Understanding IC/BPS is the first step to managing it. Education empowers IC/BPS patients, regardless of phenotype, to recognize symptom triggers, explore treatment options, and make informed lifestyle choices. You can learn more about these below.
What is pain science education?
Pain science education teaches people how pain actually works in the body and brain. One of the key lessons is that pain doesn’t always mean tissue damage. When pain persists for a long time, the nervous system can become overly sensitive, almost like a smoke alarm that starts going off when you’re just making toast. The alarm is real—you genuinely hear it—but it doesn’t mean the house is on fire.
How does this apply to IC/BPS?
In IC/BPS, the nervous system can become “wound up,” amplifying signals from the bladder so that normal sensations, like mild stretching during filling, are interpreted as pain or intense urgency. Stress, poor sleep, fear, and muscle tension can all turn up the volume on these signals. Understanding this helps explain why symptoms can flare during stressful times, even when nothing has physically changed in the bladder.
Why is this knowledge helpful?
When people understand that their sensitized nervous system is contributing to the pain, not just the bladder itself, it opens the door to a wider range of management strategies. Rather than focusing solely on the bladder, people can also work on calming the nervous system through approaches like relaxation techniques, graded movement and exercise, improved sleep, pelvic floor physical therapy, and stress management. Knowing that pain can be “turned down” by the brain gives people a greater sense of control and often reduces the fear and anxiety that can make symptoms worse.
Pain science education doesn’t dismiss anyone’s pain as imaginary. The pain is absolutely real. It simply provides a more complete picture of why the pain persists and what can be done about it, empowering people to take an active role alongside their medical treatment.
Taking the time to identify what in our lives makes us feel better or worse (e.g., what might produce a low-pain day vs. a high-pain day) can help us engage in effective self-care. For example, if we know we feel better after intentional physical activity, such as walking around the neighborhood or taking a yoga class, we can work to incorporate those activities into our daily lives. The University of Michigan Pain Guide offers helpful resources on self-care activities, such as pacing and reframing.
Stress, specifically chronic stress, can amplify our nervous system’s response to pain signals. This means that stress management is an important component of self-care. Recognizing that everyone may respond differently to different strategies, activities like meditation, guided imagery, and seeking assistance from a mental health professional may be helpful. Using a resource like Psychology Today can help you identify a mental health professional who meets your needs.
A focus on self-care does not mean that patients are solely responsible for their own health outcomes. However, self-care acknowledges the power we have in our own lives to improve how we feel.
Many of the urinary, bowel, or sexual symptoms IC/BPS patients experience can be signs of pelvic floor dysfunction, including:
- Urinary urgency, frequency, or hesitancy; stopping and starting urination; painful urination; or incomplete emptying
- Constipation, straining, and pain with bowel movements
- Unexplained pain in your low back, pelvic region, genital area, or rectum
- Pain during or after intercourse or orgasm
The pelvic floor is a group of muscles that attaches to the front, back, and sides of your pelvis and to the tailbone and sacrum. These muscles support your pelvic organs, including the bladder, uterus or prostate, and rectum, and wrap around your urethra, vagina (in women), and rectum. Coordinated contraction and relaxation of these muscles helps control bladder and bowel function.
In patients who have IC/BPS or other pelvic pain conditions, these muscles may be tight or in spasm, have a combination of tightness and weakness, or have pain-triggering spots or knots called “trigger points.” Pain “referred” from internal organs, such as the bladder, may set off these muscle problems, but the muscle problems themselves can also set off bladder symptoms. Pain can also be “referred” to the skin and other muscles, such as in your lower abdomen, lower back, buttocks, thighs, and perineal area. Pain there can also “refer” back to your internal organs, contributing to your symptoms.
Physical therapy to treat these problems can go a long way toward easing your pain and bladder symptoms. The physical therapy techniques that help relax and lengthen tight muscles and release trigger points are different from those that help incontinence patients, who may need to strengthen the pelvic floor through Kegel exercises.
Your physical therapist (PT) should be specially trained in techniques that help patients with IC/BPS and pelvic pain. When you start working with a knowledgeable PT, they will usually do an assessment before starting therapy. Assessment can include looking for external muscle problems and an internal exam. If you cannot tolerate an internal exam, that can be postponed until you can.
Here are some resources that you can use to locate a pelvic floor physical therapist:
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