Interstitial Cystitis

Interstitial cystitis (IC) is a chronic bladder syndrome characterized by pelvic pain, bladder pain or pressure, and urinary urgency and frequency.  IC affects more than 12 million people in the United States alone.  It is typically diagnosed when urinary tract symptoms last longer than 6 weeks and in the absence of any other condition, such as UTI.  Unfortunately, many patients go undiagnosed for years and live with severe pain without a known cause.  

The four most common symptoms of IC are suprapubic pain (centered below the belly button and directly above the bladder), urinary frequency, urinary urgency, and nocturia (nighttime urination).  Other symptoms include hesitancy and decreased urine flow, incomplete bladder emptying, bladder pressure, urinary incontinence, bladder and urethral pain, burning with urination, pelvic pain, and low back/groin/hip pain.  However, it is important to note that there is no “normal” or “standard” set of IC symptoms.  Each patient may present with a different set or severity of symptoms.  IC is also associated with an increased risk of other health conditions including irritable bowel syndrome, fibromyalgia, allergies/asthma, migraines, depression, and coronary artery disease.  

It is suggested that up to 85% of patients with IC have accompanying pelvic floor dysfunction.  The pelvic floor is the base of our pelvic cavity and is made of muscles, ligaments, tissue, and nerves.  Within the pelvic cavity sits our bladder, urethra, sexual organs, and rectum.  The pelvic floor muscles not only support our bladder, but also control its functions.  The pelvic floor muscles engage to hold your bladder so you can make it to the bathroom in time and relax so you can fully empty your bladder when you urinate.  Many symptoms that are associated with IC are also symptoms of pelvic floor muscle dysfunction.  Therefore a patient’s IC symptoms may be coming from their pelvic floor, bladder, or most likely BOTH.  

Researchers have found that 70-85 percent of patients with IC have pelvic floor muscles that are too “tight” or hypertonic.  A pelvic floor that is too tight tends to have trigger points, or painful spots in the muscle, that can cause spasm and soreness.  Tension in the pelvic floor muscles can create or exacerbate IC symptoms, such as urinary urgency, frequency, and the feeling of incomplete emptying.  Trigger points can also refer pain to other areas of the pelvic floor and irritate the pelvic nerves.     

Luckily, pelvic floor physical therapy is the most proven treatment for interstitial cystitis.  The American Urological Association recommends pelvic floor PT as a first-line medical treatment in their guidelines and is the only treatment with an evidence grade of “A”.  Pelvic floor physical therapists are specially trained to treat tight, painful muscles and connective tissue with manual techniques, such as myofascial release and visceral mobilization.  A pelvic floor PT can also address the internal and external trigger points to help your pelvic floor function normally again.  Despite the help that is available, many patients don’t know about pelvic floor physical therapy or find us on their own after exhausting all other treatment options.  Increasing education for both medical professionals and patients is vital for a timely and successful treatment of IC.      

Resources: 

Berry, S., M. Elliott, M. Suttorp, et al. “Prevalence of Symptoms of Bladder Pain Syndrome/Interstitial Cystitis Among Adult Females in the United States.” The Journal of Urology 186, no 2 (August 2011):540-44.

FitzGerald, M., C. Payne, E. Lukacz, et al. “Randomized Multicenter Clinical Trial of Myofascial Physical Therapy in Women with Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS) and Pelvic Floor Tenderness.” The Journal of Urology 187, no.6 (June 2012): 2113-18. 

Hanno, P., D. Burks, J. Clemens, et al. “AUA Guidelines for the Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome.” The Journal of Urology 185, no. 6 (June 2011): 2162-70.