For women living with bladder pain, an infection is often to blame — but it’s not the only possible cause.
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. Bladder cancer is rare — especially in women. Of the more than 82,000 Americans who are expected to be diagnosed with bladder cancer in 2024, the American Cancer Society (ACS) estimates that about a quarter will be female.
But pelvic or lower abdominal pain or pressure in your pelvis or lower abdomen may be coming from your bladder, and following up with a doctor is crucial. The symptoms could still be a sign of a serious health problem. This article explains the conditions that can cause bladder pain and how they affect bladder health.
Urinary tract infections (UTIs), sometimes called bladder infections, occur in women more often than men. Simple anatomy is behind this difference.
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), 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.
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 is a female hormone with close links to reproductive health, and it also plays a role in urinary tract health. After menopause, vaginal tissue thins, making it more susceptible to infection.
The UTI rate in women older than 65 is double that seen in the female population overall, according to a study. The study authors added that a peak rate of UTIs occurs during the years of maximum sexual activity, usually between the ages of 18 and 39 years.
In young women, bladder pain is a common symptom of UTIs, along with frequent and painful urination. Symptoms in older women can vary but might include muscle aches, abdominal pain, fatigue, and weakness.
It’s important to see your doctor about UTI bladder pain 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.
More than three million American women live with pelvic pain related to interstitial cystitis, a condition in which the bladder wall develops irritation and inflammation, according to the NIDDK. “Interstitial cystitis is a severe form of bladder pain syndrome,” advises Nazema Y. Siddiqui, MD, an associate professor of obstetrics and gynecology at the Duke University School of Medicine in Durham, North Carolina.
According to the NIDDK, bladder discomfort from interstitial cystitis may range from tenderness to severe pain. A persistent, urgent need to urinate is a main characteristic of the condition. Mayo Clinic says this feeling may occur up to 60 times a day — even immediately after a person has urinated. Another clue that interstitial cystitis is a possible cause of your bladder pain would be if the bladder pain worsens during menstruation.
Interstitial cystitis does not occur because of a UTI, although the symptoms may worsen if you get a UTI while you have interstitial cystitis. While the cause remains unclear, according to the NIDDK, certain events or factors seem to trigger flares in symptoms. These include stress, changes in diet, allergies, and certain medications.
Although no cure for interstitial cystitis exists, treatment options for interstitial cystitis include:
Lifestyle changes to avoid triggers, including quitting smoking and avoiding foods or drinks that trigger flareups, reducing stress, and increasing physical activity
Taking oral medication such as tricyclic antidepressants, antihistamines, and pentosan polysulfate sodium (Elmiron)
Stretching the bladder in a procedure called cystoscopy with hydrodistention that involves slowly filling it with fluid
Physical therapy to train the bladder for increased volume and the bowels to become more regular
Using an electrical nerve stimulation device to relieve pain by sending mild impulses to nerves in the lower back
If other treatments are not successful, surgery to increase the size of the bladder, remove the bladder, or reroute urine’s normal flow may be an option.
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. According to the National Institute on Aging, this can lead to other symptoms, including:
Dryness
Burning
Itching
Tightening of the vagina’s opening
Painful sex
The first-line treatment for this is a vaginal estrogen cream, which works best for atrophy. People on oral estrogen pills may need a vaginal option added to their regimen to manage symptoms involving the urinary tract, but oral options might provide relief for some people. Some of these treatments — such as Premarin and Estrace — are only available by doctor’s prescription, but over-the-counter options may also help. Typically, a person applies them daily for one to three weeks and then one to three times a week thereafter.
Talk with your doctor about bladder pain and discomfort to determine where the problem really lies, Dr. Luber says.
Bladder cancer is rare, especially in women, and it is more likely to be diagnosed in women when tumors are more advanced. Women are also more likely to die of bladder cancer than men, according to the Bladder Cancer Advocacy Network.
The most common symptom is blood in the urine. Some women also experience a painful, burning sensation when urinating. Paying attention to your other symptoms, particularly blood in your pee, can help you tell the difference between benign and cancer-related bladder pain, says Dr. Siddiqui. Bladder cancer treatments include surgery, chemotherapy, radiation therapy, and immunotherapy. According to the ACS, most people need surgery to remove a tumor or tumors. For people with advanced bladder cancer, the surgeon removes part or all of the bladder.
If you think you have bladder pain, speak with a doctor rather than guess what the pain could be. It may not be as serious as you think, but it could help you catch a health problem before it becomes severe, or what seems to be bladder pain may not even involve the bladder.
For example, 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. According to Cleveland Clinic, other symptoms include:
“If none of these conditions are present and women have ongoing bladder pain, they typically receive treatment for bladder pain syndrome, which refers to painful conditions of the bladder after a physician has excluded other causes such as UTI and cancer," says Siddiqui.
Several conditions and stages of life can be behind bladder pain. While bladder pain can be concerning, it’s more often due to a UTI in women than a more severe condition. Interstitial cystitis may be a cause if the pain occurs along with frequent urinary urgency, and bladder pain can also be part of vaginal atrophy that occurs due to reproductive system changes over time.
Bladder cancer can also cause bladder pain along with blood in the pee, but it’s rare. And what might seem to be bladder pain could relate to other parts of the pelvis. The bottom line: Don’t self-diagnose your bladder pain. A medical professional can address and treat the issue to offer relief for your body and mind.
