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Best Practices for Treating Interstitial Cystitis

In 2022 the American Urological Association (AUA) released updated guidelines for clinicians regarding the diagnosis, management, and treatment of Interstitial Cystitis (IC)/bladder pain syndrome (IC). The guideline recommendations are based on best available evidence. 

Interstitial cystitis, also known as bladder pain syndrome is a condition that presents often with urinary frequency, urinary urgency, pressure or pain when the bladder fills with urine and some relief after urination, as well as painful urination or difficulty urinating. The symptoms mimic a urinary tract infection (UTI) but when the urine is cultured no infection is found. These symptoms can be incredibly frustrating, uncomfortable and disruptive.  

IC/BPS was historically thought to be caused by bladder inflammation or injury. We now understand that, except in the rare cases involving ulcers in the bladder known as Hunner’s Lesions, IC/BPS symptoms are likely caused by musculoskeletal (specifically pelvic floor muscle dysfunction) or nervous system dysfunction.

There are a myriad of available treatment options for IC/BPS. The AUA guidelines recommend a multimodal approach. Pharmacological, stress management, and physical therapy are all listed as recommended modalities. Physical therapy is the only intervention listed by the AUA that has earned an “A” grade – meaning it has the best evidence to support its efficacy.

Physical Therapy for IC/BPS will include 1) Education – regarding normal bladder function, treatment options, and prognosis 2) Self care and behavioral modifications 3) Stress management and coping techniques 4) Manual therapy techniques/biofeedback/exercises.

If you believe you may have IC/BPS you should start with a good urology/urogynecology appointment to check for any other reason you may be having your symptoms – including an infection. If all tests come back normal then ask your doctor for a recommendation and a prescription for pelvic floor physical therapy and search for one here: www.pelvicrehab.com. You can also provide your doctor with the most updated AUA guidelines here if they are suggesting other medication or procedure options before trying pelvic floor PT. Here are the guidelines for your reference. 

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