Bladder Pain Syndrome (Interstitial Cystitis)

Bladder Pain Syndrome (Interstitial Cystitis)

Charlotte Conlon & Heidi Barlow are a Women’s Health Physiotherapists from Flow Physio Co Sutherland. Today they talks to us about Bladder Pain Syndrome (Interstitial Cystitis)

What is bladder pain syndrome?

The bladder is a pelvic organ that stores urine which is produced by the kidneys, until we decide to empty, the urine then travels down the urethra and is expelled from the body.

Interstitial cystitis is a condition causing bladder pressure, bladder pain and sometimes pelvic pain. Symptoms can vary from person to person and can range from mild to agonising. 


Common symptoms of interstitial cystitis 


• Pain in the bladder/abdomen when the bladder is filling up with urine. The kidney’s make urine constantly so they rarely get a break from pain, some may experience some temporary relief when they empty their bladder 


• Bladder urgency and frequency.  A person with a healthy bladder may urinate 7 times per day, in comparison to someone with bladder pain who may urinate in excess of 20 times day and night.

• Lower back and pelvic pain 


• Worsening of symptoms with menstruation 


• Pain with sexual intercourse 


• Ulcers/sore/bleeding in the bladder which sometimes can be seen in the urine 


• Lack of sleep to due increased urination over night 



Treatment options

• Lifestyle factors such as avoiding smoking and alcohol 


• Dietary factors such as avoiding caffeine, coffee, acidic and spicy foods 

• Managing constipation 


• Physiotherapy - Bladder pain syndrome is associated with an overactive tight pelvic floor, as the bladder fills the pelvic floor tightens and this can increase the severity of symptoms. Physio’s will perform internal and external releases of the pelvic floor and deep internal hip rotators and they can teach you how do do this. They will teach you bladder training and give you techniques to use to try and space out the time between urinating.


• Medication: Pain relief medication can help and your doctor may prescribe medication to help the bladder urgency and frequency


**There is currently no single treatment that has been found to be effective for majority of patients with bladder pain syndrome and to achieve symptom relief, many treatment options may need to be combined**

What is a pessary and how does it help treat pelvic organ prolapse?

Charlotte Conlon is a Women’s Health Physiotherapist from Flow Physio Co Sutherland. Today she talks to us about using pessaries in the management of pelvic organ prolapse

Pelvic Organ Prolapse

Pelvic organ prolapse is when one or more of the pelvic organs (bladder, uterus and bowel) slip down into the vagina causing a bulge or a heavy dragging feeling. Prolapse happens due to damage of the support structures of the pelvic floor including muscles, fascia or ligaments.

What is a pessary?

A pessary is the leading conservative treatment for pelvic organ prolapse.

A pessary is a silicone device that it inserted into the vagina to help support a pelvic organ prolapse .  A pessary can manage symptoms of a prolapse, these symptoms include a feeling of heaviness or dragging around the vagina a bulging around the vagina and incomplete emptying of your bladder or bowel.

A pessary can be very useful to help you continue  to be physically active and participate in chosen activities which may typically worsen a prolapse. A pessary can be worn all the time or it can be worn just when demands are hight i.e.: when running or jumping. 

What kind of pessary will I use?

Every womens body and prolapse is different therefore the type and size of pessary will vary immensely from women to women. The type and size will depend on the type of prolapse, the symptoms it causes and your anatomy. The pessary has to be fitted correctly and it may take several tries to get the right one. After the first fitting, you will need to be reviewed in 2 weeks to have the pessary checked. Follow up is needed every 3 months as sometimes a different size or shape of pessary will have to be fitted, as things may improve or change over time. 

What’s it like having a pessary? 

If you have a pessary that is the right size and in the right position, you won’t be able to feel it and you’ll be able to do all your normal activities. A pessary that is to small can fall out but it cannot end up anywhere else in your body. A pessary with is to big may cause rubbing and irritation. 

Does the pessary cause any side effects?

Pessary side effects are very low-risk they and you should tell your physiotherapist immediately if you have any discomfort, increased vaginal discharge or if you have trouble urinating or opening your bowels. An oestrogen cream and taking the pessary out daily or weekly may be needed to help prevent some of these side effects. 

How long will it take to fit a pessary?

A pessary fitting appointment will take 60 minutes and will include a full prolapse assessment. Measurements will be recorded for a baseline and follow-up appointments will compare these measurements to monitor changes over time. We will use a sterile pessary fitting kit to ensure we find the correct size as this may take a few attempts, once the size is decided you will then purchase that size. 

 

2019 Guidelines for Physical Activity in Pregnancy - Flow Physio Co Sutherland - Women's Health Physio

The 2019 Canadian Guideline for Physical Activity in Pregnancy  provide guidance for pregnant women, obstetric care and exercise professionals on prenatal exercise.

The guidelines provide evidence based recommendations regarding physical activity throughout pregnancy in the promotion of maternal, foetal and neonatal health. 

The Benefits of Being Active through Pregnancy

In the absence of contraindication, following these guidelines is associated with fewer newborn complications and maternal health benefits such as:

• Decreased risk of gestational diabetes and preecplamsia

• Less risk of Instrumented-assisted delivery; and

• Decreased risk urinary incontinence post birth

What is Recommended?

The guidelines make 4 strong recommendations and 2 weak recommendations:

1. All women without contraindications should be physically active throughout pregnancy (Strong recommendation, moderate-quality evidence)

2. Pregnant women should accumulate at least 150 of moderately intense physical activity each week to achieve clinically meaningful health benefits and reduction in pregnancy complications (Strong recommendation, moderate-quality evidence)

3. Physical activity should be accumulated over a minimum of 3 days per week, however being active everyday is encouraged (Strong recommendation, moderate-quality evidence)

4. Pregnant women should incorporate a variety of aerobic and resistance training activities to achieve greater benefits (Strong recommendation, high-quality evidence)

5. Pelvic floor muscle training may be performed on a daily basis to reduce the risk of urinary incontinence - instruction on proper technique is recommended (Weak recommendation, low-quality evidence)

6. Pregnant women who experience light-headedness, nausea or feel unwell when they exercise flat on their back should modify their exercise position to avoid the supine position (Weak recommendation, very-low quality evidence)

Enhancing maternal health and reducing pregnancy complications

In conclusion prenatal exercise should be therefore considered the front line therapy for reducing the risk of pregnancy complications and enhancing maternal physical and mental health. 

What should you do?

You should check with your obstetric care provider or Women’s Health Physio to make sure you don’t have any contraindications to exercise and enjoy the wonderful benefits of being active through pregnancy.

Source:

• 2019 Canadian Guidelines for Physical Activity in Pregnancy

Pelvic Floor Pain | Common but not NORMAL

Women’s Health Wednesday

Here is a great video below that talks about how pelvic floor health issues are common, but how they are not spoken about and are not normal. 

Let’s start talking about it, so we can lead happier and lives.

SOURCE

What is an over-active pelvic floor? Women's Health Wednesday

This week charlotte, our women's health physio in sutherland, explains AN OVER-ACTIVE PELVIC FLOOR?

Like any muscle in the body it is important that the pelvic floor can both contract and relax.

If you think of your bicep muscle this needs to be able to contract to pick something up and relax to put something down. Imagine if the bicep was contracted all day long, it would be really hard to use your arm functionally and your bicep muscle would not work efficiently. Especially when strength is needed, the pelvic floor is the same.

Some women have pelvic floor muscles which have difficulty relaxing and remain constantly contracted. This however does NOT mean they are strong, imagine how tired they would be when you need them! 

OVER-ACTIVE ≠ STRONG

What are the symptoms of an over-active pelvic floor?

Symptoms will vary from person to person, but often include:

• Pain with sex

• Pain with using tampons

• Pain with pap-smears

• Pelvic or back pain

• Difficulty emptying bladder or bowel (constipation)

• Incontinence

• Increased sensation of needing to urinate

Who is at risk of an over-active pelvic floor? 

People who tend to have a higher risk for an over-active pelvic floor include:

• People with an overactive bladder, this is due to always needing to squeeze their pelvic floor to minimise leaking

• Strong athletic women with strong outer core muscles

• People with anxiety

• Sedentary work/life style (poor posture can shorten the pelvic floor muscles)

• Mouth/chest breathers

What is the treatment for an over-active pelvic floor?

Our initial treatment will always look at the way you breathe!

If you imagine your core and trunk muscles as a box, your pelvic floor is the base of your core with your transverse abdominus being the walls and your diaphragm muscle (breathing muscle) being the ceiling.

It is really important that all aspects of your core are working efficiently. If you are always breathing through your mouth, with a chest pattern of breathing the pelvic floor does not have a chance to relax.

Diaphragmatic breathing or “belly” breathing is essential as this allows the pelvic floor to descend and relax. 

Can I still do pilates with an over-active pelvic floor?

Yes! However more focus should be on the strength of your muscles (not including your pelvic floor initially) therefore you should not actively contract your pelvic floor during initial pilates sessions. 

As symptoms decrease, we start to add in a graded strengthening program for you pelvic floor