Interstitial Cystitis, also known as Painful Bladder Syndrome, is a complex pain condition that involves symptoms of pain, frequency and urgency.
- Has traditionally been looked at as a problem of the bladder
- Treatment protocols in traditional medical approaches have focused exclusively on the bladder
- However, there is compelling evidence which throws doubt on the view that the bladder is the essential pain generator in IC
- In a Finnish study, 25 of 31 women who were diagnosed with IC reported pain in the pelvic muscles (their typical pain was felt in the bladder when the muscles were palpated) and not in the bladder when the bladder was palpated
- There is also compelling evidence provided by patients who have had their bladders removed because of their level of pain; tellingly, bladder removal did not reduce their pain and instead created new problems
- Dr. Robert Moldwin, a leading American urologist in Interstitial Cystitis, and author of the IC Survival Guide now believes that 70-80% of IC patients have pelvic floor muscle problems
IC may also be more predominately a problem of the Sensitive Nervous System, more similar in nature to
- Complex Regional Pain Syndrome
Interstitial Cystitis: Get the Facts
- 8x more frequent in women (men tend to get the diagnosis of chronic prostatitis, which is also seen now as a pelvic floor problem)
- Characterized by bladder dysfunction such as urinary frequency and urgency, pain felt in the area above the pubic bone, and increased symptoms of urinary urgency with intercourse
- Often coexists with Irritable Bowel Syndrome, Vulvodynia, Vestibulodynia, Raynaud’s syndrome, migraine headaches and fibromyalgia
- These are often conditions of mucosal lining irritation and/or windup of the nervous system, called central sensitization; central sensitization is an increased sensitivity of the spinal cord/brain to incoming messages; neurochemical changes including inflammation in the nervous system causes the body to be in a constant state of “red alert”
- There may be a triggering event- urinary tract infection, childbirth, surgery, viral illness, or physical or psychological trauma
- Bladder distension with visualized ulceration or inflammation is thought to be indicative of IC; however, studies have shown that many women without bladder problems, who have their bladders filled to capacity under anesthetic, demonstrate similar types of bladder lining irritation and bleeding
There are some excellent websites with a lot of helpful information on Interstitial Cystitis:
Jill Osborne, from the IC Network shares her story of optimism and hope for Interstitial Cystitis.
Healing Interstitial Cystitis
- The word healing, especially fostering and supporting the natural healing of the bladder, is rarely a focus of study in interstitial cystitis
- Other types of mucosal inflammation always heal (mouth ulcers); so too can the bladder heal itself, given the right environment, physically and emotionally
How? By treating:
- Myofascial Trigger Points
- Connective Tissue Massage
- By stopping kegels and doing Reverse Kegels instead
- Stress management/ Progressive Muscle Relaxation Techniques
- Cardiovascular exercise
- Bladder Retraining Techniques
- Nutrition: Elimination diets should be used (see auanet.org for dietary recommendations)
- Increase fluid consumption to dilute urine
- Avoid Constipation at all costs and do not strain to urinate
- Use local muscle relaxants in the vagina: compounded Diazepam
- Treat tight pelvic floor muscles with hot baths with Epsom Salts
A Randomized Clinical Trial (strongest type of study) was presented at the International Pelvic Pain Society conference (Chicago 2010), and has been published in the Journal of Urology (2012) which demonstrated that internal pelvic floor myofascial treatment in urological pain patients was effective in 59% of patients compared to generalized massage therapy. The techniques listed above were used in this study.
The NIDDK (A National Research based organization in the States) were very excited to report these results since it is the first trial that they have sponsored in ten years which has shown a positive result for painful bladder syndrome, including medication, surgery and other therapeutic techniques.
We now have Level I evidence to support the use of internal pelvic floor physiotherapy for painful bladder conditions.
The American Urological Association (2010) has issued its first set of Interstitial Cystitis Treatment Guidelines recommending diet modification and physiotherapy as the first line of defence when a patient presents with painful bladder syndrome.
Check out the American Urological Association’s website for more information.