November 19th, 2025

— Why does the pain remain even after the bladder gets better? —

A patient with Hunner-type interstitial cystitis (IC) initially had a very small voided volume of around 100 mL.

One month after undergoing bladder hydrodistention, her uroflowmetry showed:

Voided volume: 260 mL

Post-void residual: 10 mL

Voiding time: Normal

Objectively, these parameters indicated clear improvement.

However, the patient reported:

“Yes, it’s better… but the pain is still there.”

■ Why does the pain persist despite improved bladder function?

Although she was diagnosed with Hunner-type IC during her first visit, she also had:

Marked trigger points in the obturator internus Significant tenderness in the coccygeus muscle

These findings strongly suggested myofascial pelvic pain syndrome (MPPS).

We recommended pelvic floor rehabilitation at the initial consultation, but the patient understandably believed:

“The surgery will fix everything.”

This is completely natural.

When patients hear multiple explanations and multiple causes, it becomes confusing.

And understanding that pain rarely comes from a single source is one of the most challenging concepts for patients living with chronic pelvic pain.

■ What the Guidelines Tell Us: Two “Pillars” of Treatment

According to the Japanese guidelines for interstitial cystitis/bladder pain syndrome:

Bladder hydrodistention: Grade B recommendation Physical therapy (pelvic floor therapy): Grade B recommendation

This reflects the fact that many IC patients have coexisting MPPS (“vaginal tightness” or pelvic floor hypertonicity).

This means:

Treating only the bladder is often not enough Addressing pelvic floor muscle dysfunction and trigger points is equally essential

Even when hydrodistention improves bladder capacity and reduces urgency,

the muscular component of pain can remain on a separate pathway.

■ Why Treating the Pelvic Floor Relieves “Bladder Pain”

MPPS (often described by patients as “vaginal tightness”) arises from hypertonic pelvic floor muscles that can refer pain to the:

Bladder Urethra Lower abdomen Pelvic region

This is known as referred pain.

At our clinic, we combine:

• Pelvic floor rehabilitation
• Myofascial release
• Extracorporeal shockwave therapy (DUOLITH®)
• Magnetic stimulation therapy (Starformer®)

These treatments frequently lead to substantial improvement in lower abdominal and pelvic pain.

■ Our New Initiative: MPPS Self-Care Stick Program

To further support patients with MPPS,

we have introduced a self-care stick specifically designed for pelvic floor myofascial release.

Benefits include:

Can be performed at home Easy to integrate into daily life Works synergistically with clinical rehabilitation

Many patients appreciate the ability to manage their symptoms proactively.

■ Pain Treatment Requires the Right Sequence

In many cases, both the bladder and pelvic floor muscles contribute to the overall pain picture.

Ideally one treatment would resolve everything,

but in reality the process often requires:

Bladder → Pelvic floor muscles → Nervous system regulation → Lifestyle adjustments

Step by step, we work together to “remove the pieces of pain” one by one.

You are not alone in this process.

Nihonbashi Pelvic Floor Clinic (NPFC)

Specialized Care for Pelvic Floor Disorders

We provide expertise in:

Interstitial cystitis / bladder pain syndrome MPPS (myofascial pelvic pain) “Vaginal tightness” syndromes Pelvic pain Urinary incontinence Pelvic organ prolapse

▶ Official Website

https://npfclinic.jp

▶ 24/7 Online Appointments

https://npfc.mdja.jp/