Painful bladder syndrome (interstitial cystitis) is a painful dysfunction which can be described as recurring pain or pressure throughout the bladder or pelvic region, which typically becomes more painful as the bladder fills with urine. Urinary frequency and urgency, or the amount of times you need to go and the intensity at which you feel you need to eliminate, are also very common with painful bladder syndrome. Think of the pelvic floor region as the muscles that sling from the pubic bone to tailbone. The bladder is one of the organs that is supported by the pelvic floor muscles. When any of the organs becomes irritated, the pelvic floor muscles will likely spasm. This spasming contributes to a cycle of pain – the bladder affecting surrounding pelvic floor muscles and the muscles putting more stress on the bladder. With painful bladder syndrome, pelvic floor physical therapy is an excellent conservative option for treatment.
– Urinary frequency
– Urinating small amounts
– Pain prior to, during or after urination
– Pressure throughout the low abdomen
– Inability to completely void or difficulty initiating urination
– Excessive trips to the bathroom at night
– Back or abdominal pain
– Painful or difficult sex
Although the specific cause of painful bladder syndrome is unknown, it is theorized that irritation or inflammation of the bladder lining or nerve can cause this dysfunction sending mixed messages to the brain for the need to urinate. With the increased rate of urination, it is likely there will be less output of urine. In some patients, urinary retention may occur, which is when you are unable to completely void all of the urine in the bladder. This may lead to straining of the muscles to empty the bladder, and thus cause pelvic floor muscle irritation.
Your physical therapist will perform a thorough evaluation to assess your painful bladder syndrome symptoms. The evaluation will include an internal and external component. The internal component will evaluate the muscles of the pelvic floor to assess for pain, tenderness, and strength (if appropriate). The external component will look at the lower back, hip, and abdominal muscle tightness and strength. You and your therapist will work together to ensure your comfort throughout the process. If your therapist feels you may need further examination or testing that she cannot perform, she will refer you to an MD.
Treatment for painful bladder syndrome may include releasing muscular spasms throughout the pelvic floor, back, and/or hip muscles, which may be performed with stretching and gentle manual release of those muscles. Your physical therapist may also work with you to address the timing of emptying your bladder, toileting habits, assess daily food/beverage logs, and discuss specific bladder irritants that may give you an increased sense of urgency. Physical therapy can help you to manage your symptoms and take back control of your life.