Vulvodynia – Bladder Pain Syndrome/Interstitial Cystitis

What is Bladder Pain Syndrome/Interstitial Cystitis?

Women suffering with vulvodynia frequently report a range of other symptoms, many of which relate to the bladder and urinary system. Knowing where one condition begins and the other ends can be a challenge. It is estimated that in over 80% of vulvodynia cases there are urological symptoms which warrant greater consideration and co-management.

What is Bladder Pain Syndrome/Interstitial Cystitis? Bladder Pain Syndrome (also called Painful Bladder Syndrome) and Interstitial Cystitis refer to conditions characterised by pain and unpleasant sensations related to the urinary bladder and affecting the surrounding abdominal and pelvic regions. Most commonly women report experiencing discomfort, pressure or intense pain in the bladder and pelvic area with symptoms of urge, frequent daytime voiding (of more than 10 voids per day) and night-time urination (of more than two voids per night), known as nocturia. Frequency is not always related to bladder capacity as individuals with normal bladder capacity can still experience frequency. Individuals with bladder pain present with many varied symptoms, causing clinicians and researchers to believe that this disorder is not one, but several that give rise to the symptoms. Based on our pain mapping research, pain arising from the urethral and bladder regions can refer to many areas in the body, some quite distant from the pelvic area.

Pain of Paraurethral Origin

© Marek Jantos & Sherie Johns

Majority of female bladder pain/IC cases also report pain with vaginal intercourse and meet the diagnostic criteria for vulvodynia. In women the pain can vary considerably on a daily basis and increase significantly during menstruation. Where symptoms are associated with clearly defined changes (scarring, stiffness or ulcers) in the inner lining of the bladder, known as the interstitium, the condition is labelled as Interstitial Cystitis. There is considerable overlap between the two diagnostic entities of vulvodynia and bladder pain syndrome and reports of bowel problems, musculoskeletal problems, allergies, anxiety, depression and insomnia.

Common Descriptions of Pain

© Marek Jantos

Both bladder pain syndrome and interstitial cystitis are diagnosed on the basis of self-reported symptoms and medical examinations where all other causes of bladder pain, such as infections and urinary stones have been ruled out. The prevalence of this disorder has been estimated at between 6-15 per cent and affects women of all ages. The condition is far more common among women than men.

Scientific literature does not provide an explanation for the cause of these symptoms and most medical treatments, including antibiotics, are ineffective. Various theories abound in relation to mechanisms of pain. These include defective bladder lining (deficiency of the glycosaminoglycan (GAG) layer, increased nerve innervation, immune system up-regulation (mast cell proliferation) and dysfunctional muscles. Myofascial therapy with biofeedback assisted pelvic muscle retraining and behavioural management strategies are the recommended front-line treatment modalities for bladder pain syndrome and interstitial cystitis.