The Gist: What is Interstitial Cystitis?
Also known as: bladder pain syndrome, painful bladder syndrome
Interstitial Cystitis (IC) is a condition whose definition has continually evolved since it was first discovered in the late nineteenth century, as has its criteria for diagnosis and strategies for treatment. Unfortunately, these changes have inevitably led to difficulty accurately estimating the prevalence, incidence and cause of this condition, as well as developing consistency in a standard of care for individuals living with IC.
Today, IC is most commonly referred to as interstitial cystitis / bladder pain syndrome (IC/BPS) and is defined by "...chronic (>6 mos) pelvic pain, pressure or discomfort perceived to be related to the urinary bladder accompanied by at least one other urinary symptom such as persistent urge to void or frequency. Confusable diseases as the cause of the symptoms must be excluded." In order to be diagnosed with IC/BPS, a series of tests and examinations must first be completed by your doctor in order to rule out "confusable diseases" such as endometriosis, overactive bladder, and urinary tract infection. Once diagnosed with IC/BPS, further testing is performed to determine whether any distinctive, painful areas of inflammation can be found in the bladder wall, also known as Hunner's lesions, as this discovery will alter your plan of care.
Who gets Interstitial Cystitis? When does it occur for women?
Today, IC/BPS is considered more than just a "bladder disease" involving damaging lesions; instead, it is viewed as a "complex neuromuscular disorder that can involve the bladder, the pelvic floor muscles and/or the nerves." This recent recognition of the diversity in presentation of IC/BPS symptoms has since expanded the theories of its source of origin. It is now proposed that, in addition to Hunner's lesions, bladder wall injuries following UTI or chemical exposure, pelvic floor injuries stemming from childbirth or a fall, pudendal neuralgia or nerve entrapment, and multiple pain disorders may also lead to a diagnosis of IC/BPS.
The Origin Way: Physical therapy for Interstitial Cystitis
While relatively rare, if Hunner's lesions are present, this will change your course of treatment. All IC/BPS patients will receive conservative lines of treatment initially, but those patients found to have lesions present will often also be treated with medication, fulguration, cystoscopy with hydrodistension, or reconstructive surgery.
The American Urological Association (AUA) has provided guidelines for treatment of IC/BPS based upon potential benefit versus potential adverse or irreversible effects. As a "first-line" of treatment, the AUA recommends all patients receive education regarding their condition, self-care guidance, behavioral modifications, and stress management practices. The "second-line" treatment for patients with this condition includes pelvic floor Physical Therapy for reduction of pelvic floor muscle tenderness, spasms, scar tissue, and myofascial restrictions.
At Origin, our Physical Therapists are trained to support your healthcare team and you by providing both "first-" and "second-line" treatments. Our therapists are trained to help reduce pelvic floor dysfunction and myofascial restrictions with manual therapy to the muscles in and around the pelvis, as well as provide education and support regarding normal bladder habits, symptom management strategies, and breathing techniques to manage stress and anxiety.
A typical plan of care in Physical Therapy will involve working with your therapist to better understand your personal experience with IC to determine your current or most pressing symptoms and to set achievable goals that will improve your quality of life. Depending on the severity of your symptoms and compliance with your program including behavioral modifications, exercise compliance, and stress management techniques, you may develop independence in your plan of care in as little as two months.
How long does it take?
However, it is not uncommon for patients with IC to have flare ups that might require extra attention from your Physical Therapist periodically. At Origin, we are prepared to support you each step of the way, so that you can feel confident in your ability to manage your symptoms on your own, while also feeling empowered to seek support from your Physical Therapist whenever you need it.
What to expect in the future
Currently, there is no cure for IC/BPS and this can be daunting, even depressing, for many individuals diagnosed with this condition. However, much like many survivors of other incurable conditions, remission is possible and sustainable. With adequate treatment, you can become independent and confident in managing your symptoms, improving your quality of life, and achieving your goals.
Additional Reading and Sources
Han, Esther, et al. "Current Best Practice Management of Interstitial Cystitis/Bladder Pain Syndrome." Therapeutic Advances in Urology, vol. 10, no. 7, 2018, pp. 197 - 211., doi:10.1177/1756287218761574.
Hanno, Phillip M, et al. "Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome." American Urological Association, 2014, www.auanet.org/guidelines/interstitial-cystitis-(ic/bps)-guideline
Merwe, Joop P. Van De, et al. "Diagnostic Criteria, Classification, and Nomenclature for Painful Bladder Syndrome/Interstitial Cystitis: An ESSIC Proposal." European Urology, vol. 53, no. 1, 2008, pp. 60 - 67., doi:10.1016/j.eururo.2007.09.019.
Osborne, Jill. "What Is Interstitial Cystitis and Bladder Pain Syndrome" Interstitial Cystitis Network , 19 Jan. 2017, www.ic-network.com/interstitial-cystitis/what-is-ic/
Payne, Christopher K. "A New Approach to Urologic Chronic Pelvic Pain Syndromes: Applying Oncologic Principles to 'Benign' Conditions." Current Bladder Dysfunction Reports, vol. 10, no. 1, 2015, pp. 81 - 86., doi:10.1007/s11884-014-0272-5.