Chronic Urogenital Pain

Vulvodynia – Bladder Pain Syndrome/Interstitial Cystitis

Bladder Pain Syndrome and Vulvodynia, Early Onset of Symptoms

[Case Study Summary, NT, Age 25. Physiotherapist, engaged, fiancée a medical practitioner. Early onset of bladder symptoms and pain. Ten years after onset of symptoms diagnosed with Bladder Pain Syndrome and Vulvodynia. Very health conscious, living a healthy lifestyle, cautions with diet. Symptoms progressively gave rise to fear of leaving her place of residence. Urinary urge and frequency made daily activities difficult. Very responsive to therapy, with reduction in symptoms and elimination of pain following one week of intensive therapy.]

NT is 25 years of age, works as a full time physiotherapist. Decided to share her case study knowing that there are many women, including some of her friends, who suffer from chronic urogenital pain and in spite of numerous visits to specialists are not able to receive assistance.

From her earliest years NT has led an active lifestyle, rollerblading, swimming, running, cycling and skiing. She has taken special care with diet, following a very rational approach to eating. During her childhood and teens she was free of any serious illnesses, the only exception was an ilingual hernia repair. At age 15 NT experienced first urinary symptoms. Initially it was frequency but with time the intervals between voids became shorter. Further symptoms made normal daily functioning difficult. Immediately after each void she experienced sharp piercing pain, which instigated another attempt at voiding. The voiding volumes were progressively reduced but repeated attempts at micturition provided some relief. There were times when symptoms would subside for a while but returned and overshadowed the symptom free periods. During most difficult times NT would void 10-15 times a day. Other symptoms that accompanied urinary problems included pain with bloating, urge, bladder burning, discomfort during physical activities and with consumption of alcohol, as well as vaginal pain. Symptoms in the form of pain and burning around the genital area became more evident with sexual activities, though initially the pain was not always consistent.

Awareness of the absence of bathrooms in close proximity – especially when leaving her apartment or lecture theater, always brought on a renewed urge to void. With time the symptoms became more severe and growing fear and anxiety contributing another component to the problem.

The need to void progressively took on a character of desperation, with sudden urge and burning, especially after extended periods of sitting or when changing to a standing position, at which time she could feel pain in the lower abdominal – suprapubic area. These symptoms were present during stress-free times but became more intense with stress. After a period of time NT became conscious of the vicious cycle – by which awareness of symptoms generated fear, this in turn intensified their presentation. With time this led to a significant reduction in quality of life and normal functioning, creating a sense of helplessness and avoidance of certain situations such as the use of public transport.

In the course of several years, NT became a frequent patient at various medical clinics. Infections of the urinary system were frequently suspected, yet after various diagnostic investigations (ultra-sound, urine tests and cultures) findings did not support the initial assumptions. On multiple occasions NT tried over the counter self-treatments to no avail.

NT came in contact with Dr [ ] on the recommendation of a friend who earlier struggled with the same symptoms. Even though the friend encouraged her to trial therapy, skepticism made the decision difficult. Given years of struggles with her symptoms she no longer believed that anyone could assist, even to reduce the symptoms by a small degree. Progressively she gained courage and made an appointment, which consisted of as extensive medical review and finally a diagnosis. She was then referred for myofascial and biofeedback therapy. Following the very first session NT noticed significant improvements, which confirmed in her mind that she had made the right move. Subsequent sessions focused on external and internal myofascial work and muscle retraining in conjunction with diaphragmatic breathing. NT kept notes and documented the changes she experienced with each therapy session in terms of voiding patterns and pain levels. Her daily notes reflect an interesting pattern.

Day 1 Post therapy

  • Number of voids during the day – 5
  • Maximal interval between micturition – 7 hours
  • No pain in the lower abdominal region

Day 2 Post therapy

  • Number of voids during the day – 5
  • No pain or burning with intercourse

Day 3 Post therapy

  • Number of voids during the day – 6
  • Frequency of voids – every 4 hours
  • Slight stabbing discomfort while biking
  • Some pelvic muscle pain associated with therapy

Day 4 Post therapy

  • Number of voids during the day – 5
  • No burning, sharp pain, no sensation of bladder pressure
  • No sense of urge prior to leaving home

Day 5, 6 Post therapy

  • Number of voids during the day – 6
  • No burning, stabbing or bladder pressure
  • No fear of sudden urge
  • No pain with intercourse
  • No urge to void prior to leaving home

NT was delightful by the outcome of therapy, as a result of which she can function normally without any fear of the earlier symptoms. She verbalized a great sense of relief and was grateful for being diagnosed and successfully treated. She was appreciative that the whole therapeutic process progressed smoothly and professionally and that she could feel at ease and comfortable throughout the intensive period of treatment.