A Bladder Smart Diary can help patients keep track of the foods and drinks they consume.^1,51,54,55

BPS/IC patients tend to also naturally limit the fluids they drink to reduce pelvic discomfort and urinary frequency. However, drinking enough water regularly can help dilute irritants and toxins in the urine and flush the bladder as well as reduce constipation.^1,55,56

Physical therapy

If the patient is well enough, appropriate physical therapy by trained clinicians could be offered to those who have pelvic floor tenderness e.g. manoeuvres that resolve pelvic, abdominal and/or hip muscular trigger points, lengthen muscle contractures and release painful scars and other connective tissue restrictions.^53–55

Placing knees against the chest, reclining with spread legs or squatting can help relax muscle in the pelvic floor and increase urinating intervals.⁵⁶

Placing hot or cold packs on the pelvic region or taking a warm bath may relieve discomfort.⁵⁶

Behavioural therapy

Keeping a voiding diary could help patients control their fluid intake. Regular planned toilet breaks may help with any discomfort or pain, and it may be a good idea for them to reduce the amount they drink before going to bed.^1,51

Psychological therapy

Though it’s important for patients to understand that their symptoms are real and not psychosomatic, it’s equally important they get professional, emotional support if they need it. It could help patients feel listened to and understood so they can cope better with the impact the physical symptoms of BPS/IC has on their lives.^1,55,57

Patients should also be encouraged to practice stress management and improve coping techniques.^53–56

If patients need a lot of emotional support or have more severe BPS/IC symptoms and need more advanced care, they may need to be referred to a specialist.^1,58

References

• 1.Meijlink JM. Interstitial Cystitis/Bladder Pain Syndrome. Int Painful Bl Found. 2014.
• 51.Tirlapur S, Birch J, Carberry C, et al. Management of Bladder Pain Syndrome: RCOG Green-Top Guideline No. 70. Vol 124.; 2016. doi:10.1111/1471-0528.14310.
• 53.Jerauld A, Wormuth L, Carlson B. New Approaches in Managing Interstitial Cystitis/Bladder Pain Syndrome. US Pharm. 2016;41(9):29-33.
• 54.Hanno PM, Burks DA, Clemens JQ, et al. AUA Guideline for the Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome. J Urol. 2011;185:2162-2170. doi:10.1016/j.juro.2011.03.064.
• 55.Hanno PM, Burks DA, Clemens JQ, et al. Diagnosis and Treatment Interstitial Cystitis / Bladder Pain Syndrome.; 2014.
• 56.Bosch PC, Bosch DC. Treating Interstitial Cystitis/Bladder Pain Syndrome as a Chronic Disease. Rev Urol. 2014;16(2):83-87. doi:10.3909/riu0603.
• 57.Kanter G, Volpe KA, Dunivan GC, et al. Important role of physicians in addressing psychological aspects of interstitial cystitis/bladder pain syndrome (IC/BPS): a qualitative analysis. Int Urogynecol J. 2017;28(2):249-256. doi:10.1007/s00192-016-3109-2.
• 58.Canadian Urological Association Journal. CUA guideline: Diagnosis and treatment of interstitial cystitis/bladder pain syndrome. Can Urol Assoc J. 2016;10(5-6):E136-E155. doi:10.5489/cuaj.3786.