Advances in Diagnosis and Treatment of Interstitial Cystitis/Painful Bladder Syndrome
Pelvic Floor Physical Therapy
On examination, many IC/BPS patients display tension and tenderness of the pelvic floor musculature and other somatic tissues [40]. Frequently found abnormalities include myofascial trigger points defined as taut bands or tender nodules created by injury at the motor end plate as a result of acute, repetitive, or continuous muscle overloading [41]. It is not known whether these musculoskeletal abnormalities are a consequence of lower urinary tract symptoms or are a primary disorder that gives rise to secondary urinary symptoms [42]. However, the evidence suggests that myofascial physical therapy (PT) techniques can significantly relieve the symptoms of IC/BPS when musculoskeletal abnormalities exist [42–44, 45]. Weiss reported 83 % of IC/BPS patients had marked improvement or complete resolution of pelvic pain after undergoing 8–12 weeks of manual pelvic floor PT [43].
Additionally, these patients had a 65 % reduction in mean resting pelvic floor pressure on electromyography. A recent prospective randomized multicenter trial showed that a significantly higher proportion of IC/BPS patients who underwent ten sessions of myofascial PT responded to treatment than IC/ BPS patients that underwent a full-body Western massage (59 vs. 26 %; p=0.0012) [45]. Pain was the most common adverse event reported in the trial, with similar rates in both groups, but no serious adverse events were reported [45]. Pelvic floor PT, a relatively non-invasive treatment shown to help a substantial portion of IC/BPS patients, is an early intervention according to the recent AUA guidelines [6].
