The concept of interstitial cystitis (also known as painful bladder syndrome) having a connection to lower back pain would sound foreign to most physicians. That’s because connecting the bladder to the low back involves two different specialties – one that treats the bladder and the other that treats the spine. Sadly, many patients with interstitial cystitis bounce around from specialist to specialist like a pinball because no one has the expertise to connect the dots.
The Story of My Burning Bladder and Interstitial Cystitis Diagnosis
There’s the old adage of the elephant and the blindfolded men, which describes what often happens in modern medicine. You probably know the allegory… three men wearing blindfolds and standing around an elephant are asked to describe what they feel. The guy at the front thinks the trunk is a fire hose, the guy at the leg thinks it’s a tree trunk, and the guy at the tail thinks he has a rope.
I had burning in my bladder and was 100% convinced that I had some sort of urinary tract infection or prostate issue. I went to the urologist who performed his exam and tests and announced I had “interstitial cystitis”, which for a urologist is like saying, “I don’t have a clue what’s causing your bladder pain”. It was a few weeks later when my low back sciatica fired up and one of my partners gave me an epidural injection using the growth factors from my own blood platelets that I noticed my bladder pain suddenly dissipated. Researching the anatomy, it became obvious to me why this worked. Since then, I’ve since seen countless patients with bladder burning who get million dollar workups and end up getting dubious alternative medicine treatments despite it being clear that their low back is the culprit. These poor patients represent the elephant that each specialist evaluates and interprets in his own way, but like our blindfolded men, each misses the mark by a wide margin.
How can the Low Back and the Bladder be Connected?
The diagram to the left shows the sacral nerves coursing by the L5-S1 disc in the low back. These then head toward the bladder and act as a conduit for bladder sensation. Without any pressure on the nerves, they function normally to allow the sensation from the bladder to reach the brain through these spinal nerves.
The second diagram to the right shows what happens when an L5-S1 disc bulge or “slipped disc” places pressure on the sacral nerves. These irritated nerves in turn cause pain in the bladder as well as spasm. They can also make the patient believe the bladder is full when it’s not. All of this happens because the electrical impulses that represent bladder sensation get disrupted by the irritated sacral nerves.
What’s even more interesting is that only some patients who have bladder burning, spasm, and pain and get diagnosed with interstitial cystitis will have back pain. Many patients don’t have that symptom even though the trouble spot is in the spine. So whether you have back pain or not, your sacral nerves being irritated by a disc bulge can still cause bladder issues.
What Can be Done about a Burning Bladder due to Irritated Sacral Nerves?
The good news is that despite all of the run around that interstitial cystitis patients go through to try to find effective treatment, the fix is usually simple if sacral nerve irritation is causing the issue.We use an injection of the growth factors isolated from the patient’s own platelets and delivered through a precise fluoroscopy guided caudal epidural to help calm down the irritated sacral nerves. This can also be combined with physical therapy to get the stabilizer muscles back on-line and to help strengthen the pelvic floor.
The upshot? Interstitial cystitis patients often lose hope given that multiple specialists have prescribed everything from ineffective antibiotics to pelvic floor physical therapy. For some reason, most physicians never put 1 and 1 together to look into the lower back as a possible cause for the burning bladder. If your sacral nerves are causing your bladder to burn, then the solution may be very simple!