4 Causes of Bladder Pain
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Bladder pain can signal anything from a minor infection to a serious health condition like cancer. Symptoms may range from discomfort in the lower abdomen area to burning with urination.
The good news is that bladder cancer is rare — especially in women. Of the more than 82,000 Americans who are expected to be diagnosed with bladder cancer in 2023, the American Cancer Society (ACS) estimates that about a quarter will be women.
But that doesn’t mean you can ignore when you have pain or pressure in your pelvis or lower abdomen that may be coming from your bladder. The symptoms could still be a sign of a serious health problem.
How do you know whether the pain is worrisome or indicates a benign condition? Pay attention to your other symptoms, particularly if you have blood in your urine along with bladder pain, says Nazema Y. Siddiqui, MD, an associate professor of obstetrics and gynecology at the Duke University School of Medicine in Durham, North Carolina.
Bladder pain could be due to the conditions listed below. But pain in the bladder area can be caused by pelvic pain due to gynecologic conditions. Certain gastrointestinal issues can also lead to pain in or around the bladder. “When women have bladder pain, they should seek evaluation,” Dr. Siddiqui says.
1. Urinary Tract Infections: More Common in Women
Urinary tract infections (UTIs), sometimes called bladder infections, strike women more often than men, and simple anatomy is the cause.
The female urethra is closer to areas that have natural bacteria, such as the anus and vagina. It’s also shorter than a man’s urethra, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
More than half of all women have a UTI at some point in their lives, and these infections can develop at any age. The Urology Care Foundation notes that young women tend to get more of these infections with the onset of sexual activity, while older women are prone to UTIs after menopause when vaginal estrogen levels drop. Estrogen plays a role in urinary tract health, and after menopause, vaginal tissue thins, making it more susceptible to infection.
In women over age 65, the UTI rate is double that seen in the female population overall, according to a study published in 2019 in Therapeutic Advances in Urology. The same research added that a peak rate of UTIs occurs during the years of maximum sexual activity, usually between age 18 and 39.
In young women, bladder pain is a common symptom of UTIs, along with frequent and painful urination. Symptoms in older women can vary but typically include muscle aches, abdominal pain, fatigue, and weakness.
It’s important to see your doctor because treatment with antibiotics like nitrofurantoin (Macrobid), trimethoprim/sulfamethoxazole (Bactrim), and fosfomycin (Monurol) can usually clear up a urinary tract infection, per the NIDDK.
And though an infection may go away without treatment, antibiotics can speed healing and quickly eliminate uncomfortable symptoms. Drinking extra fluids and urinating frequently will also help treat the infection and your discomfort.
2. Interstitial Cystitis: A Severe Form of Bladder Pain Syndrome
More than 3 million American women live with pelvic pain related to interstitial cystitis, a condition in which the bladder wall becomes irritated and inflamed, according to the NIDDK. “Interstitial cystitis is a severe form of bladder pain syndrome,” Siddiqui says.
Bladder discomfort from interstitial cystitis may range from tenderness to severe pain, according to the NIDDK. The condition is characterized by a persistent, urgent need to urinate. The Mayo Clinic says that this feeling may occur up to 60 times a day — even immediately after a person has urinated. Another clue that interstitial cystitis is the culprit: Menstruation tends to worsen bladder pain.
Interstitial cystitis is not caused by a urinary tract infection, although the symptoms may worsen if you have interstitial cystitis and get a UTI. While the cause is not understood, according to the NIDDK, certain events or factors seem to trigger flares in symptoms. These include stress, changes in diet, allergies, and taking certain drugs, among other things.
Although there is no cure, treatment options for interstitial cystitis include distending (stretching) the bladder in a procedure that involves slowly filling it with fluid; taking oral medication such as tricyclic antidepressants, antihistamines, and pentosan polysulfate sodium (Elmiron); physical therapy; and using an electrical nerve stimulation device to alleviate pain by sending mild impulses to nerves in the lower back. In severe cases after other treatments haven’t worked, sometimes surgery is an option.
3. Changes in Your Reproductive System
Bladder pain in women may be a result of thinning vaginal skin, says Karl Luber, MD, a urogynecologist and a founder of the female pelvic medicine and reconstructive surgery fellowship program at UCSD–Kaiser Permanente in San Diego.
“This is called atrophy, and it’s most common when menopause [or perimenopause] deprives the tissues surrounding the vagina of estrogen,” he explains. When estrogen levels decline, the tissues of the vagina shrink and become thinner.
Oral estrogen doesn’t help, but a vaginal estrogen cream may ease symptoms. Some of these treatments — such as Premarin and Estrace — are only available by doctor’s prescription, but there are over-the-counter options as well. Typically, they are applied daily for one to three weeks and then one to three times a week thereafter.
Talking with your doctor about bladder pain and discomfort can help determine where the problem really lies, Dr. Luber says.
4. Bladder Cancer: Rare but Still Life-Threatening
While bladder cancer is rare, especially in women, it is more likely to be diagnosed in women when tumors are more advanced. Women are also more likely to die from bladder cancer compared with men, according to the Breast Cancer Advocacy Network. The most common symptom is blood in the urine; some women also experience a painful, burning sensation when urinating.
Bladder cancer treatments include surgery, chemotherapy, and radiation therapy, and immunotherapy. According to the ACS, most people need surgery to remove a tumor or tumors. All or parts of the bladder are removed in severe cases.
Get a Diagnosis, not a Self-Diagnosis
It’s important to consider whether the uterus and other organs of the gynecological system could be causing bladder pain, Siddiqui says, as they are close to the bladder. Pelvic floor dysfunction, such as tightness or spasms of the pelvic muscles, commonly occurs with bladder pain and may make bladder pain worse, she explains. A person with this condition may also be unable to correctly relax and coordinate these muscles to have a bowel movement. Symptoms include constipation, straining to defecate, having urine or stool leakage, and experiencing a frequent need to pee, according to the Cleveland Clinic.
Pelvic pain can also be caused by endometriosis, pelvic inflammatory disease, or ovarian cysts. Additionally, gastrointestinal problems such as inflammatory bowel diseases like Crohn’s disease or ulcerative colitis can sometimes be the source of pelvic pain, notes the Mayo Clinic.
“If none of these conditions are present and women have ongoing bladder pain, they are typically treated for bladder pain syndrome, which refers to painful conditions of the bladder after other causes such as UTI and cancer have been excluded,” says Siddiqui.
The bottom line for women to keep in mind: Don’t self-diagnose your bladder pain. Addressing and treating the issue can offer relief for body and mind.
Additional reporting by Diana Rodriguez.
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