The bladder is a hollow, balloon-shaped muscle in the middle of your pelvis. It expands and contracts as it fills with and empties your urine. As part of your urinary system, your bladder holds the urine that is passed to it from your kidneys via two tiny tubes called ureters before being released through your urethra.

Bladder pain can affect men and women and be caused by a few different conditions — some more serious than others. We’ll explore the different causes of bladder pain, what other symptoms to look out for, and treatment options.

Bladder pain of any kind requires investigation because it has several possible causes, from a urinary tract infection to chronic bladder inflammation.

Urinary tract infection

A urinary tract infection (UTI) is a bacterial infection along any part of your urinary tract, including the bladder. Men and women can get UTIs, but they are more common in women. UTIs are caused by bacteria that enter the bladder through the urethra. When left untreated, UTIs can spread to your kidneys and blood stream causing serious complications.

Symptoms of urinary tract infection

Along with bladder pain, a UTI may also cause any of the following symptoms:

Diagnosing urinary tract infections

Your doctor can diagnose a urinary tract infection using a urinalysis to check your urine sample for white and red blood cells, and bacteria. Your doctor may also use a urine culture to determine the type of bacteria present.

If you have recurrent UTIs, your doctor may recommend the further testing to check for abnormalities in your bladder or urinary tract. These tests may include:

Treatments for urinary tract infections

UTIs are treated with oral antibiotics to kill the bacteria. Your doctor may also prescribe a pain medication to relieve pain and burning. Frequent UTIs may require a longer course of antibiotics. Severe UTIs and complications may require antibiotics given through an IV in a hospital.

Interstitial cystitis/painful bladder syndrome

Interstitial cystitis, also referred to as bladder pain syndrome, is a chronic condition that causes painful urinary symptoms. It affects mostly women, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The cause of the condition is currently unknown, but certain factors may trigger symptoms, such as infections, physical or emotional stress, diet, bladder injury, or certain medications.

Symptoms of interstitial cystitis

The symptoms can range from mild to severe and vary from person to person. Symptoms can include:

Diagnosing interstitial cystitis

Your doctor may use the following tests to diagnose interstitial cystitis:

  • medical history, including symptoms
  • bladder diary of your fluid intake and the volume of urine you pass
  • pelvic exam (women)
  • prostate exam (men)
  • urinalysis to check for infection
  • cystoscopy to view the lining of your bladder
  • urinary function tests
  • potassium sensitivity test

Your doctor may also perform other tests to help rule out cancer as the cause of your symptoms, such as a biopsy, which is usually performed during cystoscopy or urine cytology to check for cancer cells in your urine.

Treatments for interstitial cystitis

There is no one specific treatment for interstitial cystitis. Your doctor will recommend treatments for your individual symptoms, which may include:

  • Lifestyle changes. The changes recommended will be based on what you feel your triggers are. These often include quitting smoking, avoiding alcohol, and dietary changes. Some people find that gentle exercise and stress reduction helps relieve symptoms.
  • Medication. Over-the-counter (OTC) pain medications may help relieve pain. Prescription medications such as Tricyclic antidepressants may help relax your bladder and block pain. Pentosan polysulfate sodium (Elmiron) is approved by the FDA to treat the condition.
  • Bladder training. Bladder training may help your bladder to hold more urine. It involves tracking how often you urinate and gradually extending the time between urinating.
  • Physical therapy. A physical therapist who specializes in the pelvis can help you stretch and strengthen your pelvic floor muscles and learn to keep them relaxed, which may help relieve your symptoms, including pelvic floor muscle spasms.
  • Bladder instillation. A small amount of liquid containing medication to ease irritation is placed in your bladder and held in for approximately 15 minutes before releasing it. The treatment can be repeated weekly or biweekly for one or two months.
  • Bladder stretching. The bladder is stretched by filling it with fluid. You will be given medication to help you hold the fluid and tolerate the stretching. Some people experience a temporary relief of symptoms after bladder stretching.
  • Transcranial magnetic stimulation. A small 2018 study found that repetitive transcranial magnetic stimulation improved chronic pelvic pain and associated urinary disorders in people with bladder pain syndrome.
  • Surgery. Surgery is only recommended if all other treatments have failed to provide relief and your symptoms are severe. Surgery may involve bladder augmentation or enlargement, a cystectomy to remove the bladder, or urinary diversion to reroute your urine flow.

Bladder cancer

Bladder cancer results when cells in the bladder grow uncontrollably. There are different types of bladder cancers but urothelial carcinoma, also known as transitional cell carcinoma, which begins in the urothelial cells in the lining of your bladder, is the most common type. Bladder cancer is more common in men than women and occurs most often after the age of 55. It’s also two to three times more common in people who smoke compared to nonsmokers.

Symptoms of bladder cancer

Painless blood in the urine is the most common symptom of bladder cancer. Most often, bladder cancer has no pain or other symptoms. However, if symptoms are present they can include:

  • having to urinate more often
  • pain or burning when urinating
  • urgency to urinate even when your bladder isn’t full
  • trouble urinating
  • weak urine stream

Advanced bladder cancer can affect other organs and systems, so symptoms may include:

  • inability to urinate
  • lower back pain on one side
  • bone pain
  • abdominal or pelvic pain
  • loss of appetite
  • weakness or fatigue

Diagnosing bladder cancer

Testing for bladder cancer may include:

  • complete medical history
  • cystoscopy
  • urinalysis
  • urine culture
  • urine cytology
  • urine tumor marker tests
  • imaging tests
  • biopsy

Treatments for bladder cancer

Treatment for bladder cancer will depend on the type of bladder cancer, the stage of the cancer, and other factors. Treatment for bladder cancer usually involves more than one of the following treatments:

  • Surgery. The type of surgery used to treat bladder cancer depends on the stage. Surgery may be used to remove a tumor, remove part of the bladder, or the entire bladder.
  • Radiation. High-energy radiation is used to kill cancer cells. It can be used to treat early stage bladder cancers, as an alternative for people who can’t have surgery, and treat or prevent symptoms of advanced bladder cancer. It’s often combined with chemotherapy.
  • Chemotherapy. Chemotherapy drugs are used to kill cancer cells. Systemic chemotherapy is given in either pill form or through an IV. Intravesical chemotherapy, which is only used for very early-stage bladder cancers, is administered directly into the bladder.
  • Immunotherapy. Immunotherapy uses medication to help your immune system recognize and kill cancer cells.

Bladder pain is more common in women. This is likely due to the fact that the two most common causes of bladder pain — urinary tract infections and interstitial cystitis — more often affect women than men. It may be also due to the fact that the bladder comes into direct contact with a woman’s reproductive organs, which may cause irritation and aggravate symptoms.

Up to 12 percent of women may have early symptoms of interstitial cystitis. Research suggests that at least 40 to 60 percent of women develop a UTI during their lifetime, most of which are bladder infections.

The differences in a woman’s anatomy increase the risk of bladder infections. A shorter urethra means that bacteria are closer to a woman’s bladder. A woman’s urethra is also closer to the rectum and vagina where bladder infection-causing bacteria live.

Men have a higher risk of developing bladder cancer. According to the American Cancer Society, bladder cancer is the fourth most common cancer in men. The chance that men will get bladder cancer in their lifetime is around 1 in 27. The lifetime chance for women is approximately 1 in 89.

Since the bladder sits in the middle of the body, bladder pain is usually felt in the center of the pelvis or lower abdomen as opposed to one side.

Any bladder pain should be evaluated by a doctor to help determine the cause and reduce the risk of complications.

The following may help you manage bladder pain:

  • OTC pain medications
  • heating pad
  • relaxation techniques
  • gentle exercise
  • loose clothing (to avoid putting pressure on the bladder)
  • dietary changes

Most bladder pain is caused by UTIs, which can be treated with antibiotics. See your doctor right away to rule out other more serious causes of bladder pain.