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Interstitial Cystitis or Bladder Pain Syndrome is estimated to affect around 12 million people in the United States alone. The diagnosis of IC/BPS is a diagnosis of exclusion, so the diagnosis is made when symptoms are present in the absence of an infection or known cause.
Symptoms May Include:
Urinary urgency, urinary frequency,
bladder pain and/or bladder pressure
Pain with sex
Bladder pain upon filling or emptying
Lower abdominal pressure or pain
Nocturia (nighttime bathroom trips to empty the bladder)
Studies show that up to 92% of people with IC/BPS experience pelvic floor dysfunction, and the American Urological Association (AUA) updated guidelines in 2022 to define IC/PBS primarily as a neuromuscular disorder rather than a bladder disease.
Symptoms can range from mild to severe, and finding a skilled pelvic floor therapist who specializes in chronic pain and sexual medicine is advised.
There are two main types of IC/BPS, ulcerative and non-ulcerative. The most common non-ulcerative types are perpetuated by the pelvic floor, the central nervous system, or by hormonal insufficiency.
A hormonal component is most frequently seen in perimenopause, menopause, and post-menopausal women. Other populations would include women who have been on oral contraceptive pills, women who are breastfeeding, or those on other medications related to altering hormonal status such as medications used in the treatment of breast cancer or endometriosis.
To help improve treatment approaches, the American Urological Association (AUA) further expanded the types of Interstitial Cystitis/ Bladder Pain Syndrome to include nine distinct phenotypes in 2022. Overlapping causative factors are often present in these phenotypes with pelvic floor dysfunction, hormonal deficiency, and nervous system dysregulation common in many.
Ulcerative
In ulcerative IC/BPS, distinct bladder lesions cause inflammation. These lesions are found on cystoscopy. It is estimated that only 5-10% of patients have this type. Ulcerative IC/BPS benefits the most from interdisciplinary care with some patients benefitting from bladder instillations and some ultimately requiring fulguration with laser or electrocautery to destroy the abnormal cells.
Infection Mediated
After repetitive urinary tract infections, this type often emerges after the infection has cleared as the bladder becomes hypersensitive.
Another explanation that is discussed in online forums is the possibility of embedded infections. Typical labs may not pick up these pathogens and newer tests such as MicroGenDX labs may help identify the pathogens involved.
In the latter case, antibiotics introduced directly into the bladder during bladder installations are sometimes recommended though working with a medical provider who well understands antibiotic resistance is advised.
Hypersensitivity
This type is neurogenic or caused by, controlled by, or arising from the nervous system. This type is often characterized by widespread pain such as seen in fibromyalgia. The patient may also have other central nervous system-mediated issues such as irritable bowel syndrome. Treatments targeted at calming the nervous system are recommended. Mindfulness and meditation are conservative approaches, and certain medications may be suggested by your medical provider.
Allergy Type
These individuals often suffer from a history of allergies such as chronic rhinitis, skin sensitivities, food allergies, and allergy-induced asthma. Histamine and mast cell-mediated issues may be a significant contributor to symptoms. Antihistamines are often beneficial in treatment as well as addressing the systemic allergy causes while making dietary changes to minimize histamine-rich floods.
Pelvic Floor Driven
This type is characterized by tight and tender pelvic floor muscles. Treating the pelvic floor muscles and the causes behind the pelvic floor tightness is paramount for symptom resolution.
Primary Storage Symptoms
Bladder distention during bladder filling can cause these symptoms with the patient often feeling the need to empty the bladder frequently for symptom reduction. Certain medications including Botox can offer relief. Pelvic floor therapy can be helpful as bladder training can be utilized in addition to treating any contributing pelvic floor dysfunction to help with symptom reduction.
Urethral Pain
This type is characterized more by urethral pain rather than bladder pain. There is often a pelvic floor component as well as the possibility of hormonal and nervous system dysregulation.
Sexual Pain and Flares are the last two phenotypes, and both are not entirely different from the other phenotypes.
Helpful website: https://www.ic-network.com/
Any questions? Brentwood Pelvic Health would love to hear from you.
*Blog content is for informational purposes only and is not considered medical advice
