Saturday, April 19, 2014

Interstitial Cystitis

Last month, I posted a Q&A about urogynecology and the topic of Interstitial Cystitis came up. So, many of you may be wondering, "what's that?" or "how can pelvic PT help?"

Interstitial Cystitis (IC) is pain in the bladder in combination with pain in the lower urinary tract system as well, with an absence of infection. Pain can also occur in the urethra, vulva, vagina, testicles, rectum and throughout the pelvis. Upon viewing of the inside of the bladder of those with IC, tiny wounds or ulcers are often found in the bladder wall that are contributing to the pain. In addition to pain, urinary frequency and urgency are found in the majority of patients with IC as they often rush to the restroom to avoid and/or reduce their pain.

Most of the patients that I see who have IC have seen many doctors and it has taken months or years before they received a diagnosis. They have been diagnosed with recurrent bladder infections and may have taken antibiotics for years without success. Unfortunately many health care practitioners are still unaware about IC. From my understanding, medical schools do not provide a lot of education about the specific pelvic pain diagnoses that I encounter on a daily basis, including IC. These are areas of interest that doctors must choose to seek out continuing education. Many doctors are unaware of the treatment options available, but fortunately there is a growing group of specialists and practitioners throughout the U.S. that are working to help those suffering with IC. And things are continuing to move in the right direction! At the 2013 meeting of the American Urological Association, two new courses were offered that trained urologists in the diagnosis of chronic pelvic pain and a very strong emphasis was placed on the examination of the pelvic floor muscles and the use of physical therapy as an important treatment tool.

This is exciting and postive news because I have seen firsthand how much physical therapy can help with the symptoms of IC! Physical therapy will not cure IC, but can help manage the symptoms of pain that these patients suffer from. Because of the pain and irritation in the pelvis that occurs with IC, many have pelvic floor dysfunction, where they develop tight, painful muscles and trigger points. Just like in other areas of the body, our muscles try to guard from the perceived injury associated with pain by tightening. However, when the tension is continuous, painful trigger points and muscle dysfunction occurs. This contributes to a pain cycle that can be broken with manual treatment, stretching and relaxation exercises for key muscle groups.

Physical therapy is key in the management of IC symptoms, but the number one, most important strategy for those with IC is changing your diet. It's also the one thing that people don't want to hear. Often, I have patients who would rather take expensive medications for the rest of their life than modify what they are putting into their bodies in regards to food and drink. But think back to those ulcers in your bladder. When you consume things that are highly acidic and
caffeinated, like sodas, coffee, citrus, and tomatoes it is like pouring acid into those wounds. You know what else is highly acidic? Cranberry juice! The one thing you have always heard is good for your bladder! The thinking behind that is that the cranberry juice makes your urine so acidic that it kills or prevents bacteria that causes a UTI from growing. So for people with IC that acidity is going to seriously irritate your bladder! Would you pour acid into a wound on your arm? Then why are you doing it to your bladder? Water consumption is also very important. When you don't get enough water during the day, your urine becomes more concentrated and acidic which, again, irritates the bladder. In addition to addressing your pelvic floor dysfunction, a pelvic PT who is familiar with IC can help educate you on what you should or shouldn't be eating. For more information about how your diet affects IC click the link below where the IC Network has some great information.

The IC Diet

If you are suffering with IC and need to find a healthcare provider who can help you get on the right path with managing your symptoms, there is some great information, again from the IC Network here. Working with the right doctor and physical therapist can help to keep your bladder happy, which in turn keeps you happy!
Happy bladder! I Heart Guts
As an aside, I LOVE the line of plush organs from I Heart Guts. The caption for the bladder is "Urine Good Hands," and I hope that you will find the right health care providers so that you will be!

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