Pelvic floor dysfunction (aka hypertonic, tense muscles) is now a distinct subtype of IC/BPS. The challenge is that most urologists have not received training in pelvic floor myalgia and tension. Some patients and doctors still don’t believe that tight pelvic floor muscles can trigger urinary symptoms and pain.
Patients with pelvic floor dysfunction may have difficulty starting their urine stream and/or struggle with constipation. They may feel as if something is falling out of them or is being pushed up in side of them. Vaginal burning is a common symptom. Many IC clinics around the country now have physical therapists on staff to provide “hands on” therapy with excellent results.
Diagnosis and Treatment
The newly updated 2022 Guidelines for the Diagnosis and Treatment of IC now strongly recommend that pelvic floor muscles be assessed at the very first appointment. If pelvic floor tenderness and/or tension is present, referral for physical therapy is immediately recommended. The physical therapist should attempt to identify and resolve rigger points, muscle contractures, painful scars, and connective tissue restrictions. Exercises to strengthen the pelvic floor (i.e Kegel’s) should be avoided.