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

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Gynecological disorders in bladder pain syndrome/interstitial cystitis patients.
Cervigni M, Natale F.
Int J Urol. 2014 Apr;21 Suppl 1:85-8. doi: 10.1111/iju.12379.

OBJECTIVES: Bladder pain syndrome/interstitial cystitis, a chronic inflammatory
condition of the bladder, is the source of pain in over 30% of female patients with chronic pelvic pain. The aim of the present study was to evaluate the most frequent associations between bladder pain syndrome/interstitial cystitis and gynecological disorders. METHODS: A literature review of the previous 10 years was carried out to evaluate the incidence of gynecological diseases in patients with bladder pain
syndrome/interstitial cystitis.


  • Hypertonic pelvic floor dysfunction with associated voiding dysfunction can be present in bladder pain syndrome/interstitial cystitis patients. It has been estimated that the prevalence ranges from 50% to 87%.
  • Endometriosis affects 1-7% of the general population and up to 70% of women with endometriosis have some type of pain symptoms, a recent systematic review estimated the prevalence of bladder pain syndrome to be 61%, of endometriosis to be 70%, and coexisting bladder pain syndrome and endometriosis to be 48%.
  • Vulvodynia is represented by pain, or an unpleasant altered sensation, in the vulva. Women with vestibulodynia are likely to have other additional pain conditions, such as fibromyalgia, irritable bowel syndrome or chronic fatigue syndrome. Recent data reported that vestibulodynia affects 25% of women with bladder pain syndrome/interstitial cystitis.

CONCLUSIONS: Bladder pain syndrome/interstitial cystitis is a complex pathology often associated with vulvodynia, endometriosis and pelvic floor dysfunctions. Therefore, it is of utmost importance to obtain an accurate evaluation ruling out confusable disease such as pudendal neuropathy. The optimal approach is a combined treatment oriented not only to treat the bladder, but also the other components responsible for the pain disorder.