English
Español
Português
简体中文
Deutsch
Русский
日本語
Italiano
Interstitial Cystitis
MAJOR SYMPTOMS WE TREAT
Most of our patients have at least two or more interstitial cystitis symptoms for which they are seeking pelvic pain relief. See a more detailed list with descriptions of the symptoms at the bottom of this page.
- Urinary Frequency / Urgency / Hesitancy
- Pain with Sitting
- Rectal / Perineum Pain
- Genital Pain
- Pain During or After Sex
- Pain or Relief After Bowel Movement
- Lower Abdominal Pain
- Tailbone / Low Back Pain
- Stress Can Increase Pain
- Hot Baths or Heat Help
- Depression / Anxiety About Symptoms
- Symptoms Reduce Quality of Life
- Conventional Treatments Don’t Help
- Medical Tests Find No Disease
INTERSTITIAL CYSTITIS (IC)
THE WISE-ANDERSON PROTOCOL (STANFORD PROTOCOL) AND TREATMENT SYMPTOMS OF INTERSTITIAL CYSTITIS (IC)
An estimated 700,000-4,000,000 people in the U.S. (about 90% of whom are women) are diagnosed with interstitial cystitis (IC), a diagnosis traditionally referring to bladder inflammation and/or ulceration in which the bladder’s capacity to hold urine is reduced. We have found that the conditions of many patients diagnosed with IC significantly improve upon implementing the Wise-Anderson Protocol, a treatment for pelvic pain relief.
INTERSTITIAL CYSTITIS (IC): A CONTROVERSIAL DIAGNOSIS
Interstitial cystitis is a diagnosis that is controversial for a number of doctors. In our own practice we have found that in many of our patients who have been diagnosed with IC, their symptoms have significantly improved without dealing with the bladder at all. More than a few of our patients have been diagnosed without any investigation of their bladder and with testing that is controversial.
Among the most effective treatments for interstitial cystitis is pelvic floor physical therapy. In the Journal of Urology, Volume 182, Issue 2, August 2009, Pages 570–580, the Mary Pat Fitzgeral and Rodney Anderson state:
There were 23 (49%) men and 24 (51%) women randomized during a 6-month period. Of the patients 24 (51%) were randomized to global therapeutic massage, 23 (49%) to myofascial physical therapy and 44 (94%) completed the study. Therapist adherence to the treatment protocols was excellent. The global response assessment response rate of 57% in the myofascial physical therapy group was significantly higher than the rate of 21% in the global therapeutic massage treatment group (p = 0.03).
Conclusions: We judged the feasibility of conducting a full-scale trial of physical therapy methods and the preliminary findings of a beneficial effect of myofascial physical therapy warrants further study.
INTERSTITIAL CYSTITIS MAY BE CONFUSED WITH PELVIC FLOOR DYSFUNCTION
Interstitial cystitis, when it does exist, may in fact be pelvic floor dysfunction. We have often found that many patients diagnosed with IC significantly improve using our protocol. While we have not studied patients with the diagnosis of IC specifically, we know that anxiety and emotional arousal is a central feature of patients diagnosed with IC and we believe our protocol that focuses on lowering nervous system arousal may be a of central benefit to these patients.
Hanno discusses the issue of anxiety and mental health comorbidity issues in his article, Painful Bladder Syndrome/Interstitial Cystitis and Related Disorder in elsevierhealth.co.uk 2007;
“There is an associated high incidence of comorbidity including depression, chronic pain and anxiety and overall mental health (Michael et al 2000: Rothrock et al 2002: Hanno, Baranowski, Fall et al 2005)”
Some researchers hypothesize bladder inflammation may occur as the result of neurogenic inflammation in response to ongoing guarding of the pelvis muscles.
LOCATIONS OF PAIN ASSOCIATED WITH INTERSTITIAL CYSTITIS
In a recent survey of 264 women with IC conducted by physicians at the University of Maryland and Johns Hopkins University, it was found that the respondents were quite precise in identifying multiple sites of pain with pain sensations described as ‘throbbing, tender, piercing or aching.’ For genital pain sites, ‘burning, stinging and sharp’ were the pain descriptions. The order ranking of the most frequently reported sites of pain were suprapubic (above the pubic bone), urethral and genital areas, followed by other non-genitourinary sites. Suprapubic and urethral pain were reported as worsening either with bladder filling or just before urination in 50% or more of the women although this symptom can also occur with non-interstitial cystitis patients. Approximately 80% of survey respondents also indicated pain worsening in these areas after consumption of certain food and drinks, as discussed below.
Cystoscopy under anesthesia with hydrodistention of the bladder has been considered the gold standard for diagnosing interstitial cystitis. This method of make a diagnosis was challenged by a significant study done by Waxman et.al. at Texas A&M (Journal of Urology, Volume 160, Issue 5, November 1998, Pages 1663–1667) found that when women who underwent tubal ligation underwent cystoscopy under anesthesia with hydrodistention, the bladders of women with no symptoms appeared no different than women diagnosed with interstitial cystitis who reported symptoms. The article stated:
Results: A total of 20 normal women with a mean age plus or minus standard deviation of 29 +/− 6 years consented to participate in this trial during laparoscopic tubal ligation. Photographs of bladder sites before and after distention with 890 +/− 140 ml. were scored as 1.4 +/− 0.3 (before distention) and 3.1 +/− 1.1 (after distention) on the scale of 1 to 5. The increase in scores following distention in normal subjects was seen to the same degree and in the same proportion as in patients with symptoms of interstitial cystitis (8 to 19 symptomatic patients in this series met current diagnostic criteria for interstitial cystitis). Slight but significant differences were seen among sites in the bladder but not between 2 and 6-minute distention durations.
Conclusions: Bladder mucosal lesions characteristically associated with irritative voiding symptoms and pelvic pain in patients diagnosed with interstitial cystitis were observed in asymptomatic women.
TRIGGER POINTS AND INTERSTITIAL CYSTITIS: A CHARLEY HORSE IN THE PELVIS
In over twenty years of clinical experience, we have identified a large number of painful, myofascial trigger points (a charley horse in the pelvis caused by stress) in the internal and external pelvic muscles in patients previously diagnosed with IC. We understand that over time, usually decades, this vicious cycle of chronic anxiety manifests itself by tightening the pelvic floor to a point that it doesn’t untighten and becomes painful and dysfunctional. We understand that where patients feel pain is often not where the pain is originating, a crucial point, as conventional medical treatment often focus on the identified state of pain rather than where the pain is being referred from. The Wise-Anderson Protocol treats both the stress that is what we believe initially causing the pain and directly where the pain is stemming from in the pelvis.
INTERRUPTING THE TENSION-PAIN-PROTECTIVE GUARDING-ANXIETY CYCLE
Tension-anxiety-pain-protective guarding self-feeding cycle
The goal of the Wise-Anderson Protocol is to interrupt the cycle of tension-anxiety-pain- and protective guarding. Quieting anxiety in our protocol is most effectively accomplished by empowering our patients how to help themselves and reduce their pain and related symptoms. The methods for doing this include regular internal and external physiotherapy self-treatment, the regular practice of Extended Paradoxical Relaxation, and the management of negative and anxious thinking that tends to spin off into catastrophic thinking. The Wise-Anderson Protocol has been shown to reduce trigger point/pelvic floor sensitivity and pain from 7.5 out of 10 to 4 out of 10 in 6 months, proving itself as an extremely effective treatment for pelvic pain relief.
Our new, FDA-approved Internal Trigger Point Wand makes self-treatment relatively simple. After evaluation and diagnosis by a physical therapist, our patients are taught how these trigger points can be accessed and manipulated by the patient themselves. We strongly believe that this autonomy in the self-treatment of trigger points is a vital component of empowering our patients out of a sense of helplessness.
We teach the Wise-Anderson Protocol in monthly 6-day immersion clinics held in Santa Rosa, California, for which we offer more detailed information below.
INTERSTITIAL CYSTITIS IS BOTH A LOCAL AND SYSTEMIC DISORDER
Pelvic pain relief — and other forms of pain — from interstitial cystitis, with its often bewildering and troubling cystitis symptoms, is what those seeking help from any treatment are looking for when they go to a doctor. Conventional medical treatment, however, almost universally misunderstands interstitial cystitis. The remedies it offers at best are partial and short-termed and at worst, remedies like surgical intervention or certain injections, can exacerbate the problem.
The fundamental error of conventional treatment for interstitial cystitis is that it does not grasp the fact that it is both a systemic and local problem — systemic in that the nervous system, typically frequently aroused, chronically tightens up the pelvic muscles. It is a local problem in that chronic worry, anxiety and nervous arousal in certain individuals results in the local pain and dysfunction of the pelvic muscles. Without effectively treating both aspects, interstitial cystitis remains.
Our 6-day clinic, offered throughout the year, is devoted to resolving both the local and systemic dimensions of interstitial cystitis by training our patients in the most advanced internal and external physical therapy self-treatment (local treatment), and practicing our relaxation protocol, Extended Paradoxical Relaxation, which is aimed at reducing nervous system arousal daily.
THE WISE-ANDERSON PROTOCOL
6-Day Immersion Clinic
We began treating varieties of pelvic floor dysfunctions in patients at Stanford University in 1995 in conventional office visits. In 2003, we reorganized our treatment in a private practice in the form of a 6-day immersion clinic held in Santa Rosa, California. The clinic, limited to 14 patients and offered throughout the year, has evolved to implement the Wise-Anderson Protocol, a treatment to teach patients to rehabilitate the chronically contracted muscles of the pelvic floor and to reduce anxiety daily. The Wise-Anderson Protocol, done daily at home by patients we have trained in self-treatment, has helped to give many their lives back. The purpose of our self-treatment is to help patients become free from having to seek additional professional help. For over a decade, research has documented our results of training patients with self-treatment for pelvic pain relief.
For more information, please visit our clinics page by clicking here.
For questions about cost and eligibility please fill out the form below, email us at ahip@sonic.net or contact our office at +1 (707) 874-2225.
SYMPTOMS OF INTERSTITIAL CYSTITIS (IC)
(Most of our patients have at least two or more symptoms)
- For patients, urinary frequency can range from being annoying to debilitating
- There is typically a feeling of something always nagging in the bladder/urethra/genitals
- Typically after someone urinates, patients don’t feel ‘emptied’ and are left with the feeling of having to urinate
- Frequency/urgency can result in the feeling of often having to be near a bathroom. Sometimes one can hardly hold in the urge to urinate when it arises
- If one is in a movie theatre, or at a sports event etc., one usually sits in an aisle seat to be prepared to exit easily
- Urinary urgency and frequency can deprive patients of sleep because of how often they wake up during the night or because they have difficulty going back to sleep after they wake up
- Dysuria can be very painful and thus, urination becomes a large ordeal and sets off further pain
- Burning or pain with urination is often disconcerting and associated with pelvic floor dysfunction
- Sometimes people feel no pain during urination but only after
- When the chronic spasm and myofascial contraction of the pelvic muscles is resolved, in many of our patients, dysuria is also resolved
- Often nocturia is a major problem because a patient’s sleep is so disturbed he or she is exhausted all the time
- Exhaustion from sleep deprivation tends to feed into the cycle of tension, pain, protective guarding and anxiety
- In men this is an important symptom to medically evaluate as to whether the source of the reduced stream is from prostate enlargement or other issues
- Some people with muscle based pelvic pain have to wait to initiate a stream of urine
- Reduced urinary stream can be a contributing symptom to low self-esteem and hypochondriasis, especially in younger men
- When urinary symptoms are part of muscle based chronic pelvic pain syndrome, after rehabilitating the pelvic floor, the flow of urine can improve
- Perineum is one of the most common sites of pelvic pain, is intimate, can hurt 24/7 and can be very distressing
- The perineum is the place where most muscles of the pelvic floor attach and therefore has many sources of referred pain (pain felt at a site other than where the cause is situated)
- Perineum is often the site of bicycle riding pain
- Perineum pain can be made worse by sitting or standing
- The perineum and the anal sphincter are parts of the body where the patients feel the feeling of “sitting on a golf ball”
- In a 2009 Stanford study of our work published in the Journal of Urology, it was documented that 79% of subjects complained of pain in the perineum
- We documented key abdominal and pelvic muscles that all refer pain to the perineum (rectus abdominus, adductor magnus, and coccygeus)
- Sitting is one of the great sufferings and scares in pelvic pain and makes all aspects of normal life difficult
- Patients often look for the padded seats in a restaurant because sitting is so uncomfortable
- Sitting pain can make it miserable to sit with friends or family and socialize
- Difficult to fly or drive for any distance without pain
- Sometimes patients have to go on disability because they can’t work because their job is a sitting job
- Sitting can trigger or exacerbate discomfort/pain/symptoms and can hurt in the front, back of the pelvis, or both
- Sitting pain usually starts out milder in the morning but increases after sitting through the day, and can last into the night
- Genital pain is usually referred from the anterior levator ani and one of the easier symptoms to resolve
- In men, pain at the tip and shaft of the penis is a common symptom
- In men, sometimes there is a redness at the tip, which can be accompanied by an irritation so that rubbing against underwear is uncomfortable
- In women, pain inside the vagina, on one side or another is common
- In women, sometimes vulvar pain accompanies pelvic pain
- Suprapubic (above the public bone) pain is a common symptom
- Suprapubic pain is common with patients who have urinary frequency, urgency, hesitancy and other anterior symptoms
- Sometimes pressing on this area can refer into the anorectal (anus and rectal) area and sometimes bladder pain is experienced here as well
- Pain can be on one side or another or in the middle
- In men this is an important symptom to medically evaluate as to whether the source of the reduced stream is from prostate enlargement or other issues
- Some people with muscle based pelvic pain have to wait to initiate a stream of urine
- Reduced urinary stream can be a contributing symptom to low self-esteem and hypochondriasis, especially in younger men
- When urinary symptoms are part of muscle based chronic pelvic pain syndrome, after rehabilitating the pelvic floor, the flow of urine can improve
- Low back pain is common and often confuses patients and practitioners because the symptoms are referred from the muscles of the pelvic floor, not the low back
- Discomfort can be on one side or another or migrate from one side to another
- Relief after a bowel movement occurs when the tight pelvic muscles relax
- Discomfort after a bowel movement can be particularly disconcerting if it triggers symptoms more strongly for the rest of the day
- Little is written about this symptom when it occurs in the absence of hemorrhoids or anal fissures, but in our experience it is common
- The mechanism of defecation typically involves the filling up of the rectum with stool, which then sends a signal for the internal anal sphincter and puborectalis muscle to relax and triggers the experience of urgency to have a bowel movement
- Once the stool passes through the relaxed anal sphincter and out of the body, the internal anal sphincter reflexively closes
- When someone has pelvic pain and exacerbation of symptoms after a bowel movement, we propose that the internal anal sphincter tends to ‘over close’
- That is, it tightens up more than it was tight before the bowel movement and sometimes appears to go into a kind of painful spasm
- Post bowel movement pain appears to occur less frequently when someone is relaxed and not hurried, and whatever contributes to a more relaxed state during a visit to the bathroom may reduce this symptom
- Resolving post bowel movement pain in our patients tends to occur as their entire chronic pelvic muscle tension releases
- Reduced interest in sex is common with pelvic pain
- In muscle related pelvic pain, there is typically no pathology of the physical structures involved in sexually activity
- Our view is that reduced libido is a mix of anxiety, reduced self-esteem and pelvic pain which all mitigate against sexual arousal and sexual interest, and resolution of pain and dysfunction of the pelvic muscles usually resolves reduced libido
- The scariest part of pelvic pain is the catastrophic thought that it will never go away
- It is a focus that distract your attention away from your life and with many patients, paints an unacceptable future
- Pelvic pain robs patients of the ability to be fully present in relationship with family and friends
- Social withdrawal often stems from chronic pain and it can detrimentally affect any enjoyment of the moment
- There is a major toll that chronic pelvic pain takes on relationships, including the partners of those in pain, such as the patient’s withdrawal from sex, withdrawal from going out and doing things with others, planning trips, parenting, socializing, and doing the normal activities of partnership or marriage
- Self-esteem almost always goes down when one has pelvic pain because patient’s almost always worry that no one will want to be with them
- Sleep disturbance is common
- Many patients wake up anxious, wondering if the pain has gone, disappointed every day that it isn’t
- Patients either wake up to urinate or because of pain and anxiety
- We wrote a paper about precipitous rise in cortisol in the morning amongst pelvic pain patients. Cortisol and Men with Chronic Prostatitis– American Urological Association Poster 2007
- Helplessness and hopelessness is the real suffering with chronic pelvic pain
- Helplessness comes from a patient’s inability to stop pain/discomfort that is draining and scary
- Hopelessness in pelvic pain patients arises when they can’t see anything on the horizon that might help them
- In our clinical practice we have found that people with IC typically have many trigger points anteriorly (in the front), in the rectus abdominus, and in the anterior levator and obturator internus muscles inside the pelvis
- Pelvic floor self-administered physical therapy and the reduction of anxiety in our experience play a large role in helping symptoms
- Can experience pain during sexual activity or afterward
- Pain is felt on the outside or inside of the vagina, or both
- Pelvic examination in which trigger points are palpated can often recreate symptoms of pain during sex
- Moldwin et. al reported in the Journal of Urology that certain foods aggravate symptoms of interstitial cystitis. They report: There is a large cohort of patients with painful bladder syndrome/interstitial cystitis in whom symptoms are exacerbated by the ingestion of specific comestibles.
- The most frequently reported and most bothersome comestibles were coffee, tea, soda, alcoholic beverages, citrus fruits and juices, artificial sweeteners and hot pepper
- We have however had patients who reported aggravation of symptoms with certain foods who had no indication of interstitial cystitis so food sensitivity is not a definitive marker of IC
- Ordinary stresses, as well as extraordinary stress, tend to increase symptoms
- When stress has triggered pelvic pain, the stress also tends to trigger the tension-anxiety-pain-protective guarding cycle that continues after the stress has gone
- Interstitial cystitis may coexist with other disorders such as irritable bowel syndrome, fibromyalgia, vulvodynia, vulvar vestibulitis, pelvic floor dysfunction, Raynaud’s syndrome, and migraine headache among others
- It is not uncommon for some diagnosed with IC to have suffered childhood trauma, anxiety and considerable current emotional distress
WHAT TEMPORARILY CAN HELP:
- Hot water or heat often helps temporarily
- Heat sometimes flares up symptoms; patients feel relief using cold packs or ice
- The family of drugs called benzodiazepines can often relieve symptoms for a few hours and are helpful when used skillfully
- Benzodiazepines are addictive and when used regularly for pelvic pain, they can lose their effectiveness
- Benzodiazepines typically make the user tired and should not be used when driving or having to be alert
- Naps, or vacations can sometimes help reduce pain