What is it?

Interstitial Cystitis (IC) or Bladder Pain Syndrome (BPS) is a chronic pelvic health condition accompanied by symptoms of bladder fullness/pressure, urinary frequency and pain (2). Symptoms may range from mild to severe, may come-and-go or stay constant at times feel like a bladder infection (4).

IC has been widely misunderstood for many years and was thought to have no effective treatment. Until 2002, IC and BPS were considered an exclusive diagnosis to patients who showed typical cystoscopic findings, such as glomerulations or Hunner’s ulcer (2). Definitions changed over the years to include more of the clinical presentation of IC, and in 2009, the Society for Urodynamics and Female Urology (SUFU) defined the term IC/BPS as “an unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms for more than six weeks duration, in the absence of infection or other identifiable causes.” (2). This is the definition widely used today and what the current treatment guidelines are based on.

IC is diagnosed bases on symptoms through history-taking. Your doctor may require some tests, such as a urine test or cystoscopy to rule out other bladder issues (4), but these tests often come back clear for people with IC. 

What are the Treatment Guidelines?

The goal of treatment is to manage and control the symtpoms of IC and improve quality of life. The American Urological Association (AUA) breaks down the treatment recommendations into six tiers focusing on conservative therapies first then progressing to non-conservative if symptoms are not controlled (1).

The table below is taken from the Current guidelines in the management of interstitial cystitis in the Journal of Translational Andrology and Urology (1).

The Role of Pelvic Floor Physiotherapy in IC/BPS

The most exciting part of the treatment guidelines above is that physical therapy (physiotherapy) is considered as a second line treatment with Grade A (high quality) evidence! As IC is becoming more understood, experts are agreeing that IC/BPS is not just a bladder issue but a whole pelvic floor issue and that treatment of the musculature within the pelvic floor as well as the neural pathways to the brain is highly effective in controlling the symptoms.

Pelvic Floor Physiotherapy treatment for IC includes detailed history taking, physical examination (external and internal), education, behavioural modification, manual therapy and exercise prescription. Education around anatomy, normal bowel function, irritants to the bladder, pelvic floor relaxation and downgrading of the central nervous system (CNS) through stress control, meditation and gentle mobility is crucial in involving the patient in their own treatment.

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