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Interstitial Cystitis

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Facts About Interstitial Cystitis

Symptoms of Interstitial Cystitis

It is estimated that 700,000-4,000,000 people in the U.S. (about 90% of whom are women) suffer from a chronic bladder condition known as interstitial cystitis in which the bladder is inflamed or ulcerated and the capacity of the bladder to hold urine is reduced. This condition is diagnosed when symptoms occur that feel like a bladder infection but no bladder infection is found. Symptoms include:

  • Urinary frequency and urgency (sometimes urinating dozens of times daily
  • Suprapubic pain (pain above the pubic bone)
  • Pain with intercourse
  • Flare up of symptoms with certain food and drink
  • Although signs and symptoms of interstitial cystitis may resemble those of a chronic urinary tract infection, urine cultures are usually free of bacteria. However, a worsening of symptoms may occur if a person with interstitial cystitis gets a urinary tract infection.

Interstitial cystitis is often accompanied with pelvic floor dysfunction in which the muscles of the pelvis. Some researchers hypothesize bladder inflammation may occur as the result of neurogenic inflammation in response to ongoing guarding of the pelvis muscles. Below is a detailed list of pelvic floor dysfunction symptoms in men and women associated with IC.

Locations of pain associated with interstitial cystitis

In a recent survey of 264 women with IC conducted by physicians at the University of Maryland and Johns Hopkins University, it was found that the respondents were quite precise in identifying multiple sites of pain with pain sensations described as ‘throbbing, tender, piercing or aching.’ For genital pain sites, ‘burning, stinging and sharp’ were the pain descriptions. The order ranking of the most frequently reported sites of pain were suprapubic (above the pubic bone), urethral and genital areas, followed by other non-genitourinary sites. Suprapubic and urethral pain were reported as worsening either with bladder filling or just before urination in 50% or more of the women. Approximately 80% of survey respondents also indicated pain worsening in these areas after consumption of certain food and drinks.

Trigger points and Interstitial Cystitis

Typically there are a large number of trigger points found in those diagnosed with IC.

We have found there are often a large number of trigger points in the pelvic floor in individuals with IC and they are often very painful. These trigger points can be accessed and manipulated by a physical therapist. However, we strongly believe that it is important that IC patients also be taught how to identify and work on the trigger points themselves.

Wise-Anderson Protocol and Interstitial Cystitis

A constellation of chronic pelvic pain, protective guarding against pain, chronic pelvic tension including pain-referring trigger points, a predisposition toward anxiety and catastrophic thinking that feeds anxiety may all be part of a self-feeding, self-perpetuating cycle of muscle based pain in women and men with IC. As with male pelvic pain, the goal of our Wise-Anderson Protocol is to interrupt this cascade of events. This is done in our treatment by training our patients to do their own internal and external physiotherapy and training our patients in reducing anxiety and the arousal of the nervous system

In the Wise-Anderson Treatment Protocol, the focus on quieting nervous system arousal needs to be done regularly, especially because IC patients may have a greater predisposition toward anxiety or have relatively more anxiety as a result of their condition. While patients may become discouraged when hearing this, we are not, and simply feel that it takes more effort and intention to reduce the general level of nervousness in order for patients to help themselves. Quieting anxiety in our protocol is most effectively done by teaching our patients how to help themselves and reduce their pain and related symptoms. The methods for doing this include regular internal and external physiotherapy self-treatment, the regular practice in Paradoxical Relaxation, the management of thinking that tends to spin off into catastrophic thinking, and dealing with lifestyle issues and one’s relationships.

A large number of women who attend our clinic have been diagnosed with Interstitial Cystitis

A large number of women who have participated in our program for pelvic pain have been diagnosed with the disorder of interstitial cystitis or bladder pain syndrome (IC/BPS). From epidemiological studies the prevalence of IC is estimated to be 300 cases per 100,000 women. While men also have this condition, it is 5 to 10 times more prevalent in women. IC is a chronic disease of unknown cause that is characterized by pelvic pain in multiple sites and bladder dysfunction including urinary frequency and urgency, nocturia (desire to urinate during the night) and increased symptoms of urinary urgency with intercourse. Patients with IC may only have bladder symptoms and no other pain. While suprapubic pain or pain felt above the pubic bone is a prominent feature, additional pain sites include the urethra, genitalia and others such as the groin, low back, thighs and buttocks.

This condition may coexist with other disorders such as irritable bowel syndrome, fibromyalgia, vulvodynia, vulvar vestibulitis, pelvic floor dysfunction, Raynaud’s syndrome, and migraine headache among others.

The new name for Interstitial Cystitis: Painful Bladder Syndrome

Recently an international consultation of scientific experts met and voted to use the new term “bladder pain syndrome” (BPS) for the disorder commonly called interstitial cystitis or painful bladder syndrome. BPS is a clinical diagnosis encompassing the pattern of multiple symptoms as described above. For our discussions herein we retain the IC terminology, although that name IC focuses narrowly on inflammation within the wall of the bladder and may not accurately describe the majority of patients with the syndrome. The trend at the present time is to identify the characteristics or phenotypes of the chronic pelvic pain syndrome in women. Analyzing these categories may help narrow the focus of treatment.