Peeing, or waiting to pee for a little while, shouldn’t hurt. Yet many women struggle with bladder pain day after day, too embarrassed to tell anyone.

When the bladder, a balloon-like organ, fills up with urine, a tight feeling in the pelvis can send some women rushing repeatedly to the bathroom—as often as 40 times a day, about 10 times the average. Other women burn, bleed or ache through their lower back, vulva and vagina, interfering with sleep, sex and other routine activities.

Pain pulsating from the bladder is a frequent symptom of a urinary tract infection (UTI), which strikes around half of U.S. women, and occasionally men, at least once in their lifetimes.

Read: Why You May Have Trouble Peeing, Plus Solutions to Help

The Office on Women’s Health estimates 40% of the female patients develop another UTI within six months. A further 3 million to 8 million women have interstitial cystitis (IC), a chronic, severe condition also known as bladder pain syndrome. IC is commonly mistaken for a UTI but isn’t an infection.

“Don’t be afraid to talk about your bladder issues—they’re incredibly prevalent,” said Kristin Christensen, a Cedars-Sinai physical therapist.

Care is fast evolving, with a flood of treatment methods that are new or under development.

Some women regularly contract UTIs during perimenopause and menopause or when they have sex. Urologists generally treat these cases with vaginal estrogen replacement or preventive antibiotics before sex.

But when the source of repeated infections is unknown, or the immune system is compromised, bacteria can easily spread to the kidneys and cause more severe damage. Complications hospitalize 100,000 people annually.

Experts said that bladder diagnosis and care are inconsistent. Many women suffer for years because of medical gaslighting, when a doctor dismisses or downplays patient symptoms or blames them on a psychological problem.

That compounds medical problems because, “The longer someone has pain, the harder it is to finally treat it when you are diagnosed,” said Cedars-Sinai urologist Karyn Eilber, MD.

Read: Everybody Hurts

The first new treatment for UTIs in two decades, the antibiotic pivmecillinam, or Pivya, was approved in early 2024. The drug adds options for patients who can’t use, or are resistant to, existing medicines—as the threat of antimicrobial resistance grows.

Possibly on the horizon is an oral vaccine called MV140, or Uromune. It could be a game-changer for women who constantly cycle through bladder infections, Eilber said.

The spray uses familiar UTI bacteria to build a patient’s immune system defenses. Although MV140 hasn’t been approved yet, robust research suggests that it can prevent infections for up to nine years, reducing the need of multiple antibiotic courses.

Read: UTIs Gotta Go

IC currently has just one approved medication, pentosan polysulfate sodium. It has serious side effects such as hair and vision loss and often takes months to work.

Faster and potentially safer off-label methods are turning the tide for the little-understood and undertreated condition.

Many physicians believe IC is caused by a damaged bladder lining, leaving the pouch vulnerable to leaks of urinary toxic waste. To neutralize that, patients undergo bladder instillations, where doctors use catheters to deliver medicine directly into the bladder. Eilber explained they often work well as a series of weekly infusions during flare-ups.

Some urologists now also use Botox to treat IC, injecting it directly into the bladder wall and floor. The idea is to target clusters of nerve endings to interrupt pain and squeezing. Each patient usually gets 100 units.

Eilber recently participated in a nationwide clinical trial of Botox for that use. She said it provides about six months of relief.

“A lot of people believe their Botox didn’t work because their symptoms come back, but it doesn’t last forever,” she cautioned.

Urologists are also exploring neuromodulation, which relies on an implant to electrically stimulate the main pelvic nerve to the bladder, retraining nerves and surrounding muscles.

Another nerve treatment for IC, bladder hydrodistension, stretches your bladder. This bladder expansion temporarily disables nerves to stop radiating soreness and to prevent muscle spasms, while also making room to hold more urine. It typically is effective for around six months to a year.

Experts emphasize the role diet plays in bladder pain. Acid, spice and citrus-heavy foods and drinks all aggravate your bladder—as do caffeinated and sparkling drinks, milk and even chocolate. Try to cut back.

Eilber also recommends taking acid-blocking supplements including sodium bicarbonate and calcium carbonate and anti-inflammatories such as aloe or quercetin.

Behaviors such as going to the bathroom when you don’t yet need to can also cause a flare-up. For example, peeing every time you leave the house can give you the urge to go whenever you get ready to head out.

People can evaluate their triggers by tracking everything they eat and drink for a couple of days, and when they use the bathroom, Christensen suggested.

Physical therapists also treat the pelvic floor. They provide therapy that relies on stretching and manual pelvic massage to release knots in supporting muscles and, in turn, the bladder. With pelvic floor therapy and other strategies to protect the bladder, patients often progress to the point where they no longer worry about bladder pain or urination.

Wherever you are in your treatment journey, Christensen encourages you to seek a referral to a physical therapist. It can help you feel better more quickly and avoid unneeded testing.

“It’s never normal to experience bladder pain,” she said. 

Read: What Women Need to Know About Pain During Sex