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Targeted physical therapy effective for female bladder pain

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – A randomized, multicenter trial has confirmed that myofascial physical therapy is an effective treatment for women with newly symptomatic interstitial cystitis/painful bladder syndrome (IC/PBS).

IC/PBS affects between 2.7 and 6.5 percent of US women, which translates to about 3 to 8 million, according to the RAND IC Epidemiology Study, a 2009 household survey that the RAND Corporation claims to be the largest IC/PBS epidemiology study to date.

This most recent trial, published online April 13 in the Journal of Urology, compared specialized pelvic floor myofascial physical therapy (N=42) with a control group that received traditional full body Western massage (N=39), which is not generally prescribed for IC/PBS. Patients in each group received up to 10, 60-minute treatment sessions during the 12-week study period.

Fifty-nine percent of patients who received myofascial physical therapy reported a moderate or marked improvement according to global response assessment at 12 weeks compared to 26% in the massage group (P=0.0012). Only 18% of patients receiving myofascial physical therapy reported no improvement, whereas 43% of patients reported no improvement with massage.

Overall, 96 percent of patients completed the study and 92% received at least seven of the 10 treatment sessions.

“It’s not common for doctors to prescribe general message for this so it is not like this [study] will cause people to switch,” said Dr. James Quentin Clemens, an associate professor and director of neurourology at the University of Michigan in Ann Arbor. “Instead it’s good evidence that [myofascial physical therapy] does help and it does work.”

Guidelines released last year by the American Urological Association (AUA) recommended manual physical therapy techniques as a second-line therapy for IC/PBS patients, behind self-care practices and behavioral modifications. IC/PBS, however, has a litany of standard therapies; the AUA guidelines list 12 different recommended treatments as well as five that should not offered.

“Because there are multiple symptoms, multiple treatments are often used simultaneously,” said Dr. Ian Oyama, an assistant professor of obstetrics, gynecology and women’s health at the University of Hawaii, in an email to Reuters Health. “In addition to medical management, many physicians, including myself, will also use [myofascial physical therapy] as a first-line treatment, particularly in patients who have a significant pain component to their condition.”

One critical aspect of the study, both Drs. Clemens and Oyama said, was that the myofascial physical therapy delivered in the study was very specialized.

The authors, led by Dr. Mary Pat FitzGerald at Loyola University Medical Center in Maywood, Illinois, described it as “targeted internal and external tissue manipulation, focusing on the muscles and connective tissues of the pelvic floor, hip girdle and abdomen.”

“The physical therapists who participated were experienced and had undergone training in the past to learn how to do this kind of therapy well,” said Dr. Clemens. “It remains to be seen if the therapy works as well if it’s administered by a group that isn’t as experienced.”


Randomized Multicenter Clinical Trial of Myofascial Physical Therapy in Women With Interstitial Cystitis/Painful Bladder Syndrome and Pelvic Floor Tenderness

J Urol. 2012 Apr 12. [Epub ahead of print]