Study: Physical Therapy for IC/PBS

A recent well designed study indicates that myofascial physical therapy can be helpful in people suffering from interstitial cystitis / painful bladder syndrome (IC/PBS).

 

Nuts and bolts of the study

 

• A randomized controlled trial of 10 scheduled treatments of myofascial physical therapy (MTP) vs global therapeutic massage (GTM)  was performed at 11 clinical centers in North America.
• Women recruited were diagnosed with interstitial cystitis/painful bladder syndrome with demonstrable pelvic floor tenderness on physical examination and a limitation of no more than 3 years’ symptom duration.
• The primary outcome was the proportion of responders defined as moderately improved or markedly improved in overall symptoms compared to baseline on a 7-point global response assessment scale.
• Secondary outcomes included ratings for pain, urgency and frequency, the O’Leary-Sant IC Symptom and Problem Index, and reports of adverse events.
• The global response assessment response rate was 26% in the global therapeutic massage group and 59% in the myofascial physical therapy group (p = 0.0012 – indicating positive statistical significance in science jargon)
• Pain, urgency and frequency ratings, and O’Leary-Sant IC Symptom and Problem Index decreased in both groups during follow-up, and were not significantly different between the groups.
• 62% (50 of 81) of participants reported at least 1 adverse event – most commonly pain  – classified as mild in 12% (10 of 81), moderate in 35% (28 of 81) or severe in 15% (12 of 81).
• After the initial 12 weeks of treatment there was a decrease in follow-up of 30 (77%) of the 39 patients assigned to MPT and on 28 (67%) of the 42 assigned to GTM.
• Of the 30 patients initially treated with MPT 4 (13%) had elected to continue with MPT during the 3-month follow-up. Of the 28 patients initially treated with GTM 8 (29%) had elected to receive MPT during the 3-month followup.
• At the end of the follow-up phase the final outcome of interest (GRA) was completed by just 11 of 42 (26%) in the GTM group and 23 of 39 (59%) in the MPT group. Therefore, we are unable to draw any conclusions about the durability of treatment outcomes in either group.
• Pain was the most common adverse event, occurring at similar rates in both groups.

My take on this:

This study had numerous strengths as discussed in the journal article: it was prospective (as opposed to retrospective – less valid), multicenter, randomized design with a standardized protocol for pelvic floor MPT and a positive control.

Monotherapy, that is, the use of one therapeutic approach for treatment of a disease or physical symptom does not bring a cure for IC/PBS patients. Each therapy, whether it is MTP or other, is one piece of the puzzle.

There is four areas that work synergistically which will get you closer to a cure in my experience: physical medicine, diet and nutrition, healing the gut and psychological treatment. All are very important – the psychological aspect may be even more crucial.

 

1. Physical medicine. It is unquestionably important to treat IC/PBS with some form of physical medicine with either MTP, acupuncture or both if myofascial disorders are found. Specialized physical therapy, like MTP, is the better-researched treatment and brings about 30 to 50% short-term relief  (1 to 3 months approximately) in my experience.  Research suggest that acupuncture brings about relief as well.  In numerous randomized trials, acupuncture has shown efficacy for pelvic pain related to prostatitis (Lee et al. 2011). There is much overlap in symptoms of patients with prostatitis and IC/ PBS.

2. Dietary approach.  Not all foods proposed to increase IC symptoms are problematic in my experience. Tea, coffee, wine, soda, citrus foods and tomatoes are most important to limit or eliminate.  I find the biggest food culprit is wheat and gluten products – not typically known as a problem food for IC.  If the patients does not address the psychological aspect of IC then eating becomes aguishly difficult – the enjoyment of eating diminishes and a subconscious neurosis with food develops. This is not fun.

3. Treat the gut. Most IC/PBS have GI problems: excess, gas, bloating, constipation, indigestion,etc. Eliminating food allergens, consumption of probotics, fish oils and maybe digestive enzymes before a meal can be helpful.

4. Psychological approach. No you are no crazy but you know stress makes symptoms worse. Moreover, a past stressor, a relationship breakup, sudden death of a love one, loss of a job, etc may actually have contributed to the cause of your IC/PBS symptoms. While some people develop chronic migraines, back pain or neck pain when stressed, you develop pelvic pain and urinary dysfunction.  Everyone has their thing, IC /PBS is yours.

A good psychotherapist is of absolute importance. Don’t get me wrong, you are not making up your symptoms up (it’s not in your head), the pain and urinary problems are real but the initial trigger is deeply imbedded in your subconscious mind. Your job is to define what that is and resolve it. Acceptance or forgiveness may do the trick if appropriate to you, I don’t know but try to figure it out.  The “over-the-hump” cure lies with resolving the subconscious initial trigger of the problem and managing daily stress more effectively.

 

Doggy bag message:

Relief from IC / PBS is journey. Mainstream medicine is of little help at this point and most urologist do not want to treat IC patients, unfortunately – MORE ON THIS HERE. There are a few who are experts in the area: Drs. Robert Moldwin, Philip Hanno, Elizabet Kavaler, just to name a few.   MTP, acupuncture, biofeedback are all  very helpful and important. As is proper nutrition and healing the gut.  Cure, ultimately comes from properly addressing the psychological triggers  you may not have connected your symptoms with and stress management.  Once psychogenic aspects are addressed, “problem foods” become less of a problem and your digestive issues resolve as well. It is all connected.

 

Good luck with your journey. Let me know how you do.

 

Reference:

IC-network: http://www.ic-network.com/

Fitzgerald MP et al.Randomized multicenter clinical trial of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome and pelvic floor tenderness. J Urol. 2012 Jun;187(6):2113-8.

Lee SH, Lee BC. Use of acupuncture as a treatment method for chronic prostatitis/chronic pelvic pain syndromes. Curr Urol Rep. 2011 Aug;12(4):288-96.