Interstitial Cystitis is a common condition that affects 3-6% of adult females and 1% of men in the US.  Despite its name, it primarily affects the bladder but can also involve other body systems, leading to a range of distressing symptoms 

The Symptoms of IC Include:

  1. Chronic Pelvic Pain
  2. Urgency and frequency of urination
  3. Pain or discomfort in the bladder and pelvic region, often worsened as the bladder fills and relieved after urination
  4. Pain during sexual intercourse
  5. Discomfort of pain in the low abdomen or low back

The new guidelines from the American Urological Association in 2022 no longer classify IC as a bladder disease. It is now considered a chronic pain syndrome. Let me repeat that— IC is not a bladder disease, it is a chronic pelvic pain syndrome. These new guidelines were created to change the way we think about treating people with this condition who have had a frustrating road to finding relief of their symptoms.

So you’ve been diagnosed with interstitial cystitis (IC) or you think maybe you have IC? Interstitial cystitis is a complex and multifaceted condition that significantly impacts the quality of life of affected individuals. While the exact cause remains elusive, it is believed to involve a combination of genetic, environmental, and immune system factors.The condition affects both women and men of all ages.

The common perception, and even the name suggests that it is inflammation of the bladder. (cyst=bladder, itis=inflammation). That being said, no wonder we assume there is something wrong with the bladder, right? However we now know that only 10% of people with IC have bladder pathology (that is, under cystoscopy there are lesions of the bladder), and that number decreases to more like 4% in a population under 50. So is it really a bladder problem if the bladder looks healthy? Hence, the new guidelines for effective diagnosis and treatment, with focus taken off the bladder.

People with IC have some or all of these symptoms which can range in severity, and for many people who are seeking treatment, these symptoms are significantly impacting quality of life. So where are these very real, sometimes very debilitating symptoms coming from? If in fact there are lesions on the wall of your bladder (Hunner’s Lesions), these can certainly be a source of pain, but we’ve already established that this is a very small group.

The bladder can tell the brain two things: time to pee, or I am in pain. When the bladder senses that something is wrong, it will tell your brain one of these two things, or both of these things. Therefore, input from your nervous system whether from the musculoskeletal system or chronic pain syndromes will stimulate your bladder to send back these signals that you are in pain or you have to pee.

Muscle tension and trigger points in the pelvic floor and surrounding muscles of the abdomen, low back and hips are significant contributors to the symptoms of IC. They are generally found in most people with IC, and can refer pain directly to the bladder. This can be the result of a previous injury, childbirth, poor posture, chronic holding patterns. These trigger points can be perpetrators to tell the bladder something is wrong. 

Chronic Pain conditions can also tell the bladder something is wrong, again sending these signals of “time to pee”, and/or, “I’m in pain”. These patients generally have involvement beyond the bladder, including but not limited to, jaw pain, headaches, IBS, and fibromyalgia. This is generally a product of the central nervous system, what we sometimes refer to as “top-down” dysregulation of the way our body processes pain.

This being said, there is generally a multifactorial cause of the condition, and up to this point in time many of the medical therapies associated with treatment are minimally effective. When Hunner’s lesions are found (in 4-10% of cases) they are treated with laser/fulguration therapy or steroid injections for the bladder, which will not help if the lesions are not present.

It is important to understand that treatment of this condition should be multidisciplinary, but recent emerging research suggests that Physical therapy is the MOST EFFECTIVE treatment in reducing discomfort associated with IC. According to the 2022 guidelines from the AUA, Physical Therapy is the only treatment with Grade A evidence to support it. Current medical interventions including oral medications, injections, bladder instillations are all classified as Grade B-C for treatment of symptoms associated with IC.

How Does PT Help?

Physical therapists specializing in pelvic health play a vital role in addressing musculoskeletal dysfunction, pelvic floor dysfunction, and associated pain in patients with interstitial cystitis. Some treatment techniques that your PT could use include:

Pelvic Floor Rehabilitation

Pelvic floor physical therapy focuses on the muscles of the pelvic floor, hips, low back and abdomen, which play a critical role in bladder control and pelvic stability. Generally with pelvic pain conditions, PT works to help with relaxation of the pelvic floor muscles before looking at strengthening.  

Myofascial Release

Intestinal cystitis is often associated with myofascial trigger points and muscle tension in the pelvic region. Myofascial release techniques, such as soft tissue mobilization and trigger point therapy, can help alleviate muscle tightness and reduce pain.

Relaxation and Stress Management

 Chronic pain conditions like IC are often exacerbated by stress and tension. Physical therapists may incorporate relaxation techniques, mindfulness practices, and stress management strategies to help patients cope with pain and improve overall well-being.

Bladder Retraining/Lifestyle Modifications

Physical therapists can educate patients on bladder retraining techniques to improve bladder function and reduce urinary urgency and frequency, as well as diet and lifestyle modifications.

Interstitial cystitis is a complex and challenging condition that requires a comprehensive treatment approach tailored to individual patient needs. By addressing musculoskeletal issues, promoting pelvic floor health, and empowering patients with self-management strategies, physical therapy plays a pivotal role in enhancing the overall quality of life for individuals living with IC.

About the Author

Dr. Sarah Koehl is a Doctor of Physical Therapy looking to make a difference in the health and well-being of the people in her community. She loves to educate patients to empower them in taking control of their health and reaching their goals including those with acute and chronic orthopedic conditions, pelvic floor dysfunction, and neurological conditions.