Interstitial Cystitis: Managing Pelvic Pain and Bladder Health
Imagine feeling the need to urinate up to 60 times a day, accompanied by relentless pelvic pain that disrupts every aspect of your life. For many suffering from Interstitial Cystitis (IC), this isn't just imagination—it's daily reality.
What Is Interstitial Cystitis?
Interstitial Cystitis, also known as painful bladder syndrome, is a chronic pelvic pain condition where symptoms characterized by bladder pressure, bladder pain, and pelvic pain are present for at least 6 weeks. Many times people equate their symptoms to feelings similar to a urinary tract infection (UTI). Unlike typical UTI’s, IC is not caused by bacteria and doesn't respond to antibiotics.
What Causes IC?
Their are many theories on the causes of IC, such as a defect in the bladder lining, autoimmune responses, genetics, and nerve hypersensitivity. However, there isn’t any evidence in current research to support a single cause. What we have found to be true is the patients with IC symptoms do have a complicated interaction between their nervous system, bladder, and pelvic floor muscles. While it may initially feel uneasy to think their is not a single cause, it actually is a great thing because it gives patients many routes and avenues to explore regarding treatment.
The Impact on Your Life
Living with IC can feel overwhelming, frustrating, and isolating. The constant urge to urinate, even right after using the restroom, can make even simple daily tasks difficult. Social events, work responsibilities, and sleep are often disrupted by frequent bathroom trips. Traveling or leaving home can feel stressful due to the uncertainty of finding available restrooms. Additionally, the pelvic pain associated with IC can strain intimate relationships, as discomfort or pain during sexual activity may occur. Beyond the physical challenges, IC often affects social connections and relationships, underscoring its wide-ranging impact.
Symptoms to Watch For
Pelvic Pain: Persistent discomfort or pain in the pelvic region, which may intensify as the bladder fills.
Frequent Urination: Needing to urinate frequently throughout the day. This might mean urinating once an hour or more.
Urgency: A constant sensation of needing to urinate, often with little output.
Painful Intercourse: Discomfort or pain during sexual activity.
Bladder Pain: A feeling of pressure or tenderness in the bladder and pelvic area. This could also look like burning or pain with urination.
Nocturia: Getting woken up in the night with an urge to urinate.
How IC Affects the Pelvic Floor
The pelvic floor muscles are essential for supporting bladder function. In individuals with IC, these muscles are often tense or tight, with up to 90% experiencing some form of pelvic floor dysfunction. (1) As a result, pelvic floor therapy plays a crucial role in treating IC and alleviating its associated symptoms.
Breaking Down the Cycle: Strategies for Relief
Managing IC involves a multifaceted approach that addresses bladder health, the nervous system, and pelvic floor function. Here are some evidence-based strategies that can help:
1. Consult a Healthcare Professional
Before starting any treatment, it's essential to consult a medical professionals to rule out true infections or other conditions. It is also important to put together a good team to fully address IC. This can include a urologist, a pelvic floor therapist, pain management, mental health therapist.
2. Pelvic Floor Physical Therapy
Pelvic Floor Therapy is a first line, recommended medical treatment for IC, and many patients show benefits. (2,3) Working with a physical therapist specialized in pelvic floor disorders can help relax and and give relief to tight pelvic muscles that might be causing symptoms. Techniques may include manual therapy, nervous system relaxation techniques, strengthening or stretching exercises tailored to what your specific body needs.
3. Bladder Training
Scheduled Voiding: Gradually increasing the time between bathroom visits can help train the bladder to hold urine longer, reducing frequency and urgency over time. This is something that pelvic floor therapy can help guide you with.
4. Stress Management
Relaxation Techniques: Stress can exacerbate IC symptoms. Practices such as deep breathing exercises, meditation, and yoga can help manage stress levels.
Counseling: Cognitive-behavioral therapy (CBT) can provide coping strategies for dealing with chronic pain and the emotional impact of IC.
5. Medications
Oral Medications: Certain medications can help reduce inflammation and pain to help with flares. These include medications like Pentosan polysulfate sodium (Elmiron) which is FDA-approved for treating IC. They can also extend to muscle relaxants, anti-depressants to address the nervous system, or anti-histamines.
Bladder Instillations: This involves directly inserting medication into the bladder via a catheter can provide localized short term relief. These can include DMSO, Heparin instillations, Lidocaine, or a “cocktail” of a few of these.
6. Neuromodulation techniques
Transcutaneous Tibial Electrical Nerve Stimulation (TTNS): This therapy uses mild electrical pulses to stimulate nerves in the ankle which share connections to the bladder. It is an at home treatment that can be used at home to help alleviate pain and help with urinary urgency or frequency.
7. Dietary Modifications
Finding Dietary Triggers: There is no “IC Diet” because dietary triggers are unique to each person. That being said, some of the most common irritants for IC include caffeine, alcohol, acidic foods, and artificial sweeteners.
8. Alternative Therapies
Acupuncture: Some patients find relief through acupuncture, which may help reduce pain and improve bladder function.
Understanding the 'Why': The Science Behind the Strategies
Pelvic Floor Therapy: By addressing muscle tension and spasms in the pelvic floor, physical therapy can reduce pain and improve bladder control.
Nervous System: Tapping into your “relaxing” nervous system, helps to not only relax muscles (including the pelvic floor), but is also helps to reduce our hypersensitivity to pain and urgency.
Bladder Training: The bladder-brain communication pathways are disrupted in IC, and thus bladder retraining coupled with the above helps to retrain these signals and reduce the hypersensativity of urgency.
Building a Support System
Living with IC can be isolating, but you're not alone. Connecting with support groups, either in person or online, can provide emotional support and practical advice from others who understand what you're going through.
Expert Support for Pelvic Floor Therapy
Pelvic Floor Therapy is the first line of recommended medical treatment for IC. According to the American Urological Association, pelvic floor therapy is the only intervention given evidence of grade “A” meaning it has been shown to be a standard of care through strong and reliable research studies. (2)
Navigating Intimacy and Relationships
IC can strain intimate relationships due to pain during intercourse and emotional stress. Open communication with your partner and seeking guidance from healthcare professionals can help navigate these challenges.
When to Consider Advanced Treatments
If conservative treatments aren't effective, more advanced options are available:
Botox Injections: These can be done to the pelvic floor or bladder to relax them.
Nerve blocks: These can be done to the pelvic nerves such as the pudendal nerve, hypogastric nerves, or the sacral nerves. Injecting botulinum toxin into the bladder muscle can help reduce symptoms.
Nerve Stimulation Therapies: Sacral nerve stimulation can modulate bladder activity.
Surgery: In severe cases, surgical interventions may be considered, although these are rare and typically last-resort options.
Taking the First Step Toward Relief
Managing IC is a journey that requires patience and persistence. The first step is acknowledging your symptoms and seeking professional help. With the right combination of treatments and lifestyle adjustments, many people with IC find significant relief and regain control over their lives.
Conclusion
Interstitial Cystitis doesn't have to define your life. By understanding the condition and actively participating in your treatment plan, you can manage symptoms and improve your quality of life. Remember, you're not alone, and help is available.
Ready to Take Control?
If you're experiencing symptoms of IC or pelvic floor dysfunction, don't wait. Schedule an appointment with our specialized team today and take the first step toward relief.
Additional Resources
American Urological Association Guidelines
Empower yourself with knowledge and take proactive steps toward managing your health. With the right support and strategies, a life with less pain and more joy is within reach.
Written by:
Dr. Jana Richardson, PT, DPT, WCS, PRPC, CIDN
Dual Board Certified Pelvic Floor Therapist and Owner of Chicago Pelvic Health
Dr. Jana Richardson is a highly accomplished pelvic floor therapist with dual board certifications and extensive experience in treating complex pelvic floor dysfunctions. As the owner of Chicago Pelvic Health, Dr. Richardson is dedicated to providing personalized and effective care for her patients. With a Doctorate in Physical Therapy, and specialized certifications in Women’s Health and Pelvic Rehabilitation, Dr. Richardson is a leading expert in her field. She is also certified in Integrative Dry Needling, further enhancing her ability to offer comprehensive treatment plans. Dr. Richardson’s commitment to patient-centered care and her passion for helping individuals achieve optimal pelvic health make her an invaluable asset to the community.
Contact Information:
References:
James Chivian Lukban, J.V. Parkin, Adam S. Holzberg, Ricardo Caraballo, Susan Kellogg-Spadt, Kristene E. Whitmore, Interstitial Cystitis and Pelvic Floor Dysfunction: A Comprehensive Review, Pain Medicine, Volume 2, Issue 1, March 2001, Pages 60–71, https://doi.org/10.1046/j.1526-4637.2001.002001060.x
Clemens JQ, Erickson DR, Varela NP, Lai HH. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome. J Urol. 2022;208(1):34-42.
FitzGerald MP, Payne CK, Lukacz ES, Yang CC, Peters KM, Chai TC, Nickel JC, Hanno PM, Kreder KJ, Burks DA, Mayer R, Kotarinos R, Fortman C, Allen TM, Fraser L, Mason-Cover M, Furey C, Odabachian L, Sanfield A, Chu J, Huestis K, Tata GE, Dugan N, Sheth H, Bewyer K, Anaeme A, Newton K, Featherstone W, Halle-Podell R, Cen L, Landis JR, Propert KJ, Foster HE Jr, Kusek JW, Nyberg LM; 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 Jun;187(6):2113-8. doi: 10.1016/j.juro.2012.01.123. Epub 2012 Apr 12. PMID: 22503015; PMCID: PMC3351550.
