By Stephanie Prendergast, MPT, PHRC Pasadena
Here at PHRC we help people recover from irritative bladder symptoms with pelvic floor physical and occupational therapy. Bladder symptoms plague millions of people on a daily basis and anyone suffering can explain how much the symptoms compromise their quality of life. Multiple terms and diagnoses have been used to describe bladder symptoms which has led to inconsistencies and diagnosis and treatment challenges amongst clinicians, researchers, and patients. The diagnosis of “Interstitial Cystitis/Painful Bladder Syndrome” (IC/PBS) is a common pelvic pain diagnosis, yet the medical community continues to struggle with terminology and treatment guidelines. One main reason is that there are various phenotypes of the disorder and each subset comes with different treatment considerations. The American Urological Association’s (updated) 2022 IC/PBS Guidelines have deemed the diagnosis one of exclusion and recommend pelvic floor manual treatment as treatment given the majority of patients also have pelvic floor pain.
If a majority subset of patients with IC/PBS have pelvic floor dysfunction it begs the question is the bladder the victim or the cause of symptoms? If we can better define WHY someone has bladder symptoms we can better help them recover. In this post we are excited to share new research from our colleagues at UCLA helping to better define and treat these symptoms!
Lower Urinary Tract Symptoms and Myofascial Pelvic Floor Dysfunction
A recent study published in Scientific Reports introduces a novel condition termed Myofascial Urinary Frequency Syndrome (MUFS), which affects approximately one-third of individuals experiencing urinary frequency. MUFS is characterized by a persistent sensation of needing to urinate, regardless of actual urine volume—a symptom the researchers refer to as “persistency.” This sensation is accompanied by signs of myofascial pelvic floor dysfunction, including pelvic floor muscle hypertonicity and tenderness.
The Presence of “Persistency”
The study involved a comprehensive examination of patients presenting with urinary frequency. Findings revealed that 97% of MUFS patients exhibited pelvic floor hypertonicity with either global tenderness or myofascial trigger points, and 92% displayed evidence of impaired muscular relaxation. These symptoms are hallmarks of myofascial dysfunction. To confirm the association between these symptoms and pelvic floor musculature, the researchers assessed 68 patients with established pelvic floor myofascial dysfunction through comprehensive examination and electromyography. The presence of “persistency” was confirmed in these patients, and improvement was observed with pelvic floor myofascial release therapy.
Importantly, MUFS presents a distinct symptom complex that differentiates it from other lower urinary tract conditions such as Overactive Bladder (OAB) and Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS). This distinction is crucial for accurate diagnosis and effective treatment, as traditional therapies for OAB and IC/BPS may not address the underlying myofascial dysfunction present in MUFS patients.
The identification of MUFS underscores the importance of considering myofascial pelvic floor dysfunction in patients with urinary frequency. It also highlights the need for targeted therapeutic approaches, such as pelvic floor myofascial release, to alleviate symptoms and improve quality of life for those affected by this condition.
Why we are so excited about this…
The diagnoses IC/PBS and OAB describe symptoms without stating a cause. This emerging research confirms that for some patients the origin of the symptoms is the musculoskeletal system and pelvic floor therapy can help! Most people go right to the doctor when bladder symptoms arise, once infections are ruled out pelvic floor therapy should be the next stop!
But the good news does not stop there. The same group of researchers took things a step further by validating a questionnaire that can help clinicians and patients identify who can benefit from myofascial pelvic therapy.
Explaining the Persistency Index
A recent study published in the American Journal of Obstetrics and Gynecology introduces the Persistency Index, a novel screening tool designed to identify myofascial pelvic floor dysfunction (MPFD) in patients experiencing lower urinary tract symptoms (LUTS). MPFD is a condition characterized by hypertonicity and tenderness of the pelvic floor muscles, often leading to urinary frequency and urgency.
The Persistency Index focuses on the symptom of “persistency,” defined as a continuous sensation of needing to urinate regardless of actual urine volume. This symptom is a hallmark of MPFD and distinguishes it from other conditions like overactive bladder or interstitial cystitis.
In the study, researchers evaluated patients with LUTS using the Persistency Index and found a significant correlation between high scores and the presence of MPFD. This suggests that the Persistency Index can serve as an effective screening tool, enabling healthcare providers to identify MPFD more accurately and tailor treatment plans accordingly.
The development of the Persistency Index represents a significant advancement in the assessment of pelvic floor disorders. By facilitating early and accurate identification of MPFD, this tool has the potential to improve patient outcomes through targeted therapeutic interventions.
Why this is so helpful…
People treating patients with bladder symptoms know very well some people have pain with their symptoms and others are more plagued with urgency and frequency without pain. By improving symptom classification we can offer more accurate therapies. For example, if someone does not have irritation of the bladder lining itself but rather pelvic floor dysfunction, this person should benefit from pelvic floor therapy and would likely not respond to procedures such as bladder installations. If someone has bladder pain from multiple UTIs and the bladder lining is irritated they may be a good candidate for an installation over physical therapy.
Conclusion
These recent diagnostic and treatment advances are helping people get to the right place for help. We are grateful to the authors for their work and for supporting myofascial pelvic floor therapy as a treatment option for patients!
Resources
Interstitial Cystitis/Bladder Pain Syndrome: Diagnosis and Subtypes
Working on mind over bladder? Urine good company
How to find informed medical providers
International Pelvic Pain Society Find a Provider
American Physical Therapy Association’s Section on Women’s Health PT Locator
Herman and Wallace Find a Provider
Pelvic Guru Provider Directory
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Check out our recently published e-book titled “Vulvodynia, Vestibulodynia, and Vaginismus,” designed to empower and inform individuals on their journey towards healing and understanding.
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tags: pelvic floor muscle dysfunction, urinary tract symptoms associated, pelvic floor myofascial release