Fibromyalgia can have a major impact on all the systems of the body including the bladder. People with fibromyalgia can experience a condition known as interstitial cystitis, which may also be known as painful bladder syndrome (PBS), as well as problems with chronic bladder infections. In fact, in studies that attempt to determine the relationship between the occurrence of bladder symptoms and fibromyalgia and chronic fatigue syndrome, the connection is clear. There is a significant increase in prevalence of interstitial cystitis and fibromyalgia as well as with chronic fatigue syndrome. This change was almost 32% higher in patients with IBS, 15% in those with fibromyalgia, and almost 8% in those with chronic fatigue syndrome. 1
The occurrence of bladder symptoms in patients with fibromyalgia has led to the development of a sensory rating tool known as the Fibromyalgia Bladder Index. This tool allows doctors and patients to assess bladder symptoms that are not related to urinary tract infections. There are two subscales on the Fibromyalgia Bladder Index, one that allows for the isolation of Bladder Urgency and Pain and Bladder Frequency and Nocturia.2 Having a consistent rating tool allows doctors to understand clearly the symptoms the patient is experiencing and help to track information about the progression or development of bladder problems in patients with fibromyalgia.
What Causes Interstitial Cystitis?
Unfortunately for people with fibromyalgia and interstitial cystitis, the cause of the bladder problems, just like the cause of fibromyalgia, is not yet understood. What it is not is a bladder infection or a urinary tract infection. In fact interstitial cystitis does not get better even when you take antibiotics, although there is growing evidence that it may be mistaken as antibiotic resistant bacterial infections. If this is correct then the actual number of individuals with Painful Bladder Syndrome is likely much higher than previously understood. Like fibromyalgia, a diagnosis is often a long process and, for many women, it is only after fibromyalgia is diagnosed that interstitial cystitis is considered.
While stress can certainly make fibromyalgia and related syndromes more problematic, it is not the major contributing cause to the development of interstitial cystitis. Anyone can have interstitial cystitis, but it is more common in women of all ages with or without fibromyalgia.
Symptoms Of Interstitial Cystitis
There are a variety of different symptoms that can occur with interstitial cystitis. These symptoms can come and go, or they may get progressively more problematic in short or long cycles. In general most people with interstitial cystitis will experience:
- Increased frequency of urination at all times of the day and night
- Increased urgency when bladder pressure develops
- Pain, pressure and spasms of the bladder if immediate urination is not possible
- Lower abdominal pain
- Pain during and after intercourse that can last for hours or days
- Vaginal or penile pain
- Pelvic Floor Dysfunction (PFD)
Other symptoms that are common to interstitial cystitis, chronic fatigue syndrome and fibromyalgia, as well as irritable bowel syndrome, can also be present. Individuals may experience headaches or migraines, joint pain, muscle pain, digestive disorders and unusual or unusually severe allergic reactions. Often these associated symptoms cause greater confusion with a diagnosis but, when occurring with the bladder dysfunction, can actually help in ruling out other issues such as bladder infections.
In a study on the specific relationship between fibromyalgia and interstitial cystitis this overlap in symptoms between the syndromes was noted. In addition this research also showed that patients with interstitial cystitis could have tender points and also, like the fibromyalgia group, had more pain or hypersensitivity to pain at control points over the body. This indicated to the researchers that both conditions may have a very similar mechanism in the body and therefore a similar origin.3
Getting A Diagnosis
As with all syndromes, a diagnosis of interstitial cystitis is completed by ruling out all other possible issues. This is often easier if you are already diagnosed with fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome or other types of chronic pain syndromes. One reason this diagnosis may be easier if you are already identified with a chronic pain syndrome is that the doctor you are working with will be aware of the often concurrent medical issues. Specialists are more likely to diagnose this syndrome than general physicians who may not be aware of all the possible complications of a major health issue like fibromyalgia.
Managing Interstitial Cystitis
Like Irritable Bowel Syndrome, many of the management strategies for interstitial cystitis will be very similar to general strategies for the management of fibromyalgia. This can help in reducing the need for medications, especially if relaxation, diet and sleep issues can be addressed effectively. There are some oral medications that can help as well. Antihistamines, even over the counter medications can help control histamine levels in the body, which has been linked to a decrease in symptoms. Antidepressants may also be beneficial in pain relief and as well as decreasing the frequency of urination. 4
Dietary factors to consider include limiting any diuretic types of foods or beverages from the diet. This includes carbonated beverages, caffeine containing beverages and all types of alcohol. Often spicy foods or highly acidic foods can trigger the conditions of interstitial cystitis, and these should be eliminated from the diet and then reintroduced with monitoring to determine which foods can be tolerated and which cannot. Smoking is linked to increased pain and bladder complications and for some people with interstitial cystitis smoking cessation is seen as a key component of management of the symptoms.
More research is needed to understand why patients that have one of the chronic pain syndromes is so much more likely to develop concurrent and similar types of very debilitating conditions. Finding the specific pathways of the development of these syndromes, and if the hormonal and chemical changes due to chronic pain play a role in the development of subsequent conditions, will certainly continue to be a major part of research into fibromyalgia, chronic fatigue syndrome, interstitial cystitis and irritable bowel syndrome in the future.
1 Nickel, J. C., Tripp, D. A., Pontari, M., & etal. (2010). Interstitial Cystitis/Painful Bladder Syndrome and Associated Medical Conditions With an Emphasis on Irritable Bowel Syndrome, Fibromyalgia and Chronic Fatigue Syndrome. Journal of Urology , 1358-1363.
2The Fibromyalgia Bladder Index . (2007). Clinical Rheumatology , 2097-2103.
3 Clauw, D., Schmidt, M., Radulovic, D., & etal. (1997). The relationship between fibromyalgia and interstitial cystitis. Journal of Psychiatric Research , 125-131.
4 Baker, K., & Barkhuizen, A. (2006). Pharmacologic treatment of fibromyalgia . Current Psychiatry Reports , 464-469
This article was originally published on July 11, 2012 and last revision and update of it was 9/7/2015