Painful bladder syndrome is just what it sounds like: an achy, urgent bladder that can feel like a constant urge to empty or severe pain just above the pubic bone by the bladder. PBS was previously known as IC or interstitial cystitis. However, the true diagnostic criteria for interstitial cystitis was the identification of bleeding lesions (Hunner’s ulcers) when doing an internal scope to see the inside of the bladder. Over time, the medical community has come to recognize a larger class of patients with the symptoms associated with IC, without the identifying lesions. For this reason, PBS is the preferred, newer terminology for this condition.
The American Urological Association released new guidelines and tiers of treatment which should be addressed in treating PBS. The treatments were divided into 4 tiers of treatment, with the intention to start with tier 1, moving towards tier 4 if not responsive.
First Tier:
1)”Patients should be educated about normal bladder function, what is known and not known about IC/BPS, the benefits vs. risks/burdens of the available treatment alternatives, the fact that no single treatment has been found effective for the majority of patients, and the fact that acceptable symptom control may require trials of multiple therapeutic options (including combination therapy) before it is achieved.” We will educate you on the latest research and give you realistic expectations of your recovery. No therapist has a 100% success rate with IC/PBS. It takes a team, but wellness IS possible.
2)”Self-care practices and behavioral modifications that can improve symptoms should be discussed and implemented as feasible.” We will help you come up with a home program that helps you stay your most functional, even with flares. As stated in #1 above, Treating IC is often a trial and error situation, as each case is very individual. We try every possible modality and approach with our patients, addressing one at a time to see which combination of modalities will leave our patients most able to lead a full life. We will work in tandem with your urologist.
3)”Patients should be encouraged to implement stress management practices to improve coping techniques and manage stress-induced symptom exacerbations.” We definitely have you covered here! Nari has actually created a meditation CD specifically for pelvic issues. We will work with you to find the right combination of techniques that work with your nervous system (and bladder!) to find the most effective use of your time. Infact, studies have shown that urgent bladder symptoms are present in around 1/3 of patients with generalized anxiety. The bladder and anxiety have a definite relationship, and we work with you to maximize your wellness. That’s not saying it is in your head. Far from it. But, working with your brain can helps us sneak in to quiet that pesky bladder.
Second Tier:
1) The second tier recommended by the AUA is physical therapy. We’ve got you covered in this aspect!
2) The second tier also includes pain-management and meds
The third tier includes cystoscopy and treatment for lesions (such as lasers and fulguration)
The fourth tier includes botox injections and electric stimulators
The fifth tier is cyclosporine, and the sixth tier is major surgery.
My point in all this is that the first and the majority of the second tier can be addressed in this practice. Yet, these are the aspects I find have not been adequately addressed in most patients coming into this practice. There is so much we can do to help in these first two tiers.
The specific manual techniques I know allow me to work on restrictions around the bladder itself, between the bladder and urethra, and also addressing the sequella of musculoskeletal findings that can contribute. If the bladder has impaired mobility or motility and is getting restricted, it will aggravate your sense of urge, and we can help with the connective tissues involved in this relationship.
In addition, diet can contribute. Treating IC is often a trial and error situation, as each case is very individual. We try every possible modality and approach with our patients, addressing one at a time to see which combination of modalities will leave our patients most able to lead a full life. We will work in tandem with your urologist.
Finally, there is more emerging research about other conditions that co-exist frequently with IC and may actually be causing some of your symptoms. We will ask your doctor to help screen for these if you fit the profile for the associated disorders.
We find that our patients have improved quality of life, less symptomatic days, and their function (ability to work, sleep, and play) is greatly increased. Let’s be clear: it is not an overnight process with IC, nor is the answer simply coming to appointments. It takes some time and trial and error. However, if you are committed, we are eager to be part of your wellness team.