By Caitlin Ruggiero PT, DPT
Do you find yourself struggling with bladder pain, urinary frequency or lower abdominal pressure? You may have a condition called Interstitial Cystitis (IC) which is defined as an unpleasant sensation perceived to be related to the urinary bladder, associated with lower urinary tract symptoms of more than six weeks duration, in the absence of infection or other identifiable causes. There are currently two subcategories of IC Hunner’s Lesions and Non-ulcer IC. Hunner lesions are the classic presentation of IC where there are ulcers present in the bladder however only about 5% to 10% of individuals will have actual ulcers present. The second for form IC effects 90% to 95% of individuals have a ‘normal’ bladder based on testing but exhibit all the signs of IC making it very hard to diagnosis. While once considered a rare condition IC is becoming more common. People who are diagnosed with IC tend to have a childhood history of bladder or toileting issues.
IC is diagnosed by ruling out other possible diseases. When getting worked up to determine if you have IC some typical tests you will go through include review of your health history, physical and neurological examination, urine testing and blood work. Urodynamic testing uses a catheter to assess the pressure in the bladder as it fills and empties- most people with IC will have smaller bladder capacity or not fully empty the bladder. Another test that is helpful in the diagnosis is a cystoscopy which uses a camera to look inside the bladder; not all but some people with IC will have ulcers present in the bladder or signs of healed up ulcers.
There is not one issue that causes IC. One cause is injury to the bladder, which includes urinary tract infections, chemical exposure from ketamine, chemotherapy and excessive consumption of bladder irritants. Like many areas in the body when the bladder is damaged there is inflammation and muscle guarding that are present with IC. Another factor causing IC is pelvic floor dysfunction resulting in tight pelvic floor muscles, traumatic childbirth, riding a bicycle or a athletic injury. Some people report having a family history of sensitive bladders indicating a possible genetic component. Lastly, many patients will also have an underlying neurosensitivty disorder including IBS, chronic fatigue syndrome and anxiety. In the latest research for IC studies are looking at specific genetic markers and specific viruses that can cause IC.
In treating interstitial Cystitis physical therapy is one of the first lines of treatments an individual should take. While physical therapists cannot directly treat the irritation of the bladder treatment can treat many of the contributing factors or sequelae of symptoms associated with the disorder. Physical therapists specialized in pelvic floor PT will perform a subjective and objective assessment of the musculoskeletal system focusing on posture, breathing, abdominal muscles and pelvic floor muscles. Based on the severity of the symptoms of the symptoms the physical therapist will assess the pelvic floor with either an external or internal assessment. Based on the objective findings the physical therapist will address the treatment in the most appropriate treatment area. A portion of the treatment consists of education about bladder irritants, voiding schedule, IC diet and bladder retraining. The muscle restrictions will be addressed with external soft tissue releases, visceral releases to the abdominal organs and possible internal releases to the pelvic floor. In order for patients to better understand relaxing the pelvic floor surface EMG biofeedback training is used to provide a visual of the pelvic floor muscle activation.
If you feel you may have IC or any other forms of pelvic floor dysfunction please contact your nearest Aquacare Physical Therapy and set up an appointment or a free screening to talk with one of our pelvic floor specialists.