“It’s like having the worst urine infection, but all the time. I can’t work, I can’t sleep, my relationship is suffering because its too painful to have sex so I don’t want him near me, and I feel ratty all the time. I’m not being a good mum, I shout at the kids. I’ve had enough.”
I first came across Bladder Pain Syndrome (previously known as Interstitial Cystitis) 8 years ago when one woman’s story really hit home. A young mum, always well dressed with her hair done who’d stopped working as her trips to the toilet every 15 minutes were annoying her boss, and her work colleagues laughed and made jokes about her bladder. It was initially something she handled well, but as she tried to hold off from going to the toilet her symptoms worsened and she retreated inside herself. Medications didn’t help the pain and quickly her world became smaller and smaller.
Her bladder was ruling her life and she was miserable. She was at the end of her tether and I was her last hope.
As I puzzled over the complex nature of her symptoms and started to tease out some improvements, I was utterly hooked. Ever since then I’ve been refining my treatment, learning more about the condition and reflecting on what more I can do as a Physio to help. Bladder Pain Syndrome is a painfully debilitating and thoroughly embarrassing condition where people experience pain when their bladder fills, they feel like they constantly need to go, have to rush to the toilet often and may not make it on time – wetting themselves at work, in the street, in the car. The bladder pain is eased temporarily with emptying the bladder, but often means that sufferers spend their lives on the toilet, looking for the toilet or in constant discomfort or pain.
During my career I’ve been drawn toward the treatment of pelvic pain – releasing pain and coaching someone back to the life they’ve wanted is just the best job in the world. When I completed my Masters I decided to focus on bladder pain syndrome. Through my work it’s a condition I’ve been so profoundly inspired to understand more deeply and I really wanted to do my bit to add to the medical knowledge. It’s an exciting time for the field with so many researchers trying to figure out the mechanisms which bring about bladder dysfunctions and pain. A large part of that is multidisciplinary working – doctors, physios and nurses working together with and alongside a patient to find what’s right for them. We’re getting into the age of individual and holistic treatment (in the true sense of the word not the industry it’s been attributed to), and that’s exciting.
We know that physio helps Bladder Pain Syndrome. I know first-hand how much of a difference it can make to lives – the doctor able to drink wine for the first time in years, a lady who managed to get pregnant after years of no intercourse due to the pain, the hundreds of men and women I’ve seen who are back in control of their bladder and able to work, socialise, exercise, wear normal clothes… not just black trousers!
For my masters research I focussed on if using a therapeutic wand in women with Bladder Pain Syndrome could potentially help manage symptoms. This is a curved plastic stick used inside the vagina to relax the pelvic floor muscles – there’s a few out there and for my trial I used the TheraWand Essential. This is something we regularly prescribe for both men and women to use to help them to manage their symptoms, but there isn’t that much evidence supporting its use – not that it doesn’t work, just we don’t have a large body of evidence in this area to draw upon. Yet. My experience tells me this can really help to reduce the urge to go to the toilet and with pain, so this warranted rigorous scientific investigation. I’ll be blogging more about this soon, but wanted to share this with you now as the pilot article will be out in a few weeks!
The efficacy of a therapeutic wand in addition to physiotherapy for treating bladder pain syndrome in women: a pilot randomised controlled trial
Bond, J, Pape, H, Ayre, C
To assess the feasibility of a randomised controlled trial investigating the use of a therapeutic wand (TW) for pelvic floor muscle (PFM) treatment in women with bladder pain syndrome (BPS).
Prolonged PFM tension contributes to bladder pain, urinary frequency and urgency in BPS. Pelvic health physiotherapists routinely provide intravaginal myofascial release to the PFM to effectively reduce symptoms. Rapid access to physiotherapy during symptom flares is effective but difficult to obtain. A TW was designed for men with chronic pelvic pain to self-treat and may be effective in women with BPS.
For six weeks two groups received weekly physiotherapist-provided MFR and were monitored for a further six-week follow-up period. One group also used a TW at home three times per week throughout. Weekly outcome measures of BPS symptoms and quality of life were recorded.
A clinically meaningful difference in ICSI and ICPI score change between groups was recorded at six weeks (control group 4.25 +0.95, 3.5 +1.91, TW group 6.2 +0.83 and 5 +1.41) and a difference observed during the follow-up period (control group 4.5 +1.73 and 4 +2.44, TW group 8 +2.12 and 7 +1.87). There were no adverse events.
Using the TW appears to have enhanced physiotherapy treatment during the initial six weeks and improved symptoms during the six-week follow-up period. The TW may be a clinically useful tool for long-term BPS management. Feasibility of the study method was proven with some recommended alterations and an RCT is now warranted.
Watch this space!