Interstitial Cystitis (IC) (PBS)

pelvic pain hurtsInterstitial Cystitis is also known as Painful Bladder Syndrome, is a complex pain condition that involves symptoms of pain, frequency and urgency. A person will tend to have a decreased bladder capacity, and an urgent need to urinate frequently. They may start to feel pressure, pain and tenderness around the bladder, pelvis and perineum. Some women have painful sexual intercourse and men may experience discomfort or pain in the penis and scrotum.

Unfortunately, the chronic inflammation of the bladder causes those who suffer with IC to urinate — sometimes painfully — as often as 40 or more times a day. Their quality of life, research suggests, resembles that of a person on kidney dialysis or suffering from chronic cancer pain. 

Most people suffering from PBS/IC have both urinary frequency/urgency and pelvic pain!

How to Diagnose IC?

You will have want to have a cystoscopy, a procedure in which a tiny camera is placed up your urethra and extended to the bladder so that it can view the bladder walls.  The bladder is inflated with saline so that its walls are no longer wrinkled. This inflation of the bladder is called a hydrodistention.

As previously stated,  a lot of symptoms can present like IC .  Chronic urinary tract infections (UTI’s), dehydration, kidney stones, neuralgias, being some of the more common ones to watch out for.

Dr. Robert Moldwin, a leading American urologist in Interstitial Cystitis, believes that it’s extremely important for patients to understand that most IC patients have multiple pain generators, such as IBS (that cause abdominal or pelvic pain), fibromyalgia, pelvic floor spasms or pelvic floor dysfunction. He further suggests that 70-80% of IC patients will have some degree of pelvic floor dysfunction or spasm that may account for even more pain than the bladder pain. Of course, vulvodynia is also frequently found. 

Types of IC Flares

There are typically 3 types of IC flares: bladder wall flares, pelvic floor flares, and muscle flares.

Bladder wall flares –  characterized by a feeling of ground glass or razor blades scraping the bladder. The bladder has often been irritated by a food/drink sensitivity and becomes more inflamed than usual.

Pelvic floor flares may happen after sexual intercourse, long periods of sitting, riding a bike or horseback riding.  It presents as a burning feeling in the urethra, vaginal area, or any part of the pelvic floor. It may feel like something is falling out of or being pushed into your vagina or urethra.

A muscle flare – the bladder muscle goes into spasms and will often cause a severe aching feeling in the bladder. The pelvic floor muscles can also become spastic, tight feeling – painful.

Treatment Options to Consider for IC

What are classic treatment options?  According to an article by blogger,  Sara K. Sauder PT, DPT, as of 2014, there is no “cure” for IC, there are just ways to manage flares and increase the time between flares.  Find below some treatment options that she has listed that can/may help those with IC. 

  • Hydrodistention – Doctor will fill your bladder to distend it.  Typically this will last only as long as necessary to fill the bladder, so just a few minutes. Here is a PDF on the treatment.
  • Instillation – Medication is placed into the bladder via an instillation.  
  • Botox – Some doctors Botox the bladder, but others will Botox the pelvic floor muscles. Botoxing the pelvic floor muscles and external muscles will not affect IC or Painful Bladder Syndrome directly, but it can help to reduce symptoms that are enhancing the IC or Painful Bladder Syndrome experience. 
  • Nerve blocks – You can get nerve blocks to lower the pelvic pain you experience with IC. 
  • Medication – Some medications are going to help you with pain management, while others will try to reinforce the lining of your bladder.
  • Suppositories – There are compounds that can help reduce the pain levels in the pelvis.  They can also help reduce the sense of urinary urgency and frequency. 
  • Diets –  There are diets you can try which can be entirely successful in getting you to a comfortable place in your life.
  • Physical Therapy – For most people, this is a great way to deal with symptoms, in addition, it’s a great way to get information to help you in making responsible flare management decisions on your own.  
  • Changing urinary pH – Check your urinary pH! If what you eat is causing your urine acid levels to rise, then that will promote your pelvic pain.  If you notice that whenever you are in a flare your urinary pH levels are quite acidic, then change your urinary pH. 

Medications to Consider for IC

According to Karen Delhey, at P.U.R.E. H.O.P.E.  the following medication has been used to treat/help with IC.

Lidocaine and Marcaine are short and long acting anesthetics that can be instilled into the bladder for immediate relief and can last hours to several days, and can be done at home.

Pentosan polysulfate sodium (Elmiron)

This is the first oral drug approved by the FDA for IC in 1996.  It is taken on an empty stomach three times a day, and can take up to 6 months to have a reduction in urinary frequency and IC pain.

 It is felt that Elmiron may work by repairing defects in the bladder lining.  Side effects include minor gastrointestinal discomfort and 4% risk of hair loss which is reversible when the drug is stopped. 

Amitryptyline (Elavil)

This is a tricyclic antidepressant which can help with sleeping and is used at lower doses than that for treatment of depression.  It can cause weight gain, constipation, and reduced libido.

Histamine Blockers (Atarax, Vistaril, Clarinex, Zyrtec)

These drugs prevent the release of histamine from mast cells in the bladder, which is felt to be one of the causes of IC.  The newer agents are taken once daily and do not cause fatigue.

Gabapentin (Neurontin), Pregabalin (Lyrica)   

These are antiseizure medications which have been used to treat chronic pain, and can have benefit in IC.  They have variable dosing and their main side effects are dizziness and fatigue.

Anticholinergic Medications (Detrol LA, Ditropan XL, Enablex, Levbid, Oxybutynin,  Oxytrol, Sanctura, Vesicare)  

These medications are used to treat an “overactive bladder”, and may work by relaxing the bladder muscle causing less urgency and frequency, or by reducing the sensation of feeling the need to urinate.  Their main side effects are dry mouth, blurred vision, and constipation.

Trigger Point Therapy and IC

A Study was done to determined the efficacy and safety of pelvic floor myofascial physical therapy compared to global therapeutic massage in women with newly symptomatic interstitial cystitis/painful bladder syndrome.

Thiele massage appears to be very helpful in improving irritative bladder symptoms in patients with interstitial cystitis and high-tone pelvic floor dysfunction in addition to decreasing pelvic floor muscle tone. (Study)

CONCLUSIONS: A significantly higher proportion of women with interstitial cystitis/painful bladder syndrome responded to treatment with myofascial physical therapy than to global therapeutic massage. Myofascial physical therapy may be a beneficial therapy in women with this syndrome.

A trip to the physio could help banish chronic cystitis – About 400,000 Britons — 90 per cent of them women — suffer from chronic cystitis, known medically as interstitial cystitis. Here the problem is not an infection, but the bladder wall becoming inflamed. Consider TP therapy.

Pelvic Floor Myofascial Trigger Points:  Manual Therapy for Interstitial Cystitis and the Urgency-Frequency Syndrome, 2001, originally published in Journal of Urology, Vol .166, pg(s) 2226-2231.

Modified Thiele massage as therapeutic intervention for female patients with interstitial cystitis and high-tone pelvic floor dysfunction.

Repeat E.coli related cystitis, recurrent cystitis, bladder infections, and UTI’s – if you have UTI’s that won’t go away, consider this article 

Natural Remedies for Interstitial Cystitis – great article on natural remedies that can help IC sufferers. 

 

 

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