Why Is My Bladder Hurting?
If you’re a typical IC patient, you have probably assumed that you were struggling with repetitive bladder infections. Maybe once or twice a year or maybe even monthly, some patients share that they’ve had these bladder episodes for years and were often treated with antibiotics. Now that your symptoms have worsened AND you’ve gotten back negative lab tests, you may have been diagnosed of interstitial cystitis or chronic non-bacterial prostatitis.
For over 100 years, IC was assumed to be a defect of the bladder lining. In 2017, we no longer consider IC is a bladder disease, but rather a syndrome that involves the bladder, the pelvic floor muscles, nerves and other structures in the pelvis.
How Does IC Begin
Think of IC more as an injury rather than an illness. Some patients symptoms begin after some type of trauma to the bladder, such as chemotherapy, radiation. a bladder or urinary tract infection (UTI) or even a decade of drinking diet sodas, coffees. When the bladder lining is damaged, urine can penetrate deeply into the tissue where it causes irritation and inflammation and triggers the classic symptoms of frequency, urgency and pain.
Yet, other patients experience IC symptoms after an injury to their pelvic floor muscles. If you had a traumatic childbirth, experienced a pelvic floor muscle injury, had pelvic surgeries (i.e. hysterectomy, bladder suspension), have a history of athletics (i.e. bike riding, gymnastics, ice skating, etc.) and/or were a victim of sexual abuse, then your pelvic floor muscles may have been injured.
It is important that you understand that tight pelvic floor muscles can and do cause symptoms that you would normally associate with the bladder. If, for example, you have tight urethral sphincter muscles, you may experience urethral burning and irritation. If you have tight “x”, you may struggle with urinary urgency and/or frequency. Tight muscles can also make it difficult to start your urine stream, difficulty sitting or driving, and/or pain with or after sexual relations.
The exception to the “injury” theory are the 5 to 10% of patients who struggle with Hunner’s lesions. Considered the most severe form of IC, these patients have clear lesions (aka ulcers) on their bladder wall that cause the most severe symptoms and high levels of pain. In 2015, researchers in Europe made the discovery that patients with Hunner’s lesions have an active virus in their urine, known as the Polyoma BK virus. This virus is well known to cause hemorrhagic cystitis in patients struggling with autoimmune diseases. Most researchers now believe that Hunner’s lesions are a separate bladder disease that deserve their own research studies.
Stuck In A Vicious Cycle
Which comes first, the chicken or the egg? Well, in our case, it’s which comes first, the bladder, the pelvic floor or the nerves. The reality is that all are usually involved though one often drives the other two.
A painful bladder injury (i.e. a UTI) can cause a secondary effect – tight pelvic floor muscles. This is called the “guarding reflex” and is entirely subconscious. For these patients, the primary goal of therapy is to calm the bladder and create an environment for healing the bladder, knowing that as the bladder heals, the muscles should relax.
On the other hand, if symptoms began after a pelvic floor injury, those tight muscles may have reduced blood flow to the bladder and/or can be squeezing important nerves. In those cases, bladder therapies will not be directly beneficial until the tight muscles are treated to restore good blow flow levels. Physical therapy will be the primary treatment though some strategies to protect the bladder and calming nerves will be important.
The final piece of the puzzle are the nerves in the bladder and pelvis which, whether you have a bladder or pelvic floor injury, become irritated and sensitized. This is why patients should avoid caffeine products. We want to avoid anything that can further irritate nerves like caffeine.
Whether you’re newly diagnosed or a grizzled veteran, you must understand that the bladder, the muscles and the nerves are intricately connected and play important roles in IC and chronic pelvic pain.