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
- 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!