Interstitial cystitis (IC)

• Bladder pain syndrome

• 595.1 Chronic interstitial cystitis
• Associated Physical Therapy Diagnoses
  • 315.4 Coordination disorder (clumsiness, dyspraxia and/or specific motor development disorder)
  • 718.45 Contracture of joint, pelvic region, and thigh
  • 719.70 Difficulty in walking
  • 728.2 Muscular wasting and disuse atrophy
  • 728.89 Disorders of muscle, ligament, and fascia
  • 729.9 Other disorders of soft tissue
  • 780.7 Malaise and fatigue
  • 782.3 Edema
  • 786.0 Dyspnea and respiratory abnormalities

• N30.10 Interstitial cystitis (chronic) without hematuria
• N30.11 Interstitial cystitis (chronic) with hematuria

• As of August 2012, the APTA Guide to Physical Therapist Practice does not include practice patterns for organ system pathology. Therefore, the associated or secondary musculoskeletal, cardiovascular/pulmonary, or potential neuromuscular patterns would be indicated.

Description

• Chronic inflammation of the bladder wall
• Frequent, painful urination
• Severe pain with or without attempts at urination, or no pain at all, especially in elderly and children

Essentials of Diagnosis

• Unknown etiology
• Frequent, painful urination
• Difficulty urinating
• Pelvic pressure
• Lower-abdomen discomfort
• Pelvic pain in women

General Considerations

• Often misdiagnosed as urinary tract infection (UTI)
• Some urogynecologic (UG) pathologies may be appropriate for PT, though PT does not usually treat UG disorders specifically.
• Diagnosis for occult problems may take time, require intensive diagnostic testing.
• May refer pain to back, pelvic region.
• UG disorders frequently refer pain to other body areas; individuals may be inappropriately referred to PT.
• May mimic colon cancer or tumor, irritable bowel, colitis.
• May mimic gynecologic problems in females: endometriosis, uterine fibroids, ectopic pregnancy.
• Can have periods of remission

Demographics

• Women more susceptible than men: female-male ratio 10:1
• Diagnosed in the 40 year old age group.
• Frequently associated with sexual intercourse
• Children also at risk

Signs and Symptoms

• Bladder pressure and pain
• Pain during sexual intercourse
• Reduced bladder capacity
• Urinary discomfort, frequency, or urgency
• Pelvic pain
• Urethra (urethritis)
  • Burning with urination
• Bladder (cystitis)
  • Pelvic pressure
  • Lower-abdomen discomfort
  • Frequent, painful urination
  • Blood in urine
• Kidney (acute pyelonephritis)
  • Upper-back and side (flank) pain
  • High fever
  • Shaking, chills
  • Nausea
  • Vomiting

Functional Implications

• Patients often self-confine to house due to fear of not being near a bathroom.
• Severe symptoms, such as urgent need to urinate, may be disabling, cause inability to leave home.
• Pain
• Urinary retention
• Dehydration secondary to diarrhea, emesis, appetite loss, nausea, inability to swallow
• Sarcopenia resulting in weakness, decreased muscle mass, inability to ambulate, perform self-care
• Presence of catheters (external, indwelling, intermittent) may present problems with stoma retraction associated with abdominal contraction.
• Decreased exercise tolerance
• Limited physical activity, activities of daily living (ADLs), instrumental activities of daily living (IADLs)
• Eating disorder, anorexia
• Fatigue
• Inappropriate self-medication
• Anxiety, depression
• Dietary limitations: reduced caffeine, alcohol, citrus intake

Possible Contributing Causes

• Female sex
• Stress, anxiety
...