Bladder Pain Syndrome (aka interstitial cystitis)
What is Bladder Pain Syndrome?
Bladder Pain Syndrome is defined as chronic pelvic pain, pressure or discomfort related to the bladder. Patients will often experience pain as the bladder fills and relief when they empty. They may also experience an increase in frequency as well as a persistent urge to empty. This condition is prevalent in both men and women.
The causes of bladder pain are still being investigated, at this stage our thinking is that it is multifactorial (aka lots of different contributing factors). Generally patients will review with a urologist to ensure that there are no other causes for their bladder pain. They may need patients to undergo further testing such as cystoscopy, bladder wall biopsy or urodynamics to help diagnose.
First line treatment as discussed by the International Continence Society include:
Patient education- including help to understand the nature of bladder pain syndrome and current available treatment options
Stress reduction- we know that stress can play a role in our experience of pain. Therefore it is important to have strategies in place for when an increase in stress occurs.
Non-prescription analgesics- this would be done via your GP, urologist or pharmacist recommendations.
Dietary manipulation- this may involve keeping a food diary to see if there are any known triggers. Certain foods such as coffee, alcohol, spicy foods, artificial sweeteners may irritate the bladder and worsen symptoms. It doesn’t mean we need to take out these foods for forever, jsut in the short term to help bring the pain down.
Pelvic Floor Relaxation (this is where your pelvic health physio comes in!)
Pelvic Floor Physical Therapy (we are here for this too!)
Consult if associated disease
Second Line Treatment:
This is more guided by your urologist or specialised GP. This may involve treatment directly to the bladder or specific medications to help alleviate the pain.
Bladder Pain Syndrome is often confused with Overactive Bladder.
They are similar in that patients often express an increase in urinary frequency as well as incease in urgency. However, the key difference is in the case of bladder pain syndrome, the desire to empty is often driven from pain, whereas in Overactive Bladder it comes from a feeling of bladder fullness and fear of leaking.
Why is correct diagnosis important?
They are treated in two very different ways. Some of the treatment options may overlap. However, there are some strategies that we would teach for OAB that may actually worsen Bladder Pain.
For instance, in the case of OAB we may teach patients to hold on or defer urge. In the case of Bladder Pain Syndrome. Constantly holding on and exacerbating pain may worsen symptoms and delay recovery.
Where do Hunner’s Lesions fit in?
If you have been diagnosed with Bladder Pain Syndrome and undergone at cystoscopy. You may or may not have been told that you have Hunner’s Lesions. These are reddened areas found on cystoscopy and are associated with increased inflammatory molecules.
There is ongoing debate about the relevance of Hunner’s lesions. As they have been found in patients that do not have Bladder Pain Syndrome and there are some people who have Bladder Pain Syndrome don’t have Hunner’s Lesions. However, if it appears that you do have them, your urologist will be able to guide you in relation to available treatment options.
What to do if you have signs of Bladder Pain Syndrome?
As mentioned earlier, Bladder Pain Syndrome is often confused with Overactive Bladder. For correct treatment correct diagnosis is key. Find yourself a pelvic health physiotherapist and urologist that understand BPS!
Know that you are not alone and that there are treatment options available to you.
How Can Pelvic Health Physio Help?
Lifestyle modification: We can provide advice around fluid manipulation to avoid exacerbating symptoms. This may include advice around increasing (to avoid concentrated urine) and equally avoiding being too hudrated to avoid continually exacerbating symptoms. We will likely get you to complete a bladder diary to help inform this decision.
Pelvic Floor Relaxation: Often when patients have been in pain for a period of time there may be an associated increase in pelvic floor tension. We can help you to relax your pelvic floor through breathing, stretches, mindfulness and internal release.
Bladder Drills: Timed emptying of your bladder to help avoid increase in symptoms
Electrotherapy: This can be done via TENS or within the pelvis. Electrotherapy has been shown to help desensitise the nervous system to help provide relief.
Advice around dietary support: Although this isn’t our main scope of practice. Physio’s are often aware of common bladder irritants and can provide advice regarding this.
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