Neuromodulation in Intractable Interstitial Cystitis and Related Pelvic Pain Syndromes

Abstract

Many people suffering with interstitial cystitis (IC) and related pelvic pain syndromes do not benefit from the standard medical or surgical treatments. The pathophysiology of IC bears striking similarities to a wide variety of disorders driven by neurogenic inflammation, many of which may someday be controlled through neuromodulation. Because the bladder is accessible to repeated inspection, functional monitoring, biopsy, and collection of effluents, the study of neuromodulation in IC promises to yield important insights into the successful application of neuromodulatory approaches to diseases of the pelvis and other areas. Clinical experience suggests that neuromodulation in pelvic pain syndromes can successfully normalize the motor function of the bladder and pelvic muscles, as well as their sensoria. Useful neuromodulatory approaches that have potential for the treatment of intractable IC and related syndromes, such as certain cases of chronic prostatitis and pelvic floor dysfunction, include stimulation of afferent pathways using high-frequency stimulation of sacral roots and low-frequency stimulation of motor fibers innervating pelvic floor muscles via sacral roots or the posterior tibial nerve. While the lifetime incidence of chronic pelvic pain in American women is estimated to be as high as 33%, fewer than 1% of these patients are ever seen by pain specialists. Developing neuromodulatory strategies for IC and pelvic pain may also hold promise for the effective treatment of certain syndromes involving intractable urinary retention, lower bowel disorders, or sexual dysfunction.