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
References
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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