Interstitial Cystitis (IC) or Bladder Pain Syndrome (BPS) is ‘an unpleasant sensation (pain, pressure, discomfort) perceived to be related to the bladder and associated with lower urinary tract symptom(s) of more than 6 weeks duration, in the absence of infection or other identifiable causes’ (AUA IC Guidelines).
Whilst we lack data for Singapore, it is reported that up to 5% of the global population suffers from BPS and a large proportion are undiagnosed.
WHAT ARE THE SYMPTOMS OF INTERSTITIAL CYSTITIS?
Sufferers will often complain of pelvic pain, from the belly button down, or inner thighs, increased urinary frequency and urgency. Other common symptoms patients may describe are generalised pelvic pain, hip/lower back/sacroiliac joint (SIJ) pain, pain due to penetration (sexual or insertion of PAP/tampon) and constipation.
No two people will experience exactly the same symptoms in the same way- it’s a pack of all-sorts really…
HOW DO WE DIAGNOSE INTERSTITIAL CYSTITIS?
It is a diagnosis of exclusion.
No tests exist to confirm or refute the diagnosis; it is a diagnosis of exclusion. Some urologists may perform a cystoscopy to rule out Hunner’s lesions or bladder cancers.
WHY DOES BLADDER PAIN SYNDROME OCCUR?
Historically, symptoms were thought to be due to a chronic inflammation of the bladder lining, the interstitium, and hence the name Interstitial Cystitis. Patients would be treated with antibiotics, but symptoms persisted. What we now know is that BPS is complex and many changes occur…
- There are changes to the parts of the brain that are responsible for the movement (motor) and feelings (sensory) that relate to the bladder
- There are changes in the sensitivity of the nerves that supply the bladder and surrounding structures
- There are changes in how much attention the brain pays to the bladder
- The brain believes the bladder to be under threat
- Due to close proximity and cross-talk between the bladder and the pelvic floor structures (muscles and fascia)- there is tension
WHY IS MY BLADDER IN DANGER?
For reasons unknown, the brain is led to believe that the bladder is in danger. It truly may have been. For example; you may have experienced a UTI or recurrent UTIs or trauma. And that would have resolved. However, these events and experiences are logged in a “logbook of bladder events”- a memory of sorts. When there is a change in the environment- pressure change (intercourse), pH change (sweat or lubricant or UTI), your brain thinks your bladder is in danger again and a cascade of protective events occur from memory. These changes in environment ordinarily would be managed without bothering you, however, since points 1-5 above have occurred your experience is amplified.
WHAT HAPPENS IN DANGER MODE?
1) Your immune system comes to the party and triggers an immune reaction- causing inflammation and swelling (think: what happens when you sprain your ankle?)
2) Nerves in the area become vigilant to make sure they are thoroughly able to assess and process the danger
3) Because of cross-talk muscles and fascia tighten, or stop them from working because you’re sore, to protect the area and prevent further damage.
Vigilance leads to lots of information being sent to the brain to process, so as your bladder fills and stretches, you might feel fuller than you are resulting in urgency and or frequency even though you might only have 100-200mls.
Frankly speaking, this IS the defense mechanism that you want, when there is a threat!
In danger mode for > 6 months…
If danger mode persists for > 6 months, the brain also starts to change…meaning that the brain is super chimed into any changes at the bladder level- you are consciously aware of how your bladder feels every time your bladder fills and how the surrounding muscles feel. Sore tight vigilant muscles can heighten your symptoms of pelvic pain, pain on intercourse and also make your feel like you need to pee all the time as the sore thigh muscles press on your sensitive bladder.
HOW DO EMOTIONS CREATE PAIN IN INTERSTITIAL CYSTITIS?
The emotional centres of the brain (limbic center) become activated as the brain struggles to cope with all the information and manage the threat response. So if you are having a bad day…you feel sad, anxious or unhappy, stressed. This is likely to intensify the pain as the emotions exacerbate the inflammation at the bladder lining as after all emotions are chemicals responses. Is it the chicken or the egg ?!?@? (not going into that today).
All of these events happen automatically as a protective response to perceived threat. In fact, there doesn’t have to be a real threat. The experience however is all real – real inflammation, real sensitivity, real pain.
HOW DOES PHYSIOTHERAPY HELP INTERSTITIAL CYSTITIS SYMPTOMS?
The good news…Physiotherapy works!
Our bodies are dynamic (bioplastic) with the potential to change no matter how long you have been experiencing symptoms.
The American Urological Association has guidelines on the treatment of IC. Physiotherapy is the only treatment proven to benefit nearly 85% of patients and the only treatment given an “A” evidence grade!
Through a detailed history and assessment, the road to healing begins…Your Women’s Health Physiotherapist will be able to identify contributing factors, educate and empower you to facilitate change. Your Women’s Health Physiotherapist will help to identify:
- Triggers- emotional, hormonal, nutritional
- Self-care strategies
- Body scanning techniques
- Breathing and mindfulness strategies
- Perform and teach internal and external pelvic floor releases
- Teach stretches
- Brainstorm a flare-up plan and
- Refer to other clinicians if required
- Self-management is a critical part of the IC healing journey, so be prepared for the journey ahead.
- Nutrition- whilst there is no IC diet, some patients find certain foods trigger their symptoms. I can refer you to a qualified dietician to help you understand which foods may be triggering your symptoms.
- Bladder treatments- bladder instillations or electrical stimulation treatments may provide some symptom relief.
- Medication- anti-histamines, anti-depressants or anti-inflammatories may be prescribed for pain relief. Botox may be useful in some patients.
- Acupuncture- may also help with symptom relief.
WHAT SHOULD I EXPECT AT MY PHYSIOTHERAPY APPOINTMENT?
- A full history and time-lining of events that may have led to the development of your symptoms
- Understanding your lifestyle, your beliefs and attitudes to your symptoms.
- Goal setting
- Advice to complete a bladder diary (download here)
- Full body assessment of posture, breathing and muscles
- Depending on patient comfort and consent an internal or external pelvic floor exam may occur.
- A management plan
- Referral to other care providers who can assist in symptom relief
Our bodies are hardwired to protect us from threat and as such we experience pain. Our brains are dynamic and as such we can change the response to perceived threat over time. Physiotherapy aims to optimise the mind-body connection to neutralise the perceived threat to help resolve your symptoms.
If you are suffering from Interstitial Cystitis, please do call/WhatsApp on 9780 7274 or reach out via email to discuss how we can work together to help you embrace life.
You can also visit our website to learn about other women’s conditions we treat through physiotherapy and how we can help you.