Today, I saw several new patients with interstitial cystitis. After explaining the treatments listed in the guidelines, I sensed a bit of relief from them, knowing there are various treatment options available.
I explained that the pain is primarily due to two causes:
1. Bladder pain that occurs when the bladder fills with urine
2. Myofascial pain originating from the fascia around the bladder
I mentioned that physical therapy can be effective for myofascial pain syndrome and performed myofascial release, which helped alleviate their pain.
A woman in her 60s developed cystitis upon arriving in the U.S. during a trip. Her cystitis did not fully resolve, leading to urinary frequency every 10 minutes. She urgently returned to Japan, visiting urologists and gynecologists, but none of the various medications were effective.
On a pelvic exam, just touching the obturator internus muscle caused significant pain. Vaginal pH was 8.5, and there were signs of inflammation on the vaginal mucosa.
She understood that this condition was likely triggered by prolonged sitting during the flight and GSM (with an alkaline vaginal pH).
The treatment plan involved addressing MPPS (vaginal muscle tightness) and GSM. She had been deeply anxious, worrying if it was some strange disease, and her anxiety only worsened.
However, once a clear treatment plan was established, it seemed to provide her with a sense of relief and reassurance.
Last month, a patient came in with frequent urination and urge incontinence. She had hip issues and was advised by an orthopedic surgeon to undergo surgery.
During the examination, I found “strong trigger points in both obturator internus muscles.” I performed myofascial release on the spot and connected them to pelvic floor rehabilitation for further treatment.
When the “vaginal tightness” was relieved, her difficulty in even turning around improved, and the hip surgery was canceled. Her symptoms of frequent urination also improved. She returned for a follow-up, saying that if I neglected treatment, the same symptoms would likely return, so she hoped to continue rehabilitation.
Today, around 40 years woman consulted our clinic because she is suffering from bladder pain and frequent urination since August.
She had already visited both gynecology and urology departments, and had been prescribed painkillers and overactive bladder medications, but they were ineffective. Due to the severity of her pain, she even visited an emergency center.
Specialists at various facilities could not identify the cause of her pain. She mentioned that the symptoms varied depending on the day and time, with some days so severe that she couldn’t leave the bathroom.
An ultrasound only revealed a Bartholin gland cyst. During the pelvic exam, trigger points pain was observed in both obturator internus muscles, particularly on the right side, which also caused radiating pain to the lower abdomen. Given that she had urinary retention symptoms, it is possible that she was unable to relax her pelvic floor muscles.
Despite performing myofascial release, the tense fascia and muscles did not relax easily, so pelvic floor rehabilitation was introduced. Considering that the pelvic blood vessels were slightly engorged, it might be beneficial to prescribe herbal medicine (to treat blood stasis) or, if opting for Western medicine, a drug with muscle relaxant properties.
In any case, the main focus will be on approaches targeting the pelvic floor muscles.
日本橋骨盤底診療所 