Demystifying Interstitial Cystitis
Demystifying Interstitial Cystitis
You just received a diagnosis of Interstitial Cystitis and may be wondering “what do I do now?” In honor of IC awareness month, this blog post is dedicated to Interstitial Cystitis/Painful Bladder Syndrome and how pelvic floor physical therapy can help.
Interstitial Cystitis (IC) is a complex pelvic pain condition affecting nearly 12 million people in the United States. IC is a diagnosis that falls under Painful Bladder Syndrome and the two are often used interchangeably. IC is more common in those with other chronic conditions such as IBS, fibromyalgia, and chronic fatigue syndrome.
Symptoms and Causes
Symptoms can vary greatly from person to person and range from mild to severe. Some describe the symptoms as feeling like a urinary tract infection though no infection is present. Symptoms may be constant or intermittent with periods of an absence of symptoms and intense flare-ups.
Common symptoms include:
Urinary urgency
Frequent urination (often in small amounts
Pelvic pain or discomfort
Pain with bladder filling and/or emptying
Burning urination
Abdominal pain
Pain with intercourse
There is no single cause of IC and it is thought to be multifactorial in nature. Contributing factors include hormonal deficiencies (oral contraceptive pills, menopause, etc.), prior abdominal or pelvic surgeries/injuries, central nervous system dysregulation, pelvic floor muscle dysfunction, GI conditions, lifestyle and behavioral factors, and endometriosis.
Common Misconceptions
Because IC is a complex diagnosis, research around the topic is ever-changing. This can certainly be confusing for both patients and providers! The most current guidelines are from the 2022 American Urological Association. Interstitial cystitis was believed to be a disorder of the bladder wall with Hunner’s lesions predominantly suspected. The condition was reclassified to a neuromuscular disorder rather than a bladder disease, with the acknowledgement of subtypes or phenotypes. Today it is believed only 5-10% of patients with IC have the Hunner’s lesions (bladder wall dysfunction phenotype) while 90% of patients do not (pelvic floor dysfunction phenotype). You can check out the full list of phenotypes here.
According to the new 2022 guidelines, IC is a clinical diagnosis. This means to make a diagnosis your doctor will evaluate your symptoms, lifestyle, and lab work. A cystoscopy is no longer a first line diagnostic test and is only used when an IC diagnosis is in doubt.
Triggers and Relief
Like symptoms, triggers will vary between individuals. However common triggers include bladder irritants such as chocolate, alcohol, coffee/caffeine, soda, spicy and/or citrus foods/drinks, MSG, and acidic foods (for a full list of The IC diet/triggers click here). Sexual activity, stress, menstruation and even tight-fitting clothing can also trigger an IC flare.
In an online survey, patients offered advice for those newly diagnosed with interstitial cystitis. Nearly 50% of respondents recommend learning your triggers and taking proactive measures if possible. Other relief strategies include increasing fluid intake, placing heat and/or ice on the perineum, reducing stress, and wearing loose clothing.
Treatment
Because IC is now regarded as a clinical diagnosis with less than 10% of patients having dysfunction of their bladder wall, surgery and select medications are no longer first line treatments. Physical therapy, patient education and behavior/lifestyle modifications are often recommended to reduce IC symptoms.
Physical therapy is the only treatment with grade A (highest) evidence in the new American Urological Association guidelines. Because nearly 90% of patients with IC have pelvic floor muscle dysfunction, physical therapy is highly successful - because we treat musculoskeletal disorders! Your therapist may relieve tight muscles and trigger points and introduce pelvic floor exercises and stretches.
For symptom relief, gentle movement such as walking or light biking may be helpful. Other exercises include:
Diaphragmatic breathing
Happy baby stretch
Deep squat
Reclining in butterfly pose
When to See a Healthcare Provider
If you suspect you may have interstitial cystitis, have new or changing symptoms, symptoms coincide with injury or surgery, and/or experience pelvic/bladder pain or discomfort it may be time to see your healthcare provider. As musculoskeletal and pelvic floor specialists, a pelvic floor physical therapist should be an integral part of your care team.
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