The Effects of Physical Therapy Intervention on Pain and Urinary Symptoms in Women with Bladder Pain Syndrome: A Randomized Controlled Trial

Hacad C1, Tanaka C1, Lucon M1, Milhomem S2, Hisano M1, Srougi M1, Bruschini H1

Research Type


Abstract Category

Pelvic Pain Syndromes / Sexual Dysfunction

Abstract 447
Pain Mediators and Interventions
Scientific Podium Short Oral Session 21
Thursday 5th September 2019
14:52 - 15:00
Hall G1
Conservative Treatment Physiotherapy Painful Bladder Syndrome/Interstitial Cystitis (IC) Pain, Pelvic/Perineal
1.University of Sao Paulo, 2.University os Sao Paulo

Claudia Rosenblatt Hacad



Hypothesis / aims of study
Physical therapy (PT) intervention, which include the use of biofeedback (BF) and the myofascial trigger point (MTP) release to promote pelvic floor muscles relaxation and pain relief, are conservative treatment for patients with Bladder Pain Syndrome (BPS). In addition, the use of transcutaneous electro neurostimulation (TENS) might be effective to decrease pain in active trigger points. Postural exercises (PE) can also lead to an improvement of pelvic mobility and stability. However, controlled studies are missing to analyze these effects on pain and urinary symptoms. Herein, our aim was to verify the effects of PT interventions on pain and urinary symptoms in women with BPS.
Study design, materials and methods
We conducted a parallel-randomized controlled trial on 24 female patients with the diagnosis of BPS according to NIH criteria. Specialized physiotherapists evaluated all women through story data, application of validated questionnaire of urinary symptoms (O´Leary), pain (VAS), sexual function (FSFI) and physical and electromyographic examination. After the assessment, patients were randomized 1:1:1, using a website (, i.e., 2 groups of treatment, consisted by 10 weekly sessions of BF plus MTP release and either TENS (EG group) or PE (PG group), and the control group (CG group), in who  treatment was delayed 3 months after the evaluation.
Twenty-two patients finished the treatment, mean age of 51.8 y.o. ± 10.9 (Table 1).  After treatment, patients from EG and PG groups referred a significant decrease of urinary symptoms (frequency, urgency and post voiding residual sensation) and urinary bothers, when compared to CG group. PG group showed a significant decrease (50%) of pain impact and the use of painkillers intake (caps/day) after treatment when compared to EG and CG. Groups EG and PG had a significant improvement of pain in perineal area compared to CG group. (Table 2).
Interpretation of results
In our study, there was a prevalence of pain and urinary symptoms and EG group and PG group had a significant improvement when compared to CG group. PG showed better results of pain impact, decrease of painkillers intake and perineal pain after treatment and these results may be related to the technique itself, particularly because postural exercises included pelvic floor relaxation, breathing exercises and pelvic mobility and not only with pelvic floor muscles alone.
Concluding message
Physical therapy intervention showed a significant improvement of pain and urinary symptoms in women with BPS compared to control group.  Longer follow up is necessary to assure persistence of improvement.
Figure 1 Table 1. Sample Characteristics (n=22)
Figure 2 Table 2. Pre and Post Treatment Results
Funding none Clinical Trial Yes Registration Number Plataforma Brasil - CAAE: 61595016.0.0000.0068 RCT Yes Subjects Human Ethics Committee Research Ethical Comitee of Hospital das Clinicas da Faculdade de Medicina - University of Sao Paulo Helsinki Yes Informed Consent Yes