Pelvic pain is complex and has many faces. We've talked about Painful Periods, Endometriosis and now we're going to tackle Bladder Pain Syndrome.
Bladder Pain Syndrome may have begun like this: You had a urinary tract infection that just didn't go away. You felt urgency to void. You felt pain just above your pubic bones (where your bladder lives), in your perineum and/or in the urethra (the tube from the bladder to the outer world). When urinary tract infections became chronic, the old thinking was that the interstitium (bladder lining) was inflamed, ergo the outdated name "Interstitial Cystitis". Bladder Pain Syndrome is far more complex, the name far more descriptive.
In 2018, we know the onset of BPS is more like this: Your bladder thinks that it's under threat…..a grizzly is at its door. Your bladder may have suffered at some point in your life, perhaps when you were a child (Chronic infections? Withholding voiding? Difficulty with bedwetting?). The part of your brain that worked with your bladder remembered this sense of distress. Later on in life (with puberty, onset of intimate relations, stressful situations, baby having, an accident or menopause), your bladder had "flashbacks" and kicked into that difficult memory. Your immune system pitched in, bringing on an immune response and inflammation. Your bladder nerve endings and the nerve pathways to the brain were woken up. Your tendons, muscles and fascia tightened up in order to protect the area.
The outcome? You may develop a hypersensitive, overactive, inflamed bladder. As your bladder fills, it naturally stretches. That tight and inflamed bladder isn't so keen on stretching, sending a threat message to the brain. Your bladder naturally fills to 500-ish mls., but with BPS it can become painful at only 100 mls.. The bladder may also not welcome urine due to the inflamed lining, so you may feel a sense of urge to get rid of it…now! If you experience these feelings for more than three months, your brain begins to focus on the bladder, becoming attentive to all bladder sensations from a little urine to moderately full to urgency to pain! The natural voiding reflex and habits become distorted over time and your bladder forgets how to feel the "Oh, I'm getting full…..I'll have to go to the loo soonish, but no rush" sensation. The rising tension in the pelvic floor creates more problems. Toilet time naturally involves releasing the pelvic floor along with opening of your sphincters in a lovely dance. With a tight pelvic floor, your urine stream may become slow, interrupted, painful and incomplete. Intimacy may become painful. You may have an accompanying challenge with bowel release (not constipation….it's the letting it go part that becomes slow and/or painful). Your stress system and brain become alerted over time and this increases your perception of pain; it attaches it to your emotional state. If you haven't slept, are having a bad day or have stress, you'll feel BPS more than you would have otherwise. It's just all so connected.
What can you do about it?
Find a pelvic certified physio. You'll be asked about how your bladder functions, how often you void, how it feels before, during and after voiding, how your bowel works (loading, comfort, movement, frequency), pelvic floor function, deep core function and how your life is working (your nutrition, sleep, understanding of pain, pelvic systems and stress management). Your internal and external pelvis and deep core will be assessed. Research has shown us that your pelvic floor needs to be calmed down in its hypertonicity (tension), pain and function or the dysfunction and pain in your bladder won't change. You will be taught pelvic floor releases with breathing patterns, general and specific stretches and perhaps the use of a wand (a pelvic trigger point tool for you to use). An elimination diet is helpful, but no two women with BPS have the same dietary triggers. Eat food that agrees with you. Get good sleep and downtime. Find and manage your stressors. Bladder Pain Syndrome can be managed well. You can experience a cascade of wonderful changes when you take charge of your own health.