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Interstitial Cystitis

What is Interstitial Cystitis?

Interstitial cystitis (IC), also known as painful bladder syndrome, is a condition that results in recurring discomfort or pain in the bladder and the surrounding pelvic region. The symptoms can vary greatly between individuals and even within the same person throughout the month.  The symptoms include an urgent need to urinate, urgency, a frequent need to urinate, frequency and, for some, pressure and/or pelvic pain.

Pain levels can range from mild tenderness to intense pain. Pain typically worsens as the bladder fills and is relieved after urination. Pain may also radiate to the lower back, upper legs, vulva and penis. Women's symptoms may fluctuate with their menstrual cycle, often flaring during ovulation and/or just before their periods. Men and women may experience discomfort during or after intercourse.  

When an IC bladder is examined using a procedure called cystoscopy with hydrodistention, physicians often find small, bleeding wounds, also known as petechial hemorrhages or glomerulations. These are usually caused by recurring irritation.  About ten percent of patients may have larger, more painful wounds, called Hunner’s Ulcers. Some patients with mild IC may have bladders that appear normal during a cystoscopy. IC patients rarely test positive for infection in standard urinalysis and urine cultures.

There is no single cause of IC in all patients; rather IC may have several different variations.

How is IC Diagnosed?

Doctors must rule out a UTI and other treatable conditions before considering a diagnosis of IC, including: prostatitis, chronic pelvic pain syndrome, pelvic floor dysfunction and bladder cancer.

Unfortunately, there is no definitive test for IC currently on the market, thus a diagnosis of IC in the general population is based on clinical symptoms, including the presence of pain, frequency and/or urgency. In recent years, diagnostic testing for IC has changed dramatically.  Previously, physicians performed a cystoscopy with hydrodistention of the bladder to confirm a diagnosis of IC.

In recent years, clinicians have favored less invasive diagnostic methods, such as The PUF Questionnaire. Based upon those results, doctors may perform a brief Potassium Sensitivity Test to determine if the bladder wall is damaged.  Hydrodistention of the bladder may be requested if a doctor wishes to perform a biopsy. A voiding diary can also be helpful.

What are the Treatments for IC?

Pelvic Floor Rehabilitation

IC patients frequently struggle with unusually tight pelvic muscles and/or trigger points that may make it difficult to start their urine stream, sit for long periods of time or enjoy sexual relations. At A Different Approach - PT for Women (ADAPT), we have physical therapist trained in reducing and controlling pelvic floor muscle tension. 

The pelvic floor is composed of an overlapping group of muscles which form a container that holds the pelvic organs in place. Frequently, these muscles can be strained by childbirth, bicycle riding, accidents, ballet and other physical activities, thus creating either painfully tight trigger points or weak unsupportive muscles.

For IC patients, the health of the pelvic floor muscles is of particular importance especially if they haven't been active for a period of time due to pain or frequency.  In a patient with IC, flares could be caused by inactivity of the pelvic floor with contributes to poor tone and weakness.   

Signs of muscle weakness may be:

  1. an uncomfortable feeling of pressure or heaviness
  2. leaking of urine when coughing, laughing, running or doing exercise,
  3. bulding of the bladder into the vagina (cystoscele)
  4. bulging of the rectum into the vagina (rectocele)
  5. the dropping of the uterus into the vagina.

The Pelvic Floor Assessment

At ADAPT our physical therapist are trained in the latest pelvic floor assessment techniques.  The assessment consists of both external and when warranted internal techniques to assess strenght, tone, and pain in the musculoskeletal system.  Specifically, the areas of primary interest are the abdomen, perinium, hips and back.  For women, a vaginal exam will allow the therapist to palpate the various internal pelvic floor muscles. Men will have their pelvic floor assessed through a simple rectal exam.

Pelvic Floor Treatments

A proactive approach to maintaining pelvic floor health is an essential for a patient with IC and can prevent future bladder problems.   At ADAPT we will utilize a variety of techniques suited to specifically address your needs including but not limited to myofascial release, soft tissue mobilization, joint mobilization, biofeedback and therapeutic exercises.  Physical Therapy can dramatically reduce symptoms for patients who are experiencing muscle pain due to IC. 

 

To learn more about how physical therapy can help treat IC please visit:

http://www.ichelp.org/AboutIC/Treatments/PhysicalTherapy/tabid/612/Default.aspx

http://www.ic-network.com/treatments/

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