Most women will suffer from
cystitis - infection of the urinary tract and bladder - at some point in their lives. With symptoms including a frequent and urgent need to urinate and pain in the bladder, it can be extremely unpleasant. Fortunately, it usually clears up after a couple of days and a course of antibiotics. But about 400,000 Britons - 90 per cent of them women - suffer from chronic cystitis, known medically as interstitial cystitis.
Here the problem is not an infection, but the bladder wall becoming inflamed.
This can occur for a number of reasons, including childbirth, surgery (such as hysterectomy) and repeated bouts of bladder infections (such as cystitis), though sometimes there is no obvious cause.
Unfortunately, say some experts, chronic cystitis patients - who tend to be aged 30 to 45 - are often misdiagnosed by GPs as simply being prone to urinary infections. They’re sent away with antibiotics without any further investigation.
In fact, the real problem could be over-active pelvic floor muscles. The pelvic floor is a large, V-shaped muscle that supports the bladder, vagina, uterus, lower back and other internal organs.'Most people know the pelvic floor can weaken, but it can also tighten,' says Vik Khullar, a consultant urogynecologist at Imperial College London.'Tension can build up in response to anything -
endometriosis, bowel or bladder problems. When the pelvic floor tightens and goes into spasm the patient can have pain at any point, such as urination and intercourse.'A tight pelvic floor can also cause the bladder to not empty properly, so it can get infected and cause a repeated cycle.'
Meanwhile, the problem could be compounded by doing pelvic floor exercises, says Christien Bird, a physiotherapist at the White Hart Clinic, London, which specialises in women’s health issues.
'Some sufferers leak (urine) and are told to tighten their pelvic floor muscles which can be detrimental.' Prolonged use of antibiotics could be a contributing factor, she says. 'People are going through the medical mill for years with no resolve.'
She is working with Mr Khullar on a multi-disciplinary approach to tackle chronic cystitis. This combines medication - such as muscle relaxants, anti-inflammatories and antibiotics - as well as physiotherapy to relax the pelvic floor. The idea is to break the cycle of inflammation and pain.
Interstitial cystitis can occur for a number of reasons, including childbirth, surgery and repeated bouts of bladder infections. The patient is first assessed using ultrasound scanning, focusing on the bladder and pelvic floor muscle while they stand, lie down and exercise. The physiotherapy treatment includes applying pressure to the pelvic floor and A trip to the physio could help banish chronic cystitis
Cystitis sufferers can have 'trigger points' in their pelvic floor muscle, much the same way as someone with neck ache will have sore points in their shoulders. The physiotherapist will apply firm pressure to the point internally, for about 20 seconds, to release it.
Patients are also given breathing exercises and stretches to do at home. Another technique is applying ice to the area. Though physiotherapy for interstitial cystitis is relatively new in Britain, it is well- established in the U.S., with several studies showing its benefits. A study reported in the Journal of Urology showed that physiotherapy can ease pelvic pain in patients with interstitial cystitis. Previously, a U.S. urologist found that relieving pelvic floor trigger points provided complete relief or marked improvement in women with interstitial cystitis.
