Voiding Dysfunction in Interstitial Cystitis Patients and the Relation to Pelvic Floor Dysfunction

Abstract

Background: A large proportion of patients with interstitial cystitis have concomitant pelvic floor muscle dysfunction. Objective: To assess voiding dysfunction in patients with interstitial cystitis who have varying degrees of pelvic floor dysfunction. Study Design: A retrospective cohort study. Methods: Women with interstitial cystitis who underwent cystoscopy/bladder hydrodistension and urodynamic testing from November 2015 to February 2019 were divided into 2 cohorts based on severity of pelvic floor dysfunction (nonsevere and severe). The primary outcome was voiding dysfunction (bladder outlet obstruction and/or pelvic floor muscle dyssynergia by electromyography during voiding). Symptom severity, cystoscopy findings, and urodynamic findings were compared. Results: Fifty-one patients were included—36 in the severe and 15 in the nonsevere cohort. The mean age was 48 years. Those in the severe cohort showed higher rates of voiding dysfunction than those in the nonsevere cohort (89.7% vs 64.3%, respectively, P = .045). Seventy-three percent of subjects had glomerulations and 12% had Hunner's lesions. The presence of Hunner's lesions was associated with a lower first urge volume on urodynamic testing compared with non-Hunner's lesions (75.8 vs 148 mL, P = .046). Modest negative correlations were obtained between interstitial cystitis symptom severity and most urodynamic volumes. Conclusion: Patients with interstitial cystitis with more severe pelvic floor dysfunction demonstrated higher rates of dysfunctional voiding than those with nonsevere dysfunction, and may benefit from advanced pelvic floor therapy.