Interstitial Cystitis/ Painful Bladder Syndrome

What is it?

Interstitial Cystitis (IC), also known as Bladder Pain Syndrome (BPS), is a chronic pelvic condition characterized by symptoms like bladder pressure, frequent urination, and pelvic pain. Symptoms can vary from mild to severe, may be intermittent or constant, and often mimic those of a bladder infection.

For many years, IC was poorly understood and thought to lack effective treatments. Until 2002, it was only diagnosed in patients with certain cystoscopic findings, such as glomerulations or Hunner's ulcers. In 2009, the Society for Urodynamics and Female Urology (SUFU) redefined IC/BPS as “an unpleasant sensation (pain, pressure, discomfort) perceived to be related to the bladder, associated with lower urinary tract symptoms for more than six weeks, without infection or other identifiable causes.” This broader definition is now widely used in current treatment guidelines.

IC is typically diagnosed based on symptoms and medical history. Your doctor may perform tests, like a urine test or cystoscopy, to rule out other conditions, but these tests usually come back clear in patients with IC.

What are the Treatment Guidelines?

The main goal of treatment for IC is to manage symptoms and improve quality of life. The American Urological Association (AUA) has established six tiers of treatment, starting with conservative therapies and progressing to more invasive options if symptoms persist.

The Role of Pelvic Floor Physiotherapy in IC/BPS

Excitingly, pelvic floor physiotherapy is considered a second-line treatment for IC/BPS, supported by high-quality evidence. Experts now recognize that IC/BPS is not just a bladder issue but a pelvic floor condition, and treating the muscles and neural pathways in the pelvic region can be highly effective.

Physiotherapy for IC involves taking a detailed history, performing external and internal physical exams, and educating patients about bladder anatomy, function, and irritants. Treatment also includes behavioral modifications, manual therapy, and exercises. Techniques such as pelvic floor relaxation, stress management, and gentle mobility exercises help reduce symptoms and calm the central nervous system, empowering patients to participate in their own recovery.

References

1- Colaco M, Evans R. (2015). Current guidelines in the management of interstitial cystitis.   

Transl Androl Urol. 4(6):677-83. doi: 10.3978/j.issn.2223-4683.2015.11.03. PMID: 26816869; PMCID: PMC4708542.

2 - Cox, A., Golda, N., Nadeau, G., Nickel, J. C., Carr, L., Corcos, J., & Teichman, J. (2016). CUA guideline: Diagnosis and treatment of interstitial cystitis/ bladder pain syndrome. Canadian Urological Association Journal, 10(5-6), 136. https://doi.org/10.5489/cuaj.3786 

3- Hanno, P. M., Erickson, D., Moldwin, R., & Faraday, M. M. (2015). Diagnosis and treatment of interstitial cystitis/bladder pain syndrome: AUA guideline amendment. Journal of Urology, 193(5), 1545–1553. https://doi.org/10.1016/j.juro.2015.01.086 

4 - Interstitial cystitis. What is Interstitial Cystitis(IC)/Bladder Pain Syndrome? - Urology Care Foundation. (n.d.). Retrieved October 25, 2021, from https://www.urologyhealth.org/urology-a-z/i/interstitial-cystitis.

5- Interstitial cystitis history.  Interstitial Cystitis Network . (2019, January 7). Retrieved October 25, 2021, from https://www.ic-network.com/interstitial-cystitis-history/. 

6- Grundy, L., Caldwell, A., & Brierley, S. M. (2018). Mechanisms underlying overactive bladder and interstitial cystitis/painful bladder syndrome. Frontiers in Neuroscience, 12. https://doi.org/10.3389/fnins.2018.00931