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.

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 (random.org), 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).

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.

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.