A woman in her 60s had been experiencing discomfort and pain in the pelvic region and had consulted gynecology and urology departments. She was also suffering from pelvic organ prolapse, for which she recently underwent mesh surgery. After the surgery, her pain worsened, and she reached out to us for consultation.
Based on the keywords “No issues detected by gynecology or urology!” I immediately thought of “interstitial cystitis,” “GSM,” and “myofascial pelvic pain syndrome (MPPS).”
Upon performing a cystoscopy, Hunner’s ulcers were found, and upon examination, pain was detected in the obturator internus muscle. The vaginal mucosa showed signs of atrophy, dryness, and the pH was 6.5, leading to a diagnosis of GSM.
So why did the pain worsen after mesh surgery?!
Here’s my hypothesis:
The patient already had pain symptoms from interstitial cystitis. The mesh surgery likely triggered inflammation around the bladder, intensifying the pain. This inflammation spread to the surrounding fascia, causing decreased mobility. As a result, the pain likely compounded with the effects of myofascial pelvic pain syndrome.
Now, the order of treatment:
- Hydrodistention and electrocoagulation for interstitial cystitis
- Physical therapy for MPPS
- Local hormone therapy and laser treatment for GSM
In terms of priority, starting with (1) is essential, and rehabilitation should follow immediately. (3) can be addressed more gradually.
Many patients arrive after starting with (3), but doing things out of order can lead to a longer treatment journey, though that’s still a valid approach (with some frustration, of course).
Unfortunately, diagnostic methods are not yet widespread, and the healthcare system is not meeting patient needs.
I apologize 🙇
I hope to nurture many guardians who can help guide this process. ^ ^
日本橋骨盤底診療所 
“interstitial cystitis and pelvic organ prolapse” への5件のフィードバック
I was diagnosed with Interstitial cystitis in 1995. It is a horrible disease with no cure.
いいねいいね
As you mentioned, interstitial cystitis is notoriously difficult to treat, and I understand how challenging it must be to manage. I feel that in addition to bladder treatment, incorporating pelvic floor muscle care and mental health support can make a significant difference. In Japan, under the insurance system, only bladder treatments were covered, but I believe that physical therapy and magnetic stimulation therapy are also valuable treatment options.
いいねいいね: 1人
I have not heard of magnetic stimulation therapy. I have done physical therapy on and off over the years. Do you know of any medications that are effective in treating the symptoms of Interstitial Cystitis other than Elmiron? Also thank you for your quick response. I appreciate it.
いいねいいね: 1人
Here are the treatment options for interstitial cystitis (IC)
1. Lifestyle Modifications*
– Diet changes (avoiding foods that may irritate the bladder, such as caffeine, alcohol, and spicy foods)
– Stress management and relaxation techniques
2. Physical Therapy:
– Pelvic floor therapy to relax and retrain pelvic muscles
– Myofascial release for muscle and fascia tension relief → also magnetic stimulation
3. **Bladder Training**:
– Timed voiding and bladder training techniques to gradually increase the time between urination
4. Medications:
– Oral medications such as antihistamines (e.g., hydroxyzine), tricyclic antidepressants (e.g., amitriptyline), or pain relievers
– Pentosan polysulfate sodium (Elmiron), the only oral drug approved specifically for IC
– Intravesical therapies (directly instilled into the bladder), such as dimethyl sulfoxide (DMSO), heparin, or lidocaine
5. Hydrodistention:
– A procedure where the bladder is stretched by filling it with liquid under anesthesia to relieve symptoms temporarily
6. Bladder Instillations:
– Direct instillation of medications into the bladder, such as DMSO, heparin, or hyaluronic acid
7. Neuromodulation Therapy:
– Electrical stimulation therapies, such as sacral nerve stimulation (InterStim), or percutaneous tibial nerve stimulation (PTNS)
8. **Botulinum Toxin Injections (Botox)**:
– Injected into the bladder muscle to reduce pain and urgency
9. Laser Therapy:
– Used to treat bladder ulcers (Hunner’s lesions) in some cases
10. Surgical Options:
– Surgery is considered a last resort and may include bladder augmentation, urinary diversion, or cystectomy in severe cases.
11. Alternative Therapies:
– Acupuncture, biofeedback, and mindfulness-based therapies are sometimes used to manage symptoms.
いいねいいね: 1人
Thanks for the information.
いいねいいね: 1人