Interstitial cystitis: Symptoms & Causes

Interstitial cystitis (IC)/ Painful Bladder Syndrome/ Chronic pelvic pain

IC/PBS is one of the many varieties of chronic pelvic pain (CPP) which is one of the most difficult and perplexing health conditions that has a major impact on health-related quality of life (Qol), work productivity and health care utilization. Living with CPP may lead to anxiety, depression, sexual dysfunction.

Symptoms:

Painful bladder syndrome (PBS)/interstitial cystitis (IC) is a condition characterized by pain over the lower abdomen with bladder filling and increased urge to urinate both during day and night. There is an urgency need to urinate frequently even when the bladder is not full and they pass only small quantities of urine after considerable difficulty to initiate and sustain the flow of urine. Usually, repeated urine examinations and cultures are negative. Sleep is majorly disturbed as the problems increase at night and keep them awake and many of them are unable to hold down a job because of this problem during travel and at work. Distress levels are very high in most patietns because they usually present long after the disease has set in. They are embarrassed by their condition and delay seeking help.
In spite of all the available treatments, most IC patients continue to have significant distress as indicated by the multiple suggested treatments with questionable results. This is mainly due to a basic lack of understanding about what causes the pain and how to tackle the symptoms which we have overcome at our clinic.
CPP may also be because of involvement of other systems as shown in table

Causes of Chronic Pelvic Pains

The system	Conditions that cause CPP
Urologic CPP	IC/PBS. Persistent urethritis
Gynaecological CPP	25% of routine gynecological office visits. Endometriosis, Post surgical pains after hysterectomy, caesarian section, pelvic inflammatory disease, ovarian cysts and other problems, uterine fibroids, tubal pathology (hydrosalpinx, pyosalpinx), adhesive disease, problems with pelvic blood vessels.
CPP from male reproductive system	Sterile epididymitis, chronic prostatitis, After surgery of varicocoele, hernia etc
Gastrointestinal CPP	Irritable bowel syndrome, inflammatory bowel disease, TB abdomen chronic appendicitis, rectal surgery (piles, fissure etc)
Neurologic CPP	Entrapment of pelvic nerves/irritations/ impingement, disc herniation, post herpetic neuralgia
Musculoskeletal CPP	Pelvic floor dysfunction, after surgery on urethra, anus etcFibromyalgia, abdominal wall myalgias, pelvic floor tension myalgias, sacroiliac joint dysfunction, symphysis pubis pain, coccydynia
Coccygodynia	After pelvic fractures, fracture of coccyx , malformed coccyx
Psychological	Anxiety/depression, somatization disorders, psychosexual dysfunction, sexual abuse, post-traumatic stress disorder

Our understanding of IC/PBS and other chronic pelvic pains:

We have developed a new understanding of what causes the problems of IC/PBS and have devloped specific and innovative treatments for the problems Subsequent use of these treatments in other patients with similar problems has helped several IC patietns to return to a normal professional and personal life in the last 1½ decades. Not only IC/PBS, but patients with CPP benefit from our novel approach. This is because all
CPPs suffer from 2 main issues

A nervous system which has been highly irritated by prolonged CPP/ IC
The genesis of the CPP starts with pelvic floor muscle dysfunction which causes
- urinary problems in PBS/IC,
- rectal anal problems in gastrointestional issues
- vaginal and other gynaecological issues if it is due to endometriosis or the various other causes of gynaecological CPP
- the musculoskeletal and neurological variants of CPP may or may not cause urological, vaginal or rectal issues but cause a perineal pain or coccygodynia like clinical picture.

We tackle the problem in two steps, we do a caudal catheter treatment where local anesthetic and steroid is put in the epidural space around the spina cord near the nerves that supply the pelvis. We then tackle the muscles using either BOTOX injection into the tight pelvic muscles or Ultrasound guided dry needling of the same muscles. This decision depends on the severity of muscle tightness.
Due to the incoordination between the bladder muscle and the pelvic floor there is obstruction which causes the patient to strain. This abnormal straining leads to abnormal pressures at the bottom of the. Unless this obstruction is released the difficulty in urination will never settle down. USGDN or botox injection into the pelvic floor relaxes the muscles so that it opens when the bladder contracts and the normal cocordination is restored. After our treatment, we observe that their pains are gone, the quality of life is majorly enhanced and they lead a normal presonal, professional and sexual life.
The understanding derived from IC/PBS patients applies to other CPPs as well be it rectal/anal dysfunction and pain, or vaginal pain, vaginismus etc.
Counselling, mindfulness practices and cognitive behavioural therapy(CBT) help a lot in bringing objectivity to the patietn outlook on their pain. In all these treatments, be it caudal catheter , USGDN/botox, physiotherapy and CBT active participation of the patient is vital. Negative attitudes towards the treatment, the doctor or about themselves, their circumstances will all negate the treatment’s benefits.

So in summary there are useful effective treatments available at our clinic for CPP and they comprise