Spotlight on Pelvic Floor Problems: Interstitial Cystitis
Updated: Oct 7, 2019
What is interstitial cystitis?
Interstitial cystitis, or IC, is also known as painful bladder syndrome (PBS), and this name is a perfect descriptor for the condition: patients with IC/PBS experience a constellation of symptoms, usually involving both deep pelvic pain in the region of the bladder or urethra, and increased urinary frequency, or the urge to go pee quite often. This frequency may also be accompanied by pain during attempts to urinate. IC can affect people of all ages and genders, and symptoms can begin at any point in one's life.
In male patients, a condition called chronic prostatitis may exist alongside IC - the two conditions have very similar symptoms, and some researchers speculate that they may even be the same disorder with different names.
How is IC diagnosed?
IC can be difficult to diagnose, as many patients do not present with any observable "problem" with the bladder itself - the bladder tissue often looks healthy on imaging, so many times, the condition may go undiagnosed and untreated for years. IC is a "diagnosis of exclusion", meaning that other disorders that can cause similar symptoms, such as a urinary tract infection (UTI), must be ruled out before IC is considered as a possible cause.
What are some symptoms of IC?
IC is complex and variable, and many patients experience different symptoms at different times in their life; some patients may have many different symptoms, while others may only have one or two. Some common complaints include (but are not limited to!) the following:
Urinary frequency (the urge to empty the bladder more often than every 2-4 hours)
Burning or intense pain with urination
Nocturia (needing to get up multiple times at night to go to the bathroom)
Lower abdominal pain and/or pain deep in the pelvis
Low back pain
Pain with or following sexual activity
Increased bladder/urethral pain after consuming spicy foods, caffeine, alcohol, or other specific foods
Slow urinary stream and/or the inability to fully empty the bladder
Urinary incontinence (leaking urine during certain activities, such as exercise or sneezing, or in response to certain triggers, such as the sound of running water or arriving at the front door of one's home)
What are some treatments for IC?
IC usually requires a multidisciplinary approach to treatment, involving a variety of different healthcare providers and interventions. A care team might include a primary care physician (PCP), a urologist or urogynecologist, a pelvic floor physical therapist, a mental health counselor or psychologist, a dietician or nutritionist, and a number of alternative health providers such as acupuncturists, massage therapists, or chiropractors. Patients with IC often benefit from a variety of different therapies, including medications, dietary modification, manual therapy (hands on treatment) to address pain, an exercise/stretching routine, and a whole lot of self-care.
How can pelvic floor physical therapy (PFPT) help patients with IC?
Despite the wide variety in symptoms and problems present in people with IC, dysfunction in the pelvic floor (the muscles, joints, nerves, and connective tissue that support the pelvic organs) is a nearly universal issue for all patients. The muscles within and around the pelvis (including the muscles in the lower back, hips, buttocks, and abdominals), can be overly tight, strained, and/or weak in patients with IC, and all of this results in prolonged discomfort and increased strain on the pelvic floor and pelvic organs. A physical therapist who specializes in pelvic floor dysfunction can help address this dysfunction by stretching overly tight muscles, releasing trigger points (dysfunctional knots in muscle tissue), mobilizing restricted or inflamed connective tissue and joints around the pelvis, and teaching patients to stretch and strengthen appropriately to reduce imbalance in these areas. Certain behavioral modifications in bathroom habits can also be helpful, and pelvic floor PTs are trained in these techniques as well. In clinical trials of treatments for IC, pelvic floor PT is one of the few consistently helpful approaches for reducing both pelvic pain and urinary frequency in these patients.
How do I get help for my IC?
Come see us at Roaring Fork PT! Our pelvic floor specialist, Caitlyn, has the training and skills necessary to evaluate you and help you develop a plan for treating your symptoms. If you have Medicare, you’ll need a referral from a physician first - your primary care physician or a specialist physician you see for bladder or pelvic problems can refer you to PT. For most folks with commercial (non-Medicare) insurance, however, a physician referral is not required to see a physical therapist - call us today at 970-927-9319 to learn how we can help!
Acknowledgements: Thanks to Herman and Wallace Pelvic Rehabilitation Institute and "The Interstitial Cystitis Solution" by Nicole Cozean, PT, DPT, WCS, and Jesse Cozean for much of the information about IC and treatment included in this blog post.