Bladder Pain Bladder Syndrome is a chronic disabling condition that mainly affects women. It is also commonly called Interstitial Cystitis.
Symptoms of Bladder Pain Syndrome may include:
· Bladder Pain
· Urinary urgency/frequency
· Nocturia (waking up several times at night to void)
· Burning with urination
· Suprapubic pain
Other symptoms can include:
· Low back pain
· Pain with intercourse
· Hip, groin, or tailbone pain
· Difficulty starting/maintaining urine stream
Pelvic floor physiotherapy is the most proven treatment for Bladder Pain Syndrome.
Physiotherapy is recommended as first line treatment and is the only therapy given grade ‘A’ by the American Urological Association.
Goal of Physiotherapy
The muscles of the pelvic floor are often tight in patients with Bladder Pain Syndrome. This can cause trigger points to develop in these muscles.
Trigger points, muscle tightness, and inflammation can combine to irritate the nerves that run through the pelvis, that can cause pain in the pelvis and surrounding areas.
Physiotherapy can help restore tight muscles and trigger points to normal.
One of the biggest myths of Bladder Pain Syndrome is that it is exclusively a bladder condition. Fewer than 10% of patients have confirmed damage to the lining of the bladder (known as Hunner’s lesions).
Some symptoms of Bladder Pain Syndrome can be caused by either the bladder or pelvic floor (or a combination of both). Others may be exclusively due to the pelvic floor.
Even patients who have surgery to remove the bladder may still report the same symptoms persist after the procedure (this surgery is now recommended only as a last resort).
What to Expect from Pelvic Floor Physiotherapy
Initial one hour appointment.
This is to allow time to address the complexity of your condition. Follow up appointments will be 30 to 45 minutes long.
Both internal and external physio.
Physiotherapy shoulder focus on big external muscles of the pelvis (abdominals, hamstrings, gluts, hips and low back) and the smaller internal muscles of the pelvic floor. Your physio be finding and resolving issues in each of these muscles.
No pelvic floor exercises and no 'kegels'.
Traditional pelvic floor exercises or squeezes should not be performed. If these muscles are already tight, the goal is to relax these muscles, not further irritate and shorten them. Strengthening exercises may be appropriate later in treatment symptoms when symptoms have settled.
Physiotherapy should not cause pain or a flare up in your pain. You may feel some discomfort with initial treatment but in general this should be tolerated comfortably. Symptoms may occasionally increase for a short time, or you may be a little sore after treatment, but physiotherapy should not increase your symptoms.
Manual, hands-on therapy should be the gold standard of Bladder Pain Syndrome.
Just as Bladder Pain Syndrome is not just about the bladder, pelvic physiotherapy should not be solely about the pelvic floor – the entire pelvic and abdominal area needs to be addressed and treated.
Patients should start to see a significant change or initial improvement within the first 3 physiotherapy visits.