Recently, our clinic has seen a large number of patients with chronic interstitial cystitis that has not been cured. These patients have slowly developed progressive pelvic floor pain, which can be manifested in a variety of ways, including intermittent or persistent pain in the perineal region of the pelvic floor, muscle cramps, difficulty urinating, stubborn frequency of urination, a feeling of incomplete urination, straining to pass stool, lumbosacral discomfort, and even discomfort in both lower limbs. In women, vaginal pain can be experienced, and in severe cases, it can affect sexual function and prevent the completion of intercourse. Patients may experience slight relief through sitz baths, local compressions, and hot compresses, but the symptoms recur and get progressively worse, seriously affecting the patient’s quality of life, so I think it is necessary to explain the characteristics and treatment strategies of this syndrome to everyone here.
Interstitial cystitis, chronic prostatitis or prostatodynia are all chronic inflammatory diseases of the pelvic organs in their essence. If prolonged, it causes a change in the nature of the cells of the dorsal horn of the spinal cord, which, through complex neurophysiological changes, causes hypertonic dysfunction of the pelvic floor muscles and subsequently causes the various symptoms mentioned above.
The first step in the treatment strategy is still the active treatment of the primary cause – that is, the treatment of interstitial cystitis. However, all current oral medications, bladder irrigation medications, intervene against the chronic inflammation of the bladder mucosa. These treatments are not effective for pelvic floor pain if the patient is already experiencing it! If one wants to address pelvic floor spasm or pain, one has to consider pelvic floor electrical stimulation or bladder pacemaker treatment. The mechanism of action of both is to regulate the afferent nerves associated with the pelvic floor and pelvic organs through electrical stimulation of different nature, thus achieving the purpose of regulating functional disorders, but the therapeutic effect of pelvic floor electrical stimulation is significantly slower than that of pacemaker treatment, and the effect maintenance time is also short. Personally, I suggest that pelvic floor stimulation should be done at least 20-40 times before the effect can be slowly achieved. If the effect is not good, further pacemaker intervention can be considered. However, for patients with severe pelvic floor pain at the first visit, it is not recommended to try the pelvic floor stimulation – pacemaker sequence, because the efficiency of pelvic floor stimulation is very low in patients with very severe pelvic floor pain.
In general: interstitial cystitis combined with pelvic floor pain requires a combination of oral medications + bladder irrigation + physical therapy + sacral neuromodulation.