Do you have vulvar pain in addition to your IC?
How about a history of endometriosis?
Struggling with tight pelvic floor muscles?
You are certainly not alone. We’ve long known that there was a connection between IC and other conditions of the pelvis. Researchers in Italy gathered the essential incidence data demonstrating that a diagnosis of IC/BPS is complex, encouraging physicians to assess for other common pelvic pain conditions, such as endometriosis, vulvodynia and a tight pelvic floor. There is a growing movement to label IC not just a “Chronic pelvic pain syndrome (CPPS)”.. but also a “Complex abdominal & pelvic pain syndrome (CAPPS)”
Clearly, the wise patient will make sure that doctors check for other, related conditions which could mimic bladder symptoms. At a minimum, the following questions are worth asking:
PELVIC FLOOR (Men & Women)– Are the pelvic floor muscles tight? Is sex uncomfortable? Does the patient feel that something is dropping or falling out of their pelvis or feel as if a foreign object is stuck inside their vagina or bladder? Does movement provoke symptoms? A simple pelvic floor assessment should be done during the initial doctors visit, either by a urologist, ob-gyn or physical therapist to determine if the pelvic floor muscles are tight, weak or compromised in some way. Learn more about pelvic floor dysfunction here.
VULVA (Women) – If any pain is “external” rather than “internal”, particular on the vulva or entrance to the urethra, the physician should look at the quality and health of the skin. Is it dry and/or showing signs of atrophy? Does the patient have pain when the vestibular glands are lightly touched? Learn more about vulvodynia here!
ENDOMETRIOSIS (Women) – Does the patient have a history of painful, irregular periods? Do they bleed heavily? Are their flares and/or symptoms driven by hormone changes? An endometriosis assessment, perhaps via sonogram, can help determine if endometrial adhesions could be contributing to or influencing bladder symptoms. Learn more about endometriosis here!
BOWEL (Men & Women) – Researchers have shown that when the bowel is irritated, the bladder may also show signs of irritation and vice versa. Thus, it’s worth asking if the bowel a source of discomfort. Does the patient struggle with irritable bowel symptoms, such as chronic diarrhea, constipation or both? Is the rectum sensitive? Patients have long reported that constipation triggers bladder discomfort, thus treating it essential.
PUDENDAL NEURALGIA (Men & Women) – Are symptoms positional? Do they get worse while sitting or laying down, rather than standing? Does movement (i.e. walking, bending over, etc.) provoke symptoms? Is the pain electrical, sharp or shoot down the leg? Does the patient have a painful arousal sensation? If so, then a nerve may be compromised or compressed, perhaps by tight muscles. Learn more about pudendal neuralgia here!
As the 2011 AUA Diagnostic & Treatment Guidelines suggest, if a patient is not improving using the classic bladder symptoms, it’s important to revisit the diagnosis to ensure that another condition isn’t, perhaps, contributing to their pain. Make sense?
Jill H. Osborne, ICN President & Founder