Interstitial Cystitis

You have a heavy burning sensation in your bladder, you have an urgency to urinate and you notice you have been increasing your frequency of visits to the washroom. When you do urinate you feel burning pain which persists in your genital area. These symptoms may have come out of the blue, or maybe you can identify a particular event which triggered your pain such as an infection, childbirth or surgery. If a visit to your family physician has cleared you of infection or anything more sinister, you may have Interstitial Cystitis (IC).

What is IC?

IC affects millions of men and women around the world. There is 4-12 million cases in the US alone, with 90% of all cases being women (1)(2). The American Urology Association defines IC as “an unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms of more than six weeks duration, in the absence of infection or other identifiable causes.” (3) In essence, this is a diagnosis of exclusion; meaning urine cultures are negative, antibiotics are not working, infection and other more sinister causes are ruled out, then IC is ruled in (2). The average onset of IC is 40 years of age with only 25% of patients being under the age of 30 (4). Quite often these IC patients report a history of childhood bladder problems and urinary tract infections (2). IC will often coexists with irritable bowel syndrome, vulvodynia, vestibulodynia, raynaud’s syndrome, migraine headaches and fibromyalgia (2).

The cause of IC is still unknown but researchers think it may be linked to an event which caused trauma on the bladder lining (5). This may include but is not limited to:

• pelvic surgery
• bladder distension (possibly linked to long periods without bathroom use)
• pelvic floor muscle dysfunction
• bacterial infection

If referred to a Urologist a cystoscopy (internal examination of your bladder) may reveal Hunner’s Lesions, which are distinct areas of inflammation in the bladder lining (1). These Hunner’s lesions are one of the main diagnostic criteria for interstitial cystitis but occur in only 9-10% of cases (1). The other 90% of cases may find irritation and inflammation of the bladder lining, called glomerulations which have been linked to IC but are not specific to it (1).

What do you do if you have been diagnosed with IC?

As no two patients with IC are alike, The American Urology Association IC Guidelines (2010) helps to bring light the to the best course of action for someone diagnosed with IC (3).

First Line Treatment:

1. Education – patients armed with the knowledge about normal bladder function, what is known about IC, and the available treatments as well as their effectiveness, generally fair the best (3)(6).
2. Self Care and Behavioural Modifications – this may include changing your diet and water intake, avoiding your known triggers, meditation and muscle relaxation techniques (3)(6).

Second Line Treatment:

1. Physical Therapy! Most IC patients have some form of pelvic floor dysfunction – increased tightness in the muscles and connective tissue of the pelvic floor, hips and abdomen (3)(6). A recent study demonstrated that pelvic floor myofascial release was effective in 59% of urological pain patients compared to just general massage (7).
2. Pain management including pharmacological, manual therapy, and stress reduction techniques (3)(6).

Further recommendations for treatment continue with more invasive procedures being recommended only as a last resort when conservative management fails.

If you have been diagnosed with IC there are many resources available to help you manage and live successfully with IC. See the links below for more about IC and what you can do about it:

www.ic-network.com
www.ichelp.org

Talk to one of our pelvic physiotherapists today to learn more about what pelvic physiotherapy can do to help you manage your IC symptoms.

References:

1. What is Interstitial Cystitis (IC)?.(2015, January) http://www.ichelp.org/about-ic/what-is-interstitial-cystitis/
2. What is Interstitial Cystitis. (2016) http://pelvichealthsolutions.ca/for-the-patient/what-is-interstitial-cystitis/
3. Hanno PM, et al. AUA Guidelines for the diagnosis and treatment of IC/BPS J Urol. 2011;185(6):2162-2170
4. Osborne, J. (2015). What is IC/BPS?. http://www.ic-network.com/conditions/interstitial-cystitis/what-is-ic/
5. Causes of IC. (2015). http://www.ichelp.org/about-ic/causes-of-ic/
6. IC Treatments. (2015). http://www.ic-network.com/conditions/interstitial-cystitis/exploring-treatments/
7. Fitzgerald M.P et al. (2012). Randomized Multicenter Clinical Trial of Myofascial Physical Therapy in Women with Interstitial Cystitis/Painful Bladder Syndrome and Pelvic Floor Tenderness. The Journal of Urology. Vol 187(6): 2113–2118