**Interstitial Cystitis: a common pelvic condition
**

By Carrie Seow, women’s health physiotherapist

What is interstitial cystitis (IC)? The word “cystitis” means inflammation of the bladder and “interstitial” refers to the lining of the bladder.  IC is a chronic pain and bladder condition characterized by symptoms such as pelvic pain and frequent urination accompanied by an urgent need urinate, including night time urination. Its prevalence is estimated to be about 1 in 20 people (more common than previously thought) and contrary to popular belief, IC is not exclusively a bladder condition even though symptoms are often urinary related.

How do we diagnose IC?

There is no “test” for IC and it is diagnosed based on symptoms and the exclusion of other conditions such as urinary tract infections or pelvic organ prolapse. The spectrum of IC symptoms include:

• high urinary frequency, urgency and needing to wee more than 2 times per night
• urinary hesitancy and decreased flow
• difficulty fully emptying the bladder
• bladder pressure
• incontinence
• pain felt above the pubic bone
• pain and/or burning related to urinating
• chronic pelvic pain
• lower back, hip, or tailbone pain
• pain with sex

That is a lot of symptoms! You don’t need to have all the symptoms in the table to be diagnosed with IC but typically there will be a mixture of pain and urinary symptoms.

So what causes IC?

Simply put, the root cause of IC is not yet known. In 10% of IC cases there are Hunner’s lesions in the bladder seen via cystoscopy but 90% of time no visible damage to the bladder can be detected. There are many theories floating around including:

• Disruption of the bladder lining allows urinate to irritate sensitive structures underneath
• Disease in the nerves that supply the bladder
• Potential immune system causes.

However, research has not yet confirmed the cause. It could be multifactorial. But that doesn’t mean the condition can’t be treated. And that is why physiotherapy is important…

How can physiotherapy help with IC?

Physiotherapy for IC is all about breaking the vicious cycle of symptoms that may have been plaguing the sufferer for a long time. Most people don’t know that the bladder has the highest nerve density of any organ in the body. Thankfully, most of these nerves are normally “silent”. But in conditions like IC, they get fired up and start sending lots of messages to the brain, resulting in the need to urgently and frequently urinate. These nerves have become very sensitive to stimulation and it can be difficult to switch them off.

The pelvic floor muscle system is located in close proximity to the bladder and they are linked in function. If you always need to urinate, your pelvic floor is going to be working very hard to hold your bladder all the time, resulting in pelvic floor spasm or hyper-tonicity. The increased activity from the bladder therefore irritates the pelvic floor and vice versa, hence the vicious cycle. This is just one example of the how the nervous system gets “up-regulated” in the body. As pelvic floor physiotherapists, we treat the symptoms and work to break the vicious cycle and calm down the nervous system.

What does physiotherapy involve?

• Manual therapy – myofascial release, trigger point release of the abdomen, diaphragm, hips, legs and even the pelvic floor
• Breathing and pelvic floor relaxation exercises to reduce the spasm of these muscles
• Stretching exercises for the pelvis, abdomen, glutes, pelvic floor and legs
• Developing good bladder and bowel habits
• Transcutaneous Electrical Nerve Stimulation
• Bladder Training

If you think you suffer from IC please get in touch with us to find out how we can help!

Not such a dirty word.

by Carrie Seow, women’s health physiotherapist

The idea of having a pelvic organ prolapse (POP) can be very daunting and upsetting to most women when they first hear that they may have one. They may feel abnormal, ashamed or the odd one out.  But POP is more common than you think, with approximately 50% of adult women having some degree of it. POP means that the pelvic organs (bladder, uterus or rectum) start to descend or fall downward into the vagina from their usual position higher in the pelvis.

Symptoms of POP can include:

• Vaginal heaviness or bulging sensation in vagina
• Dragging in the lower back pain
• Painful intercourse
• Reduced control of bladder or bowels
• Urinary or defecation difficulties

However, it is good to remember, that POP can also be asymptomatic. Yes, the organs may be sitting lower, but there are no symptoms to be felt with this. The degree to which a prolapse bothers a woman (if at all) will be highly based on individual factors.

POP can be caused by pregnancy and childbirth, aging and menopause, obesity, chronic coughing, chronic constipation and heavy lifting. When you think about all the different life stages women go through, it is not surprising that a degree of vaginal laxity is common and quite normal after giving birth, pregnancy or after going through menopause. After-all, the rest of the soft tissues start to sag a little too with gravity, such as our skin, or our breasts! The same is happening within our bodies also.  

Treatment may involve a spectrum of approaches including:

• doing nothing (some POP is asymptomatic and is unlikely to get any worse depending on lifestyle factors)
• conservative treatments such as lifestyle modifications, pelvic floor exercises, vaginal pessaries, and oestrogen cream
• surgical treatment.

It’s always a good idea to get assessed by a women’s health physiotherapist if you suspect that you have a pelvic organ prolapse.

**Pessaries can save the day!
**

by Carrie Seow, women’s health physiotherapist

Prolapse and surgery has been in the news recently with the legal class action in Australia against Johnson&Johnson. With the horrific stories from many women of their pain and suffering after surgical mesh implant treatment of prolapse, surgery sounds like something to well and truly avoid. 

Conservative or non-surgical management of prolapse is very successful and often prevents the need for surgery for women living with pelvic organ prolapse (POP). POP is the term to describe the sitting of a woman’s bladder, uterus or bowel lower in the pelvis than should be. Pregnancy, child birth, menopause, much heavy lifting and age are all factors that can contribute to this very common issue. Did you know that 50% of women have a degree of POP, with many asymptomatic? This sagging of the organs can create pain, incontinence, heaviness and sometimes presentation of the organ outside of the vagina.

Conservative management for POP can include pelvic floor exercises and the prescription of pessaries. Surprisingly, not many women may have heard of these options in managing the symptoms of POP.

What is a pessary?

Pessaries come in different shapes and sizes. They are usually made of silicone, vinyl or latex and are inserted into the vagina (like a tampon) to support the walls of the vagina and uterus and reduce the strain to your pelvic ligaments. They offer support from below your organ to hold it in place. Women will often wear these all day. Some may just wear one for exercise and take it out immediately after. Some new mothers in early post natal weeks, may wish to return to running or other exercise before they have stopped breastfeeding or have full recovery of their pelvic floor strength and control. A pessary allows for a quicker return to exercise as she desires.

Pessaries are very easy to wear and to insert and remove yourself.  Your women’s health physiotherapist will advise you of the type of pessary that would be most beneficial for your condition. Wearing a pessary should be comfortable, in fact you should not even feel that it is there.

What should I expect?

Your women’s health physiotherapist is able to measure and fit you with a pessary if you have a POP.  A pessary fitting consultation will involve finding the correct type and fit of pessary for your anatomy, and often you will need to try more than one pessary to find the right one that works for you. Your pessary can be self-managed – you will be taught how to insert, remove and care for your pessary.

Many women feel an instant improvement in their POP symptoms (heaviness, dragging, lower back pain) and with their bladder, bowel and sexual function by wearing a pessary. Another huge benefit is the confidence that the pessary offers a woman - to return to exercise altogether and to get back to running, jumping or other high intensity / impact exercises without leaking or experiencing pelvic discomfort.

As with all foreign objects that are inserted into the body, there are some risks with wearing pessaries including:

• Bacterial vaginosis. This is a type of bacterial infection that can be treated with antibiotics.
• Vaginal erosion. The pressure from the pessary may damage the internal skin of the vagina. This is why finding the correct size is important.

At your fitting and compulsory followup checks, your physiotherapist will discuss with you the relevant risks of wearing pessaries in further detail before fitting one and also advise you of signs and symptoms to watch out for.