Myofascial trigger point assessment and treatment in patients with interstitial cystitis and painful bladder syndrome

Myofascial trigger points (MTPs) have been described as focal areas of tenderness within a muscle belly and have been identified as sources of pain. Soft-tissue manual therapy (MTP release) can be used to manage trigger point pain. Interstitial cystitis and painful bladder syndrome (IC/PBS) are characterized by symptoms of pelvic pain, frequency, urgency and nocturia, but the definitions and diagnoses of these conditions are contentious. Although a number of studies have reported a high prevalence of pelvic floor muscle (PFM) MTPs in IC/PBS, the quality of this literature is questionable. Furthermore, the diagnostic criteria for MTPs are poorly defined and the reliability of PFM MTP assessment is not known. Only a few studies have investigated PFM MTP release in IC/PBS. The treatment interventions reported in these publications varied greatly and only two randomized controlled trials were of high quality, but all the studies demonstrated positive outcomes. It is recommended that patients with IC/PBS should be assessed for PFM MTPs and treated with MTP release as appropriate. The outcome measures utilized in the literature were: visual analogue scales for pain, frequency and urgency; the Interstitial Cystitis Symptom Index; and the Interstitial Cystitis Problem Index. Clinically, these may be supplemented with a bladder diary and the Pain and Urgency/Frequency questionnaire.