Pelvic Floor Dysfunction
The single greatest change in interstitial cystitis treatment in the past decade is the integration of pelvic floor assessments and treatments in most interstitial cystitis clinics. Why?? It appears that the great majority of IC patients have or are experiencing pelvic floor muscle tension to the point that it interferes with urination and/or creates pain and discomfort.
The pelvic floor is composed of an overlapping series of muscles which form a sling or funnel that holds the pelvic organs in place. Frequently, these muscles can be strained by childbirth, bicycle riding, accidents and even ballet, thus creating either painfully tight trigger points or weak, unsupportive muscles.
For IC patients, the health of the pelvic floor muscles merit a second glance particularly if they haven't been active for a period of time due to pain or frequency. Just the inactivity of an IC patient in a flare could lead to poor muscle tone.
Signs of muscle weakness may be:
- an uncomfortable feeling of pressure or heaviness
- leaking of urine when coughing, laughing, running or doing exercise,
- bulding of the bladder into the vagina (cystoscele)
- bulging of the rectum into the vagina (rectocele)
- the dropping of the uterus into the vagina.
The Pelvic Floor Assessment
If you are interested in learning more about your pelvic floor, your first goal is to obtain a pelvic floor assessment by a physician or physical therapist who is familiar with the latest in pelvic floor theories. Generally, the examination is done both externally and internally. The therapist may do an examination of the abdominal and perineal muscles to locate tender muscle areas. For women, a vaginal exam will allow the therapist to palpate the various internal pelvic floor muscles. Men will have their pelvic floor assessed through a simple rectal exam.
Pelvic Floor Treatments
A proactive approach to maintaining pelvic floor health is a vital tool in an IC patient treatment arsenal and can prevent future bladder problems (i.e. stress incontinence, leakage) from developing. If your care provider finds that you have muscle problems, there are two common approaches to pelvic floor treatment: (1) myofascial release and (2) biofeedback
Myofascial release is used to directly massage and reduce any myofascial trigger points (muscle knots) found. It may take several (many) sessions of physical therapy to reduce the tension in those muscle areas. In some cases, doctors may inject a local anesthetic directly into the muscle knot to relieve and reduce pain. Remember, muscle knots are tender. This therapy may be initially uncomfortable. Heat or ice may help reduce symptoms. If they are uncomfortable, talk with your care provider about how you can reduce your symptoms.
Biofeedback involves the use of a small machine and a wand, gently inserted in the vagina. It measures muscle tone and offers a pitched, audible sound to help patients relax the proper muscle areas. This can eventually be done at home, after proper training.
Does pelvic floor therapy cure IC?
No. Pelvic therapy is not a complete cure for IC, but it can dramatically reduce symptoms for patients who are experiencing muscle pain. It can also facilitate good muscle health and tone for men and women as they get older.
The ICN has had several guest presenters who have discussed and/or advocated pelvic floor therapies, including:
- Rodney Anderson, MD- Stanford University
- Jerome Weiss, MD - Pacific Center for Pelvic Pain
- David Kaufman, MD - Central Park Urology, NYC
- Rhonda Kotarinos, PT
