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Interstitial Cystitis and Pelvic Floor Dysfunction

Instructor: Kaitlin Baker

Kaitlin has taught nursing students and has a master's degree in nursing leaderhsip, as well as a bachelor's degree in English literature.

This lesson will discuss the connection between interstitial cystitis (IC) and pelvic floor dysfunction (PFD). We will describe and discuss symptoms of and treatments for both conditions, as well as their similarities and differences.

Interstitial Cystitis: Painful Bladder Syndrome

Have you ever had a urinary tract infection (UTI)? If you have, then you are familiar with the pain that increases as your bladder fills, the hurt that continues when you urinate, and the urgent need to void (urinate) that only finds relief for a minute before you feel like you need to go to the bathroom again. However, with a UTI your doctor will have you urinate in a cup, go home with an antibiotic, and back to normal in a few days.

Interstitial cystitis (IC) is a condition with symptoms similar to those of a UTI: dysuria (pain with urination), urinary urgency (feeling of having to void right away), urinary frequency (having to void often), nocturia (voiding throughout the night), and/or only voiding small amounts at a time. But, the pain is much more debilitating and long-lasting. The American Urological Association defines IC as ''an unpleasant sensation (pain, pressure, discomfort)…related to the urinary bladder…of more than 6 weeks' duration'' when there is not infection at fault. IC is also called Painful Bladder Syndrome.

The exact causes of IC are not known with certainty, but it is possible that IC patients have a leak in the lining of the bladder that allows toxic substances to irritate it. Another possibility is allergic reaction, chronic infection, or allergy in the bladder.

What is the Pelvic Floor?

Before we go into how IC relates to the pelvic floor, we first must establish what the pelvic floor is! The pelvic floor can be pictured as a hammock. It rests inside the pelvis, and is made up of muscles attaching to the pelvic bone and sacrum (large bone just above the tailbone). The pelvic floor, like a hammock, supports your internal organs, including the bladder, uterus or prostate, rectum, and vagina. The muscles have many jobs: they contract when you walk, relax during sexual intercourse, bowel movements or urination, and their movements are ideally very coordinated.

The pelvic floor muscles

What is Pelvic Floor Dysfunction?

In some cases, the pelvic floor muscles do not function correctly; this is called pelvic floor dysfunction. The symptoms of this condition are similar to those of IC and include:

  • Urinary frequency, urgency, or pain
  • Incomplete bladder emptying
  • Constipation pain with bowel movements
  • Pain in the lower back, pelvis, rectum, urethra, or genitals that can't be explained by another cause
  • Pain during or after a pelvic exam or sexual intercourse
  • Muscle spasms

Connection between IC and PFD

You now know that both disorders (IC and PFD) can involve the pelvic area. Many studies have looked into the connection between these problems. Several possibilities have been suggested:

  • Problems with the pelvic floor muscles can mimic urinary problems. In other words, it can look like IC, but really be PFD.
  • Long-lasting problems with IC can lead to PFD. If you have problems urinating due to IC, you may feel the need to push or bear down during voiding, or have painful intercourse. These can cause the pelvic floor muscles to inappropriately contract, leading to PFD.
  • PFD is a subtype of IC.
  • They are two separate conditions that commonly occur together. Often, patients have both conditions.

IC and PFD: Differences

While the two conditions are certainly connected and the symptoms overlap to an extent, there are some differences.

On the one hand, IC patients have a poor flow rate of urine (the stream is weak or slow), nocturia, and symptoms that are often affected by diet (citrus, caffeine, tomatoes, and chocolate).

On the other hand, PFD patients may have urinary symptoms, but the flow rate of urine is often normal. Also, they rarely have nocturia, and diet is less likely to worsen symptoms.

In IC, the pelvic floor muscles may be either too tight or too weak. In PFD, the muscles are nearly always too tight.

Diet (coffee, tomatoes, citrus) may aggravate IC symptoms, but seldom worsen PFD.

Treatment for IC and PFD

Treatment for both conditions aims to relax and void stress to tight pelvic floor muscles. This may involve a combination of self-care, medications, physical therapy (PT) and home exercises.

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