Interstitial Cystitis (IC), also known as Painful Bladder Syndrome (PBS), is chronic inflammation of the bladder wall. Symptoms of IC include bladder pressure or pain, urinary frequency, urge, and pelvic pain including painful intercourse. Unfortunately IC is wrongly and over diagnosed quite often and should more accurately be called Pelvic Floor Dysfunction(PFD). Palpation of the pelvic floor muscles by a pelvic floor physical therapist will typically recreate or elicit the familiar pain the patient is complaining of when the pelvic floor muscles are a factor. A recent study indicated that 60% of patients with IC improved with myofascial therapy (manual therapy) by a trained pelvic floor physical therapist.
The pelvic floor muscles are often the source of the symptoms and/or can trigger the inflammation of the bladder leading to urge, urinary frequency, and pelvic pain. Diet and habits also contribute to these symptoms and very often the condition can be resolved with bladder retraining, diet modifications, and physical therapy intervention including Manual Therapy. Kegel exercises are contraindicated for patients with “Interstitial Cystitis” or any pelvic pain presentation.
In the small population that are correctly diagnosed with Interstitial Cystitis and truly have a neurogenic chronic state of inflammation of their bladder wall, the signs and symptoms will be more severe and will include the following:
*REQUIRED FINDINGS FOR APPROPRIATE DIAGNOSIS OF INTERSTITIAL CYSTITIS:
- Pain, pressure or discomfort in the pelvic area
- Related to bladder filling
- Pain in urethra, vulva, vagina, rectum, even low back and abdomen
- Daytime urinary frequency 8x or more or urgency due to pain, pressure, or discomfort, not out of fear of leaking but to avoid pain
- Symptoms greater than 3 months with the absence of infection or neoplastic disease and symptoms did not resolve after treatment with antibiotics
- No treatment with hormone injection therapy for endometriosis**
MOST COMMON SIGNS AND SYMPTOMS OF INTERSTITIAL CYSTITIS:
- Frequency of urination (including frequent nighttime voids)
- Urgency of urination
- Suprapubic pelvic pain or pressure that worsens with bladder filling that is temporarily relieved (sometimes for only minutes) by bladder emptying
- Excessive nighttime voids (Nocturia)
*American Urological Association (AUA)
The AUA further recommends that cystoscopy and/or urodynamics should be considered as an aid to diagnose IC for complex presentations and only 10% of IC patients will have a Hunner’s ulcer present. According to Intersitial Cystitis Assocation (ICS) The Potassium Sensitivity test is no longer a widely used or accepted test due to its low sensitivity and specificity. The invasive urinary catheterization often elicits pain and increases IC and PFD symptoms.
Diagnosis made based on signs and symptoms (or patient’s subjective report) alone may lead to misdiagnosis of IC and in my experience is more accurately PFD. Keep in mind that with any presentation a cluster of signs and symptoms need to be present not simply one or two to be appropriately diagnosed. Physical therapy should be the first line of treatment prior to drugs such as Elmiron, especially considering the drug only has 50% efficacy and takes a minimum of 6 months to improve symptoms. Regardless of whether it is IC or PFD physical therapy is recommended as the first line of treatment. **Endometriosis is known as the ‘evil twin syndrome’ and may present similar to IC when endo is present on bladder