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The Facts

Interstitial Cystitis/Painful Bladder Syndrome affects millions of people in the United States. To diagnose this condition, medical professionals rule out other causes of symptoms, such as infections. Only a small percentage of patients with IC/PBS have specific bladder lesions called Hunner’s Lesions, which are detected through cystoscopy. Most patients experience symptoms from other underlying causes like pelvic floor dysfunction, hormonal deficiencies, or central nervous system dysregulation. For the majority of individuals, the diagnosis is based solely on reported symptoms.

Symptoms

  • Urinary urgency, frequency, and pain in the absence of infection
  • Lower abdominal pressure
  • Pain upon bladder filling or emptying
  • Painful sex
  • Painful orgasm
  • Generalized pelvic pain
  • Nocturia (waking at night to urinate)
Interstitial Cystitis Symptoms

Symptoms

  • Urinary urgency, frequency, and pain in the absence of infection
  • Lower abdominal pressure
  • Pain upon bladder filling or emptying
  • Painful sex
  • Painful orgasm
  • Generalized pelvic pain
  • Nocturia (waking at night to urinate)
Interstitial Cystitis Symptoms

Many individuals discover their symptoms only when they come across our website, blog, or social media. Some have a diagnosis but lack a local pelvic floor physical therapist. Others may already have a therapist but feel stuck or are not improving. Some seek opinions from other trusted experts, and in uncertain times, some prefer not to leave their homes. Whatever your needs, we’re here and ready to assist!

Our team members specializing in pelvic floor disorders offer a range of expertise. Whether you prefer in-person or virtual appointments, we are ready to assist you. Please be aware that virtual visits require advance payment and are non-refundable.

Associated Diagnoses

IC/PBS, a chronic overlapping pain condition (COPC), commonly coexists with other conditions such as Vulvodynia, Endometriosis, Fibromyalgia, TMJ, and migraines. Fortunately, pelvic floor physical therapy offers effective relief for all these conditions by addressing pelvic floor dysfunction.

Causes of IC

Causes of IC/PBS

  • Pelvic floor dysfunction
  • Hormonal deficiencies
  • Central Nervous Dysfunction
  • Repetitive Urinary Tract Infections
  • Orthopedic injuries/trauma
  • Surgical trauma
  • Endometriosis
  • GI dysregulation
Causes of IC

Causes of IC/PBS

  • Pelvic floor dysfunction
  • Hormonal deficiencies
  • Central Nervous Dysfunction
  • Repetitive Urinary Tract Infections
  • Orthopedic injuries/trauma
  • Surgical trauma
  • Endometriosis
  • GI dysregulation

Diagnostic Challenges

IC/PBS and its subtypes are well-understood by many experts. It is important to note that IC/PBS is not a bladder disease, but rather a syndrome that can be effectively managed through interdisciplinary care. However, it is concerning that most urologists in the US have not received proper training in pelvic pain syndromes like IC/PBS, leading to misdiagnosis and inadequate treatment. To address this issue, the American Urologic Association has recently updated their guidelines in 2022, recommending manual pelvic floor physical therapy for individuals who meet the diagnostic criteria for IC/PBS.

Diagnostic Challenges

Treatment:

How we can help you

pelvic pain rehab

If you’re experiencing sexual function issues, it’s important to see a therapist for pelvic floor therapy. Before coming in, you can always take advantage of Telehealth through technologies, such as computers and mobile devices, to access healthcare services remotely and manage your health care. This approach allows patients to receive care and consultation from the comfort of their homes. After a virtual consultation, you can then follow whatever the health professional suggests. When you are advised to go to a clinic, they will evaluate your pelvic floor to determine if it’s contributing to your symptoms. The physical therapist will discuss your medical history, previous diagnoses, and treatments you’ve tried, as well as their effectiveness. We understand what you’re going through and many people come to us feeling frustrated.

Our physical therapist will thoroughly evaluate your nerves, muscles, joints, tissues, and movement patterns during the examination. Once the assessment is complete, the therapist will discuss the results with you. Through this evaluation, we aim to diagnose the source of your symptoms and establish both short-term and long-term therapy goals. Typically, physical therapy treatments occur once or twice a week for about 12 weeks. Your therapist will work with other members of your treatment team to ensure a coordinated recovery plan. They will provide you with exercises to do at home and guide you through in-person sessions. Our goal is to help you improve and live your best life.

For more information about IC/PBS please check out our IC/PBS Resource List.

pelvic pain rehab

Treatment:

How We Can Help You

Frequently Asked Questions

What is Interstitial Cystitis (IC)?

Interstitial Cystitis (IC) is a condition marked by certain symptoms. These symptoms include urinary urgency, frequent urination, difficulty starting urination, and ongoing bladder pressure or pain. Importantly, these symptoms persist for at least a few weeks, and there is no evidence of infection or disease.

Is a cystoscopy needed to diagnose IC?

While a cystoscopy can verify the existence of Hunner’s Ulcers, it is not necessary or advised for diagnosing Interstitial Cystitis.

What are common symptoms of Interstitial Cystitis?

Urinary urgency, frequency, hesitancy, pain upon bladder filling, urethral and/or lower abdominal pain, and/or painful sex.

What are recommended treatments for people with IC?

Interstitial Cystitis (IC) can occur for various reasons, and suggested treatments encompass pelvic floor physical therapy, oral medications, and specific procedures tailored to address the root cause of an individual’s symptoms.

How common is it for people with IC to also have pelvic floor dysfunction?

Research conducted in the US and around the world consistently reveals that a staggering 92% of individuals with IC/Painful Bladder Syndrome experience pelvic floor dysfunction. This prevalence is so significant that the American Urologic Association has recognized pelvic floor dysfunction as a leading cause of these symptoms.

How common is it for people with IC to have vulvodynia?

Many individuals with bothersome bladder symptoms may also encounter pain during sex and vulvar discomfort. Unfortunately, depending on whether they consult a gynecologist or a urologist, they might receive a diagnosis of vulvodynia or IC/PBS. It’s crucial to recognize that most physicians lack specific training in these diagnoses, causing confusion among patients about their actual condition. The terms “vulvodynia” and “IC/PBS” describe the pain but don’t explain the underlying reasons for the symptoms. It’s important to identify the root cause of the pain rather than just labeling it. Collaborative efforts involving medical and physical therapy providers can help individuals comprehend the reasons behind their pain and formulate an effective treatment plan.

Are there exercises that can make IC symptoms worse?

Exercising the wrong muscles can worsen symptoms for people with tight pelvic floor muscles. Avoid activities like kegel exercises, “clam shells,” sit-ups, and lunges/squats with heavy weights.

Are there exercises that can make IC symptoms better?

Diaphragmatic breathing is a powerful technique to relax the nervous system and potentially alleviate symptoms. In pelvic floor physical therapy, personalized home exercises are provided to target the patient’s unique needs.

What are different causes of IC?

Many people experience IC symptoms even after clearing a UTI. Hormonal imbalances, caused by contraceptive pills, certain acne medications, breastfeeding, or menopause, can also lead to symptoms. Sedentary or athletic activities can cause pelvic floor dysfunction. Some individuals with sensitivities in their central nervous system may develop IC and widespread body pain. IC is often seen in conjunction with vulvodynia, endometriosis, and fibromyalgia. Identifying the underlying causes is a key aspect of pelvic floor physical therapy.

Do all physical therapists know how to treat IC?

No. Physical therapy and medical school education often lack comprehensive information on pelvic pain syndromes like IC/PBS, despite the significant number of people affected by these conditions. While some physical therapists can specialize in pelvic floor dysfunction through post-graduate education, it’s essential to note that not all pelvic floor therapists receive specific training in pelvic pain syndromes, such as IC/PBS.

What does a PT evaluation for IC entail?

A pelvic floor physical therapy examination is a comprehensive process that includes taking a detailed history, conducting both external and internal manual evaluations, and assessing neuromuscular control and biomechanics. Subsequently, we communicate our findings with the patients, forming an assessment. This assessment encompasses short-term goals aimed at alleviating the causes of symptoms and long-term goals focused on restoring normal function and improving the overall quality of life. The frequency and duration of pelvic floor physical therapy can vary based on the specifics of each case.

How many physical therapy visits does it typically take for people with IC to feel better?

The number of physical therapy visits required for individuals with IC to experience improvement varies depending on the severity and chronicity of their symptoms. Typically, most people seeking therapy have been dealing with symptoms for at least six months, and in many cases, symptoms have persisted for years before seeking help. As a general practice, individuals usually attend physical therapy for at least two months, with sessions scheduled once per week. However, the specific timeframe for noticeable improvement can differ for each individual.

Why didn’t my doctor tell me about pelvic floor physical therapy?

Regrettably, most US physicians lack knowledge about pelvic floor dysfunction, resulting in their limited understanding of pelvic floor physical therapy as the main treatment for IC.

Can menopause cause IC?

Hormonal deficiencies can lead to bothersome bladder symptoms and a higher likelihood of recurring urinary tract infections. As a result, menopause and a diagnosis of interstitial cystitis (IC) may be given to the same individual. The most effective approach to treatment will involve hormone therapy and pelvic floor physical therapy.

Can birth control pills cause IC?

Yes. Birth control pills can potentially lead to hormonal imbalances, contributing to irritative bladder symptoms, vulvar pain, and recurrent urinary tract infections (UTIs) in some individuals.

What are IC subtypes?

The American Urologic Association (AUA) updated their guidelines in 2022 to change how Interstitial Cystitis/ Painful Bladder Syndrome (IC/PBS) is classified. It is no longer considered just a bladder disease, but rather a syndrome with different subtypes.
Less than 10% of people with IC symptoms have Hunner’s Ulcers, which are lesions on the bladder lining. Another group experiences pelvic-floor related issues as the cause of their pain. A third group reports more widespread body pain, with some symptoms occurring outside of the bladder.
To determine if pelvic floor dysfunction is contributing to their symptoms, individuals are advised to undergo a pelvic floor physical therapy evaluation. If pelvic floor dysfunction is identified, the AUA recommends including manual pelvic floor physical therapy in the treatment plan.

Is it normal to flare after pelvic floor physical therapy?

Manual therapy might induce soreness for up to 72 hours post-treatment, but it should not worsen the underlying symptoms. Nonetheless, individuals with IC/PBS often have sensitized nervous systems and may react more intensely to physical therapy and home exercises. If such reactions occur frequently, combining medical management with pelvic floor physical therapy can be beneficial.

Do I need a physician’s prescription to come to physical therapy?

In many states, Direct Access laws allow individuals to initiate physical therapy without a doctor’s prescription. However, certain states and insurance providers may necessitate physician approval for the treatment plan to extend beyond a specific number of sessions. You can also consult a medical professional through telehealth or virtual consultation for convenience.