Interstitial Cystitis (IC) is a condition that lasts 6 weeks or longer and presents as lower urinary tract symptoms (such a urinary frequency or urgency) along with pain, pressure, or discomfort in the area of the urinary bladder. IC is also known as Bladder Pain Syndrome (BPS), Hypersensitive Bladder Syndrome (HBS), Painful Bladder Syndrome (PBS), or Urologic Chronic Pelvic Pain Syndrome (UCPPS). In the United States IC affects 12 million people. While the prevalence of IC is higher in women, men are also affected by it.
There are two subtypes of IC: non-ulcerative and ulcerative. Ulcerative IC is diagnosed by cystoscopy, which involves a scope of the lining of the bladder. If the cystoscopy shows the presence of Hunner’s lesions on the bladder wall the patient has ulcerative IC. However, it should be noted that only 5-10% of IC patients have the ulcerative form. The majority of patients with complaints of urinary frequency, urgency, and pain have non-ulcerative IC, and for these patients diagnosis is one of exclusion as they have unremarkable results on cystoscopy and lab cultures.
In 2014 the American Urological Association (AUA) conducted a systematic review, whereby the looked a literature on IC published between 1983-2009. Based on this review the AUA rated the evidence with a strength rating of A (high), B (moderate), or C (low). Their recommendation is that more conservative therapies should be used first, “with less conservative therapies employed if symptom control is inadequate for acceptable quality of life”. They acknowledge that “no single treatment has been found effective for the majority of patients, and the fact that acceptable symptom control may require trials of multiple therapeutic options (including combination therapy) before it is achieved”. What does this mean for you as a patient? Don’t focus on only one type of treatment as you are better off with trying a combination of treatments. As to what treatments are best, the AUA recommends that first-line treatments should be performed on all patients regardless of IC type. First-line treatments include:
- Patient education about normal bladder function
- Self-care practices and behavioral modifications that can improve symptoms
- Implementing stress management practices to improve coping techniques and for the management of stress-induced symptom exacerbation
If first-line treatments alone do not alleviate symptoms, second-line treatments can be employed to help patients with IC better manage their symptoms and reduce their pain. The good news is that after conducting their systematic review of the literature, the AUA gave a Grade A to physical therapy, which means that the strength of evidence supporting physical therapy treatment is high. Furthermore, unlike medication physical therapy has little side-effect. What can you expect during your physical therapy session?
As pelvic floor physical therapists we treat a variety of bladder pain syndromes. Treatment depends on the individual as we always perform a comprehensive evaluation, taking into account your medical history and any other issues that would affect the plan of care. Depending on the findings of the evaluation you may receive manual physical therapy techniques on your pelvic floor muscles, your abdominals and/or your hips, trigger point release of painful muscles, neuromuscular re-education to activate appropriate muscles, a stretching and/or strengthening program as needed. Your pelvic floor physical therapist will also work with you on bladder habits and explain how your symptoms can be affected by your food and liquid intake, as well as any medications you are taking. If you have IC call us for a free 15 minute phone consult with one of our pelvic floor physical therapists.