Always have to pee? Have the urge to pee and then very little comes out? Pain in the bladder or pelvic region? Ever feel like you have a UTI but testing shows otherwise? These symptoms might be associated with Interstitial Cystitis or Bladder Pain Syndrome (BPS), a chronic condition that affects men and women of all ages.
Common symptoms include pain, pressure, or discomfort in the pelvic area; increased urinary frequency to 10+ times daily due to pain, pressure, or discomfort; and lower urinary tract symptoms that last for more than 6 weeks without an infection or other clear cause. The exact cause of interstitial cystitis is unknown, and a diagnosis is usually made after excluding all other urinary and bladder pathology. Given the difficulty of diagnosis, estimates of prevalence vary greatly, but the condition occurs more commonly in women, affecting up to an estimated 12% of women and up to 4.6% of men.
While there is no one-size-fits-all treatment for IC/BPS, working with a healthcare team to develop individualized treatment plans enables many people to lead lives without pain and in control of their bladder symptoms. In 2022, the American Urological Association (AUA) released updated guidelines on treatment for IC/BPS based on newly published scientific research. The Guidelines indicate how effective various treatments are, and recommend Physical Therapy as Grade A evidence, while various medications ranked as Grade B or C evidence, and procedures such as cystoscopies and surgeries such as urinary diversion surgeries were rated as Grade C evidence.
The AUA Guidelines recommend a management approach where treatment decisions are made after shared decision-making with patients informed of the risks, benefits, and alternatives of each option. Pain management is an important part of care, and should include multiple treatment options, for example, manual physical therapy techniques, stress management techniques, and pharmacological treatment. They also recommend that ineffective treatments should be stopped and that pain management and overall treatment strategies should be regularly reassessed.
Further details and information on AUA recommendations are summarized below:
- Physical Therapy (Grade A scientific evidence) including manual therapy techniques and avoiding pelvic floor strengthening activities (ie Kegel exercises)
- Education on normal bladder function, what is known and not known about IC/BPS, treatment options available and their risks/benefits, and the fact that no single treatment is effective for the majority of patients, and finding successful options may require trial and error
- Self-care practices and stress management practices, and practices to improve coping techniques and manage stress-induced exacerbations of symptoms
- Medication for pain: pharmacological pain management principles for IC/BPS should be similar to those for management of other chronic pain conditions. Clinicians may prescribe pharmacologic pain management agents such as urinary analgesics, NSAIDS, opion/non-opiod medications after counseling patients on the risks and benefits.
- Additional Grade B and C medications may be administered orally (see AUA recommendations for further details)
Procedures and Major Surgeries:
- Listed as Grade C evidence and may be undertaken in carefully selected patients for whom all other therapies have failed to provide adequate symptom control and quality of life improvement
Treatments that Should Not be Offered:
- Long-term oral antibiotic or glucocorticoid administration (see AUA recommendations for further recommendations)
Words of Wisdom for Managing IC/PBS
- Get to know your symptoms: if you have been experiencing bladder pain or increased urinary urgency or frequency, keep a log of your daily urinary habits and symptoms to help you better understand your symptoms, as well as help your healthcare team diagnose and treat your condition.
- Know that it is common for IC/PBS to be misdiagnosed, underdiagnosed, and mistreated, and especially to have pain undertreated. Empower yourself by sharing and discussing the AUA guidelines with your healthcare providers.
- Recognize that healing from IC/BPS may be a long journey with bumps and missteps along the way, but that a healthy life with control over pain and bladder symptoms is possible
- Find a Pelvic Health Physical Therapist: reach out to N2 or find a local pelvic health physical therapist to support and guide your journey