Original Article

Interstitial cystitis (painful bladder syndrome) may, in some cases, be a referred pain from the uterosacral ligaments


Pelviperineology 2010;29(2):60-61


To directly test the hypothesis that painful bladder syndrome/interstitial cystitis may be a referred pain from the uterosacral ligaments.


Previous studies have demonstrated high statistical relationships between painful bladder syndrome/interstitial cystitis, and symptoms such as low abdominal pain, dyspareunia, nocturia, urgency, abnormal bladder emptying. These symptoms first described as part of the “posterior fornix syndrome” in 1993, are potentially curable by surgical reinforcement of the uterosacral ligaments.


Five ml of xylocaine 1% local anesthetic solution were injected just lateral to the position of the uterosacral ligaments of 3 patients with symptoms of painful bladder syndrome/interstitial cystitis, all of whom had vascular glomerular changes in the bladder wall vessels observed during cystoscopy and bladder distension. All 3 patients also had symptoms of vulvodynia, low abdominal pain, dyspareunia, nocturia, urgency, and abnormal bladder emptying.


The abdominal, urethral, introital and cervical tenderness and pain which were demonstrated objectively in all 3 patients immediately before the intervention, disappeared entirely, or were substantially improved, within 5 minutes of the injection.


Though only 3 patients were tested, the association of painful bladder syndrome/interstitial cystitis vulvodynia, lower abdominal pain, nocturia, urgency and abnormal emptying symptoms suggests a possible link with previous studies, where such symptoms improved following surgical tensioning of the uterosacral ligaments. The hypothesis concerning this group of IC patients awaits this crucial test.