The Conundrum of Bladder Pain Syndrome

According to the Interstitial Cystitis Association (ICA), as many as 3 to 8 million women and 1 to 4 million men in the US experience symptoms of the condition known as Interstitial cystitis, painful bladder syndrome, or hypersensitive bladder syndrome.

Symptoms can include bladder pain, a sense of urinary urgency, or frequent sensation of needing to urinate even when the bladder is not full. These sensations can occur with bladder filling, with voiding, with sitting, exercise, or sexual activity. They are sometimes reduced or alleviated by urinating, but often only for a short time. Sometimes pain is absent, and urinary urgency/frequency is the only symptom.

IC.PBS has historically been objectively diagnosed by a urological examination called cystoscopy, which can identify the presence of lesions in the lining of the bladder, called Hunner’s ulcers. Now it is recognized that 90% of people with IC do not have ulcers in the bladder wall.

IC/PBS is considered a syndrome because it is a collection of symptoms and is diagnosed by exclusion. That is, you can say that someone has this condition if there is pain present in the bladder (or other symptoms mentioned), and that there are no other diseases present that could cause the symptoms.

IC/PBS is often present with a collection of other conditions such as allergies, food sensitivities, migraines, autoimmune conditions. Some sufferers benefit from medications such as Elmiron, histamine blockers, or medicines for nerve pain such as amitryptiline. Many also benefit from dietary changes.

Conservative treatment approaches including dietary changes and physical therapy are now the recommended first courses of action to address painful bladder syndrome, according to the American Urological Association (AUA). How does this work?
Most individuals with bladder symptoms as described will have overactive or shortened pelvic floor muscles and connective tissues. Also present will be painful or tender points that can be felt in the muscles when they are examined either from outside or from inside the pelvis.
A recent study which proposed a new method for confirming or diagnosing pelvic floor myofascial pain syndrome, found that this presentation of the pelvic floor is also common in people with other painful conditions in and around the pelvis, such as chronic prostatitis in men, endometriosis in women, vuvlodynia, and pudendal neuralgia or pudendal nerve entrapment. Identification of the locations of tender, short muscle and connective tissue involves a through manual examination of the abdomen, pelvis, hips, and trunk. Treating these trigger points involves a variety of manual soft tissue techniques. A skilled physical therapist will be able to do this in a way that minimizes discomfort to the patient, and will ensure that there is constant open communication during treatment. The patient must always feels safe and comfortable.
Diagnosis and treatment of any underlying orthopedic problems is also a vital part of treating bladder pain syndromes. Problems with joints in the lumbar or thoracic spine, pelvic joints, or hips are a common reason why pelvic floor muscles become short, tight, or tender. Often, treating the orthopedic “driver” of pelvic floor dysfunction will have a tremendous positive impact on reducing an individual’s bladder symptoms. Other common threads in the history of this condition include problematic childbirth, pelvic or abdominal surgeries, and sporting injuries, yeast or bacterial infections, allergic reactions to personal care products, and excessive sitting, especially bicycle riding. Also common are lifestyle habits or work conditions that lend themselves to an individual holding their urine for long periods of time. When all of these issues are indentified and corrected, the body’s natural capacity for healing can provide significant symptom relief.

Every few weeks, someone asks me “Do you believe IC is real?” There is no doubt in my mind that a syndrome truly exists, plaguing millions of women and men with bladder pain and discomfort, and urinary urgency and frequency. Nonetheless, this question give me pause, because I know that under the surface is the struggle with how to properly categorize or diagnose this complex and widely variable condition and how to treat it. This is a task that continues to challenge all branches of the health care community. While I understand the confusion in many peoples’ minds, experience and research are mounting to show that, when a highly trained and caring physical therapist is part of the excellent health care team, symptoms of IC/PBS can be significantly reduced and often eliminated.

Please feel free to contact me with any questions, or to set up a courtesy phone call.
 All the best in health and healing,
 Debbie
 References:
Itza, F., Zarza, D., Salinas, J., Teba, F., & Ximenez, C. (2015). Turn-amplitude analysis as a diagnostic test for myofascial syndrome in patients with chronic pelvic pain. Pain Research & Management : The Journal of the Canadian Pain Society, 20(2), 96–100.

FitzGerald MP, Payne CK, Lukacz ES, et al; Interstitial Cystitis Collaborative Research Network. Randomized multicenter clinical trial of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome and pelvic floor tenderness. J Urol. 2012;187(6):2113-2118.

King HH. Manual Therapy May Benefit Women With Interstitial Cystitis and Pelvic Floor Pain. J Am Osteopath Assoc 2013;113(4):360-361.​

Weiss JM. Pelvic floor myofascial trigger points: manual therapy for interstitial cystitis and the urgency-frequency syndrome. J Urology 2001; 166:2226-31.