Understanding Interstitial Cystitis
Diagnosis, Symptoms, and the Role of Pelvic Floor Physical Therapy
Interstitial Cystitis (IC), also known as painful bladder syndrome, is a condition that affects approximately 1 in 20 people (women and men) in the United States. It can lead to discomfort, pain, and a decreased quality of life for those who suffer from it. In this blog post, we'll delve into what IC is, how it's diagnosed, common and uncommon symptoms, and how pelvic floor physical therapy can be a crucial treatment option. We'll also explore the effectiveness of pelvic floor physical therapy in managing IC symptoms.
What Is Interstitial Cystitis?
Interstitial Cystitis is a condition characterized by urinary symptoms, pelvic pain, and discomfort. It is a diagnosis of exclusion, meaning other medical conditions have been ruled out. It can affect individuals of any age or gender, but it is more common in women. The exact cause of IC is still not fully understood, making it a challenging condition to diagnose and treat. Additionally, painful bladder syndrome can be found clustered with other conditions such as pudendal neuralgia or endometriosis.
Diagnosis of Interstitial Cystitis
Diagnosing IC can be a complex process, as there isn't a single definitive test. As stated earlier, it is a diagnosis of exclusion. Medical professionals often use a combination of medical history, symptom evaluation, physical examinations, and various tests to rule out other conditions. Some common diagnostic tools include:
Cystoscopy: This procedure involves inserting a thin tube with a camera (cystoscope) into the bladder to examine the bladder lining for signs of inflammation or other abnormalities.
Urodynamic Testing: This assesses bladder function and how it stores and releases urine.
Biopsy: In some cases, a small tissue sample of the bladder lining may be taken during cystoscopy to rule out other conditions.
Common and Uncommon Symptoms
IC presents a wide range of symptoms that can vary in intensity. The most common symptoms of IC include:
Frequent urination: individuals with IC may need to urinate more often, including during the night (nocturia).
Urgency: a sudden, strong urge to urinate.
Pelvic pain: this can range from mild discomfort to severe, debilitating pain.
Pain during sexual intercourse (dyspareunia): some individuals may experience pain during or after sexual activity.
Less common symptoms may include:
Pain in the lower back, abdomen, or groin
Pain in the pelvic floor muscles
Depression and anxiety, often related to the chronic nature of the condition
How Pelvic Floor Physical Therapy Can Help
While IC has been coined “painful bladder syndrome”, it is a big misconception that it is exclusively a condition of the bladder. Dr. Ken Peters, an international expert on IC, has said that the bladder is an “innocent bystander” in this condition. Due to this, treatment is often focused solely on the bladder rather than the actual underlying cause of their symptoms.
Research has shown that more than 90% of people with IC have pelvic floor dysfunction, which can be the cause or intensify the typical symptoms associated with IC, such as urinary frequency/urgency, low back pain, pelvic pain and painful intercourse. It is because of this that pelvic floor physical therapy has become the #1 proven treatment for IC. It’s recommended by the American Urological Association (AUA) as a first-line medical treatment in their IC Guidelines, and is the only treatment given an evidence grade of ‘A’.
If you decide to see a pelvic floor physical therapist for evaluation of your IC symptoms, you may have a pelvic floor examination, discuss past medical history and comorbidities, review typical diet and fluid intake and discuss lifestyle factors that influence your symptoms. Treatment will focus on the muscles, ligaments, and connective tissues of the pelvic region, aiming to improve their function, help down regulate the nervous system and reduce pain. Some techniques that are often used in pelvic floor physical therapy include:
Muscle Relaxation: Pelvic floor physical therapists can teach relaxation techniques to help reduce tension in the pelvic floor musculature which can contribute to IC symptoms.
Biofeedback: Biofeedback can be used to help patients gain awareness and control over their pelvic muscles, enabling them to reduce pain and improve bladder function.
Strengthening Exercises: Strengthening weak muscles surrounding the pelvic floor can support better bladder control and overall pelvic health.
Manual Therapy: Hands-on techniques like myofascial release can help alleviate muscle tension and pain in the pelvic area.
Neuromuscular Re-education: Downregulation of the nervous system and management of central sensitization with mindfulness and breathing strategies are techniques that can help manage chronic pain or discomfort.
Bowel and Bladder Diary: Thorough review of bowel and bladder health can be crucial for reducing urinary symptoms and pain.
Conclusion
Interstitial Cystitis can be a challenging condition to live with, but there are effective treatment options available. Pelvic floor physical therapy, with its focus on muscle function and pain reduction, has shown promise in helping individuals with IC regain control over their symptoms and improve their quality of life. If you or someone you know is struggling with IC, consider exploring the potential benefits of pelvic floor physical therapy as a part of your treatment plan.