The AAO Journal, 2022/06, 32(2):19. doi: 10.53702/2375-5717-32.2.15, type of study: ,cr,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

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Keywords:

bladder pain syndrome [1]
case report [736]
interstitial cystitis [4]
female [654]
women [607]
OMT [3924]
osteopathic manipulative treatment [3945]

Abstract:

Introduction/Background: Interstitial cystitis (IC) is a chronic disorder of the bladder characterized by urinary frequency, urgency, bladder pressure and pain; affecting 3-7% women. Proposed pathology includes altered urothelium, toxin-induced uro-inflammation, neural upregulation, and hypertonic pelvic floor musculature. Multiple mechanisms contribute to symptomatology which account for the range of treatments and differences in therapeutic effect. Treatments include stress management, education, behavioral/diet modification, pain management, and manual therapies. Case: A 26 year-old female with history of IC presented with an 8 week “flare” of constant, bladder pain, urinary urgency, and frequency. Pain and pressure were rated a constant 2/10, with sudden daily worsening to 10/10. She was taking Uribel for pain and Elmiron to rebuild the urothelium ($950/month; discontinued 1-month), prior to seeking Osteopathic Manipulative Treatment (OMT). OMT was provided three times. Somatic dysfunction included cranial, innominate/sacral, and thoracolumbar regions. Treatment included cranial; sacral counterstrain, articulation, and myofascial release; soft tissue thoracolumbar region; and muscle energy of innominates. The Bladder Pain Interstitial Cystitis Symptom Score (BPICSS) was completed before treatments and one week after last treatment. Results: OMT improved structural asymmetry and myofascial restrictions. Following treatments the patient experienced short-term reductions in frequency, urgency, and most intense pain (BPIC-SS: 25/38 to 14/38 after final treatment); and reduced frequency of oral analgesics. Discussion: Reducing myofascial restrictions around the sacrum may address IC pathology by facilitating drainage of toxins associated with peripheral uro-inflammation and neural upregulation of pain. Cranial OMT may reduce stress and catecholamines which are implicated in IC. This study suggests OMT may be a cost-effective approach to IC. It is limited by case/sample size. Future research is needed to investigate effect of OMT on uro-inflammatory biomarkers.