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Deborah Howell (Host): Welcome, if you’re living with somebody who’s coping with painful bladder syndrome, you know that it’s no fun at all, but could these symptoms actually be interstitial cystitis? My guest today is Erika McCombs, a physical therapy at the Pelvic Health and Wellness Center at Deaconess the Women’s Hospital. Erika, before we begin, tell us a bit about the partnership between the Pelvic Health and Wellness Center and Deaconess Hospital if you would.

Erika McCombs (Guest): So the Pelvic Health and Wellness Center is located on the campus of the Women’s Hospital. We were established under the direction of some of the gynecologists at the women’s hospital in order to treat pelvic conditions, pain with intercourse, incontinence, prolapse, and even pregnancy related pains and postpartum conditions.

Host: Got it, and now what is interstitial cystitis?

Erika: Interstitial cystitis can be called painful bladder syndrome. It’s an inflammation of the bladder that can be characterized by urinary frequency, urinary urgency, pain in the abdominal area. Patients with interstitial cystitis can also have pain with intercourse or even constipation.

Host: Doesn’t sound like a whole lot of fun. Now is it true that interstitial cystitis is often underdiagnosed or misdiagnosed as a bladder infection?

Erika: That is very true because the main complaints with interstitial cystitis are urinary frequency and urinary urgency, it is very common for a patient to be diagnosed multiple times with a urinary tract infection when in fact that is not what’s going on at all. It’s difficult to diagnose interstitial cystitis because the symptoms mimic symptoms that can be another diagnosis such as a urinary tract infection or even endometriosis. There can be multiple symptoms that overlap, and so then therefore the diagnosis can take time to get there and can be misdiagnosed.

Host: And what do you mean by underdiagnosed?

Erika: The condition can be underdiagnosed because of the symptoms that it promotes and so sometimes patients are diagnosed with other things, whereas the inflammation of the bladder is really the driving force behind the patient’s pains of urinary frequency, urinary urgency, and even pain.

Host: How does one go about diagnosing interstitial cystitis?

Erika: Sometimes the diagnosis of interstitial cystitis is based on ruling out other conditions. So if a urinalysis is negative or there is no endometriosis or no other condition can be attributed to interstitial cystitis, then the diagnosis is made in that respect; however, there can be a process called a cystoscopy that can be done by a urologist and a cystoscopy is when there is a small scope that is inserted and starts to look at the bladder, and based on what the cystoscopy shows as far as inflammation or even ulcers in the bladder, then a definite diagnosis of interstitial cystitis can be made.

Host: Okay Erika, now let’s say we’ve gotten to the diagnosis and the patient does have interstitial cystitis, what are some of the treatment options?

Erika: One of the most important things that a patient can do that has been diagnosed with interstitial cystitis is to make some diet modifications. There are certain things that we could eat or drink on a regular basis that can promote more inflammation of the bladder. Some of those things include caffeine, carbonation, artificial sweeteners, even spicy or citrus foods. So if we decrease the consumption of those things, then the bladder can calm down and it’s not as inflamed or irritated. At the pelvic health and wellness center, we offer a couple of options that can provide patients with relief from their symptoms of interstitial cystitis. Our nurse practioner can prescribe medications to help with pain control and inflammation control. Our procedure nurses can also perform bladder instillations where medication is put into the bladder directly to decrease inflammation and pain, and then physical therapy. Physical therapy can be used for patients that have interstitial cystitis in order to address some pelvic floor muscle dysfunction that may be there.

Host: That’s interesting. I hadn’t heard that. I’m assuming you’re doing crunches or you’re doing some core work?

Erika: So there’s a group of muscles in the pelvis called your pelvic floor muscles, and the pelvic floor muscles span from hip to hip and then they also come from the pubic bone and then wrap around to the tailbone, and if those muscles are inflamed secondarily because of interstitial cystitis and there can be tightness and restriction in those pelvic floor muscles, and so we actually don’t do crunches and sit ups and a lot of contractions. We actually work on pelvic floor relaxation. We work on stretching of the muscles in the pelvic area, not only on the outside of the pelvis, but also those internal pelvic floor muscles, and we can even do manual therapy techniques to promote relaxation to those pelvic floor muscles.

Host: When you say manual, are you talking like massage?

Erika: There are manual techniques including myofascial releases and trigger point releases that we can utilize to the pelvic floor muscles to promote relaxation, to promote blood flow to those muscles, and in doing so it helps to promote relaxation and decrease pain.

Host: And I suppose better sleep as well?

Erika: Exactly, if the patient has tightness in those pelvic floor muscles, finding a comfortable sleeping position may be challenging, plus if a patient has pain related to interstitial cystitis then sleep may be difficult. So relaxing the tension in those muscles can allow a patient to not only have better sleep, it can allow them to have less constipation. It can allow them to engage in intercourse without pain.

Host: What would you say to a person who was just diagnosed with interstitial cystitis?

Erika: If I am treating a patient that has just been diagnosed with interstitial cystitis, one of the first things that we address is diet and making sure that the patient is drinking plenty of water, that they’re staying hydrated and that they’re eliminating any irritants to the bladder such as caffeine, carbonation, artificial sweeteners, and even citrus and acidic foods and after we’ve established an improved diet I order to decrease the inflammation of the bladder, then we start talking about some pelvic floor relaxation techniques. As a physical therapist my job is to assess and treat muscle function and the resting state of that muscle, and so if a muscle is tight and restricted, that’s going to promote more pain. So we start talking about pelvic floor relaxation techniques, breathing techniques, to improve the ability for those muscles to relax and to minimize the effects of the interstitial cystitis.

Host: Well this has all been excellent information Erika and I thank you so much for being with us today to talk about painful bladder syndrome and interstitial cystitis. It is wonderful what you can do for patients at the Pelvic Health and Wellness Center. I know I learned a whole lot from you. Thank you so much for being on the show.

Erika: Thank you for having me.

Host: This is Deaconess the Women’s Hospital, a place for all your life. For more info or scheduling, please visit deaconess.com/pelvichealth or call 812-858-5950. This is Deborah Howell, thanks for listening and have yourself a great day.