Current Urology Reports

, Volume 7, Issue 6, pp 450–455 | Cite as

Frequency, urgency, and pelvic pain: Treating the pelvic floor versus the epithelium

Article

Abstract

For years the bladder epithelium has been the focus for diagnosing and treating the frequency, urgency, and pelvic pain of interstitial cystitis. However, many patients have not found symptom relief with these therapies. Pelvic floor dysfunction is often present in these patients, yet it is often untreated. Pelvic floor dysfunction may be related to abuse, past surgeries, or other causes. It is important to look outside of the bladder and explore other causes and treatments for this condition. Pelvic floor therapies should be a first line of treatment for those women with chronic pelvic pain related to pelvic floor dysfunction.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Propert KJ, Schaeffer J, Brensinger CM, et al.: A prospective study of interstitial cystitis: results of longitudinal follow-up of the interstitial cystitis data base cohort. J Urol 2000, 163:1434–1439.PubMedCrossRefGoogle Scholar
  2. 2.
    Hunner GL: A rare type of bladder ulcer in women: report of cases. Boston Med Surg J 2000, 172:660–664.Google Scholar
  3. 3.
    Tissot WD, Diokno AC, Peters KM: A referral center’s experience with transitional cell carcinoma misdiagnosed as interstitial cystitis. J Urol 2004, 172:478–480.PubMedCrossRefGoogle Scholar
  4. 4.
    Anderson RU: Traditional therapy for chronic pelvic pain does not work: what do we do now? Nat Clin Pract Urol 2006, 3:145–156. CPPS is being treated with therapies that are less than efficacious. There seems to be an imbalance of somatic and smooth muscles of the pelvis in CPPS, and studies are needed to explore alternative therapies.PubMedCrossRefGoogle Scholar
  5. 5.
    Bernstein IT: The pelvic floor muscles. Neurourol Urodyn 1997, 16:240–243.CrossRefGoogle Scholar
  6. 6.
    Strohbehn K: Urogynecology and pelvic floor dysfunction. Obstet Gynecol Clin North Am 1998, 25:691–693.CrossRefGoogle Scholar
  7. 7.
    DeLancey JOL, Delmas V: Gross anatomy and functional anatomy of the pelvic floor. In Pelvic Floor Disorders. Edited by Bourcier AP, McGuire EJ, Abrams P. Philadelphia: Elsevier Saunders; 2004:3–4.Google Scholar
  8. 8.
    Butrick C: Interstitial cystitis and chronic pelvic pain: new insights in neuropathology, diagnosis, and treatment. Clin Obstet Gynecol 2003, 46:811–823.PubMedCrossRefGoogle Scholar
  9. 9.
    Pezzone MA, Liang R, Fraser MO: A model of neural crosstalk and irritation in the pelvis: implications for the overlap of chronic pelvic pain disorders. Gastroenterology 2005, 128:1953–1964. Bidirectional cross-sensitization of the colon and lower urinary tract may play a role in chronic pelvic pain disorders. One irritated pelvic organ may upregulate other nearby afferent nerves, affecting other pelvic organs.PubMedCrossRefGoogle Scholar
  10. 10.
    Ratner V, Slade D, Greene G: Interstitial cystitis. A patient’s perspective. Urol Clin North Am 1994, 21:1–5.PubMedGoogle Scholar
  11. 11.
    Slade D, Ratner V, Chalker R: A collaborative approach to managing interstitial cystitis. Urology 1997, 49(Suppl 5A):10–13.PubMedCrossRefGoogle Scholar
  12. 12.
    Slade DKA: Interstitial cystitis: a challenge to urology. Urol Nurs 1989, 9:5–7.PubMedGoogle Scholar
  13. 13.
    Myers DL, Aguilar VC: Gynecologic manifestations of interstitial cystitis. Clin Obstet Gynecol 2002, 45:233–241.PubMedCrossRefGoogle Scholar
  14. 14.
    Devroede G: Early life abuses in the past history of patients with gastrointestinal tract and pelvic floor disorders. Prog Brain Res 2000, 122:131–155.PubMedCrossRefGoogle Scholar
  15. 15.
    US Dept Health and Human Services, Administration for Children & Families, National Clearinghouse on Child Abuse and Neglect 2004. http://www.acf.hhs.gov/programs/ cb/stats_research/index.htm. Accessed July 10, 2006.Google Scholar
  16. 16.
    Silverman JG, Raj A, Mucci LA, Hathaway JE: Dating violence against adolescent girls and associated substance use, unhealthy weight control, sexual risk behavior, pregnancy, and suicidality. JAMA 2001, 286:572–579.PubMedCrossRefGoogle Scholar
  17. 17.
    Gorey K, Leslie D: The prevalence of child sexual abuse: integrative review adjustment for potential response and measurement bias. Child Abuse Negl 1997, 21:391–398.PubMedCrossRefGoogle Scholar
  18. 18.
    The Commonwealth Fund: Health Concerns Across a Woman’s Lifespan: 1998 Survey of Women’s Health. New York, May 1999. http://www.cmwf.org/publications/publications_ show.htm?doc_id=221554. Accessed July 10, 2006.Google Scholar
  19. 19.
    Seng JS, Graham-Bermann SA, Clark MK, et al.: Posttraumatic stress disorder and physical comorbidity among female children and adolescents: results from service-use data. Pediatrics 2005, 116:767–776.CrossRefGoogle Scholar
  20. 20.
    Haefner HK, Collins ME, Davis GD, et al.: The vulvodynia guideline. J Low Genit Tract Dis 2005, 9:40–51.PubMedCrossRefGoogle Scholar
  21. 21.
    Oyama IA, Rejba A, Lukban JC, et al.: Modified Thiele massage as therapeutic intervention for female patients with interstitial cystitis and high-tone pelvic floor dysfunction. Urology 2004, 64:862–865. Thiele massage significantly improved bladder symptoms in IC patients with pelvic floor dysfunction.PubMedCrossRefGoogle Scholar
  22. 22.
    Rosamilia A: Painful bladder syndrome/interstitial cystitis. Best Pract Res Clin Obstet Gynaecol 2005, 19:843–859.PubMedCrossRefGoogle Scholar
  23. 23.
    Weiss J: Pelvic floor myofascial trigger points: manual therapy for interstitial cystitis and the urgency-frequency syndrome. J Urol 2001, 166:2226–2231.PubMedCrossRefGoogle Scholar
  24. 24.
    Anderson RU, Wise D, Sawyer T, Chan C: Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men. J Urol 2005, 174:155–160.PubMedCrossRefGoogle Scholar
  25. 25.
    Heah SM, Ho YH, Tan M, et al.: Biofeedback is effective treatment for levator ani syndrome. Dis Colon Rectum 1997, 40:187–189.PubMedCrossRefGoogle Scholar
  26. 26.
    Hull TL, Milsom JW, Church J, et al.: Electrogalvanic stimulation for levator syndrome: how effective is it in the long term? Dis Colon Rectum 1993, 36:731–733.PubMedCrossRefGoogle Scholar
  27. 27.
    Fall M, Carlsson CA, Erlandson BE: Electrical stimulation in interstitial cystitis. J Urol 1980, 123:192–195.PubMedGoogle Scholar
  28. 28.
    Maher CF, Carey MP, Dwyer PL, Schluter PL: Percutaneous sacral nerve root neuromodulation for intractable interstitial cystitis. J Urol 2001, 165:884–886.PubMedCrossRefGoogle Scholar
  29. 29.
    Zermann DH, Weirich T, Wunderlich H, et al.: Sacral nerve stimulation for pain relief in interstitial cystitis. Urol Int 2000, 65:120–121.PubMedCrossRefGoogle Scholar
  30. 30.
    Chai TC, Zhang C, Warren JW, Keay S: Percutaneous sacral third nerve rood neurostimulation improves symptoms and normalizes urinary HB-EGF levels and antiproliferative activity in patients with interstitial cystitis. Urology 2000, 55:643–646.PubMedCrossRefGoogle Scholar
  31. 31.
    Peters KM, Carey JM, Konstandt DB: Sacral neuromodulation for the treatment of interstitial cystitis: outcomes based on technique. Int Urogynecol J Pelvic Floor Dysfunct 2003, 14:223–228.PubMedCrossRefGoogle Scholar
  32. 32.
    Comiter CV: Sacral neuromodulation for the symptomatic treatment of refractory interstitial cystitis: a prospective study. J Urol 2003, 169:139–1373.CrossRefGoogle Scholar
  33. 33.
    Peters KM, Konstandt D: Sacral neuromodulation decreases narcotic requirements in refractory interstitial cystitis. BJU Int 2004, 93:777–779.PubMedCrossRefGoogle Scholar
  34. 34.
    van Balken MR, Vandoninck V, Gisolf K, et al.: Posterior tibial nervestimulation as neuromodulative treatment of lower urinary tract dysfunction. J Urol 2001, 166:914–918.PubMedCrossRefGoogle Scholar
  35. 35.
    Jarvis SK, Abbott JA, Lenart MB, et al.: Pilot study of botulinum toxin type A in the treatment of chronic pelvic pain associated with spasm of the levator ani muscles. Aust NZJ Obstet Gynaecol 2004, 44:46–50. Botulinum toxin type A was effective in decreasing chronic pelvic pain when injected into the pelvic floor muscles of 12 women. Quality of life was also improved.CrossRefGoogle Scholar
  36. 36.
    Thomson AJ, Jarvis SK, Lenart M, et al.: The use of botulinum toxin type A (Botox®) as treatment for intractable chronic pelvic pain associated with spasm of the levator ani muscles. BJOG 2005, 112:247–249.PubMedCrossRefGoogle Scholar
  37. 37.
    Gajraj NM: Botulinum toxin a injection of the obturator internus muscle for chronic perineal pain. J Pain 2005, 6:333–337.PubMedCrossRefGoogle Scholar
  38. 38.
    Schaeffer AJ: Etiology and management of chronic pelvic pain syndrome in men. Urology 2004, 63(Suppl 3A):75–84.PubMedCrossRefGoogle Scholar
  39. 39.
    Nickel JC, Johnston B, Downey J, et al.: Pentosan polysulfate therapy for chronic nonbacterial prostatitis (chronic pelvic pain syndrome category IIIA): a prospective multicenter clinical trial. Urology 2000, 56:413–417.PubMedCrossRefGoogle Scholar
  40. 40.
    Sant GR, Theoharides TC: Interstitial cystitis. Curr Opin Urol 1999, 9:297–302.PubMedCrossRefGoogle Scholar
  41. 41.
    Novicki DE, Larson TR, Swanson SK: Interstitial cystitis in men. Urology 1998, 52:621–624.PubMedCrossRefGoogle Scholar
  42. 42.
    Berger RE, Miller JE, Rothman I, et al.: Bladder petechiae after cystoscopy and hydrodistension in men diagnosed with prostate pain. J Urol 2001, 159:83–85.CrossRefGoogle Scholar

Copyright information

© Current Science Inc 2006

Authors and Affiliations

  1. 1.Royal OakUSA

Personalised recommendations