Monday, February 17, 2020

Interstitial Cystitis Part IV

Treatment Modalities: Yoga
Due to the fact that IC is a disorder oftentimes associated with poor musculoskeletal, neural and myofascial function of the back and/or pelvis, yoga has been shown to be an effective tool in the amelioration of IC symptoms as well as the accompanying psychological challenges.34 It has been suggested that programs formulated to sustain balance of the main contributing muscles which affect the pelvic structure and lower back should be used in IC patients to help with symptom management.34
In a small randomized controlled trial of 20 women, researchers looked at the use of mindfulness-based stress reduction (MBSR), combining the modalities of meditation and yoga, and its effect on IC.35 Researchers stated that because stress exacerbates the symptoms of IC significantly, this treatment method is highly warranted due to its strong stress-reducing effects.35 Women in the study were divided into two groups, one receiving usual care (UC) and the other receiving UC as well as engaging in MBSR.35 Though the MBSR group did not exceed symptom amelioration on all measures when compared to the UC group, significant improvement was seen in the women engaged in MBSR.35 More MBSR patients reported post-treatment symptom improvement when compared to the UC group (87.5% of MBSR group versus 36.4% of UC group).35 Though some of the MBSR group improvement was not statistically significant, it still provides insight into the therapy method and its potential effect on IC.35 Researchers concluded that the results of this study provide evidence to reinforce the role of MBSR as a significantly useful tool for the treatment of IC and should be incorporated into the care plan of IC patients.35 Limitations presented by small sample size should also be taken into consideration.
Though not specifically referring to IC, the results of a meta-analysis may shed light on the possibility of the benefit of using yoga for IC patients.36 Though small, the study further supports the use of yoga in those who suffer from prolonged pain.36 Researchers concluded that the use of yoga as a complementary approach for those suffering from pain is a useful tool that produces moderate effect sizes on pain-ridden individuals.36 This finding can indirectly be applied to the possibility of yoga providing similar benefit to those suffering from the pain associated with IC.36
Treatment Modalities: Physical Therapy
Physical therapy (PT) has been used to treat IC patients and shown benefit.26 PT for IC patients frequently centers around soft tissue manipulation and rehabilitation that can help facilitate scar reduction and pain improvement.26 Exercises oftentimes focus on pelvic floor relaxation rather than strengthening pelvic floor muscles.26
In a randomized, multicenter clinical trial of 81 women suffering from IC, researchers looked at the benefit of myofascial physical therapy (MPT) when compared to global therapeutic massage (BTM).37 Though results displayed superior benefit of the MPT when compared to the GTM (59% improvement in the MPT group versus 26% in the GTM group), both categories experienced amelioration of some symptoms.37 In addition, the sample size was small, thus presenting the need for caution in regard to drawing broad conclusions.37
A pilot study of 16 female IC-diagnosed patients who suffered from high-tone pelvic floor dysfunction were monitored following manual PT.38 Therapy included several techniques including direct myofascial release, joint mobilization, muscle energy techniques, strengthening, stretching, and neuromuscular reeducation.38 Patients were tested for symptoms before and after treatment to determine levels of improvement.38 Greatest improvement was seen in frequency of pain and suprapubic pain, while improvement in urgency and nocturia showed smaller changes.38 Researchers concluded that manual PT may be a positive therapeutic tool in the treatment of IC.38
Forty-five women and seven men with IC or urgency-frequency syndrome were followed in a study to determine the effects of manual PT on the symptoms of these disorders.39 Researchers stated that, “The rationale was based on the hypothesis that pelvic floor myofascial trigger points are not only a source of pain and voiding symptoms, but also a trigger for neurogenic bladder inflammation via antidromic reflexes”, thus attempting to reach a deeper part of the problem.39 PT centered around the pelvic floor and was conducted one to two times per week for eight to twelve weeks.39 Results demonstrated that the specific manual PT employed was highly effective in symptom amelioration for both groups of patients.39
Treatment Modalities: Acupuncture
Acupuncture has long been known for its beneficial effect on pain. A study involving a small sample of IC-diagnosed female patients examined the usefulness of acupuncture on symptom reduction.40 All twelve participants received ten acupuncture administrations twice a week and evaluations of symptoms were completed in the 1st, 3rd, 6th and 12th months.40 Results showed a statistically significant decrease in all measures in the first month.40 Improvement scores varied at different points in the study, with positive effect demonstrated in differing areas during all evaluations.40 Despite the small sample size, based upon the study results, researchers concluded that acupuncture displays a promising, non-invasive and efficacious treatment option for those suffering with IC.40
A systematic review of complementary therapies for bladder pain syndrome looked at 11 studies, all of which were evaluated for quality based on the Cochrane risk of bias scale prior to their inclusion.41 Several key interventions were discussed amongst the studies including acupuncture, relaxation therapy, physical therapy, hydrogen-rich therapy, diet and nitric oxide synthetase.41 Following careful evaluation, researchers concluded that dietary management, acupuncture and physical therapy had the highest potential for providing benefit to patients with bladder pain syndrome.41 Researchers advised caution in regard to these results due to the limited study sizes included in the review.41

34. Ripoll E, Mahowald D. Hatha Yoga therapy management of urologic disorders. World Journal of Urology. 2002; 20: 306–309.
35. Kanter G, Komesu YM, Qaedan F, et al. Mindfulness-based stress reduction as a novel treatment for interstitial cystitis/bladder pain syndrome: a randomized controlled trial. International Urogynecology Journal. 2016; 27(11): 1705-1711. 
36. Büssing A, Ostermann T, Lüdtke R, Michalsen A. Effects of yoga interventions on pain and pain-associated disability: a meta-analysis. Translational Andrology and Urology. 2015 4(6); 653-661. 
37. FitzGerald M, Payne C, Lukacz E, et al. Randomized multicenter clinical trial of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome (IC/PBS) and pelvic floor tenderness. The Journal of Urology. 2012; 187(6): 2113-2118. 
38. Lukban J1, Whitmore K, Kellogg-Spadt S, Bologna R, Lesher A, Fletcher E. The effect of manual physical therapy in patients diagnosed with interstitial cystitis, high-tone pelvic floor dysfunction, and sacroiliac dysfunction. Urology. 2001; 57(6)(1): 121-122.
39. Weiss JM. Pelvic floor myofascial trigger points: manual therapy for interstitial cystitis and the urgency-frequency syndrome. The Journal of Urology. 2001; 166(6): 2226-2231.
40. Sönmez MG1, Kozanhan B. Complete response to acupuncture therapy in female patients with refractory interstitial cystitis/bladder pain syndrome. Ginekologia Polska. 2017; 88(2): 61-67.
41. Verghese TS, Riordain RN, Champaneria R, Latthe PM. Complementary therapies for bladder pain syndrome: a systematic review. International Urogynecology Journal. 2016; 27: 1127-1136. 

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