Fibromyalgia, Chronic Fatigue Syndrome & Interstitial Cystitis

Dealing With Multiple Conditions

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Fibromyalgia, chronic fatigue syndrome and interstitial cystitis (IC) – a painful bladder condition – frequently occur together. IC is more common in women, and women with IC are significantly more likely to develop fibromyalgia and chronic fatigue.

Having IC alone can impose a lot of restrictions on your lifestyle and, like fibromyalgia (FMS) and chronic fatigue syndrome (CFS or ME/CFS), it's linked to depression. Also like FMS and ME/CFS, IC can be difficult to diagnose, treat and manage. Some people have good luck with basic treatments and dietary changes, while others may need more intensive treatments or even surgery.

Woman sitting on the toilet holding toilet paper
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Interstitial cystitis (IC) is abdominal or pelvic pain related to your bladder getting full, often accompanied by other urinary symptoms, but with no infection or other obvious diseases. The cause of IC is unknown. Frequently, healthcare providers misdiagnose it as a urinary tract infection, and since diagnosis is made based on ruling out other conditions, people can have IC for months or years before being diagnosed correctly.


  • Urinary frequency (more than 8 times a day)
  • Urinary urgency
  • Urinary discomfort
  • Pain during or after intercourse
  • Pelvic pain

You're most likely to develop IC between age 20 and 50, but it's also possible to get it earlier or later.

Why the overlap? Good question! Problem is, we don't have an answer. Researchers are still trying to puzzle out the causes and underlying mechanisms of all these conditions, and until they can, we probably won't understand why they overlap. Some possibilities exist, including:

  • Researchers suspect chronic infection could play a role for all 3 diseases
  • The pain of all 3 is believed to originate in the nerves
  • Chronic pain from IC may lead to the central sensitization suspected in FMS and ME/CFS
  • Research released in early 2019 shows that some patients with IC have a systemic syndrome and not one that's confined to the bladder

Because all 3 conditions are far more common in women, hormonal or anatomical differences may be at work as well.

An emerging umbrella term for conditions involving central sensitization is central sensitivity syndromes.


IC is diagnosed primarily based on symptoms. Before diagnosing IC, your healthcare provider will need to rule out other possible causes of your symptoms. Tests include:

  • Bladder biopsy
  • Cystoscopy (endoscopy of bladder)
  • Urine analysis & culture
  • Urine cytology (for detecting cancer and inflammatory diseases in the urinary tract)
  • Video urodynamics (which shows how much urine it takes for you to feel the need to urinate)

To confirm an IC diagnosis, your healthcare provider may perform a hydrodistention, in which your bladder is filled with water. That helps your practitioner view your bladder walls for possible hemorrhages common in people with IC.

IC isn't well recognized or easily diagnosed, so if you think you have it, mention it to your heatlhcare provider.


There's no cure for IC, and treatment needs to be tailored to the individual. It can take a lot of trial and error before you find the right combination of therapies and lifestyle changes.

Your healthcare provider may prescribe one of the several medications for IC:

  • Elmiron (pentosan)
  • Opioid painkillers, such as Vicodin (hydrocodone-acetaminophen) or Percocet (oxycodone-acetaminophen)
  • Tricyclic antidepressants, such as Elavil (amitriptyline)
  • Vistaril (hydroxyzine)

Other treatments include:

  • Bladder training (relaxation techniques to train the bladder to go only at specific times)
  • Medicines placed directly into the bladder
  • Physical therapy and biofeedback (aimed at relieving muscle spasms)
  • Surgery

Dietary changes also can help manage IC. The Interstitial Cystitis Association has information about dietary changes that may help.

Combining Multiple Treatments

If you're being treated for IC and FMS or ME/CFS, you should talk to your healthcare provider and pharmacist about any possible drug interactions. For instance, you shouldn't take SSRI/SNRI-type antidepressants, which are common treatments for FMS and ME/CFS, with tricyclic antidepressants used for IC. Also, the FMS treatment Lyrica (pregabalin) doesn't mix well with prescription pain medicines.

However, the tricyclic antidepressants prescribed for IC work well for some people with FMS or ME/CFS, and other IC treatments such as physical therapy and biofeedback may provide a cross-over benefit. You may also have food sensitivities that exacerbate more than one condition, so an elimination diet could really help you.

Because pain from other conditions can make FMS symptoms worse, you'll really benefit from finding a good treatment regimen for IC.


Any one of these conditions is hard to live with, so when you have them in combination it can take a big toll on your life. Limitations imposed on your life by pain, fatigue, and urinating possibly dozens of times a day often can lead to depression, loss of social life, unemployment, and other problems.

It's important to find and follow a treatment regimen that works for you, and to seek out support either from people in your life or support groups, online or in your community.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Harvard Health Publishing, Harvard Medical School. Diagnosing and treating interstitial cystitis.

  2. Cleveland Clinic. Interstitial cystitis (painful bladder syndrome): diagnosis and tests.

  3. Interstitial Cystitis Association. IC treatments.

  4. National Institute of Diabetes and Digestive and Kidney Diseases. Treatment for interstitial cystitis: how do doctors treat IC?.

  5. Dunner DL. Combining antidepressantsShanghai Arch Psychiatry. 2014;26(6):363–364. doi:10.11919/j.issn.1002-0829.214177

  6. Interstitial Cystitis Association. Antidepressants.

Additional Reading
  • Hanno PM. Painful Bladder Syndrome/Interstitial Cystitis and Related Disorders. In: Wein AJ. Wein: Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; chap 74.

  • Leslie A. Aaron, Ph.D., MPH; Mary M. Burke, MD; Dedra Buchwald, MD Arch Intern Med; 160:221-227.

  • Moldwin RM. Rational approaches to the treatment of patients with interstitial cystitis. Urology; 69:73-81.

  • Webster, D.C. “Sex, Lies, and Stereotypes: Women and Interstitial Cystitis” The Journal of Sex Research Volume 33, Issue 3: 197-204.

By Adrienne Dellwo
Adrienne Dellwo is an experienced journalist who was diagnosed with fibromyalgia and has written extensively on the topic.