Daily Decision Making Regarding Occupations and Its Effect on Women With Chronic Pelvic Pain

PURPOSE: Approximately one in seven women in the United States suffer from chronic pelvic pain (CPP). An estimated 3 to 7 million have been diagnosed with painful bladder syndrome (PBS), also known as interstitial cystitis (IC). Individuals with IC/PBS report that flares increase pelvic pain and urological symptoms, disrupting daily life and resulting in greater use of health care. Although there are studies reporting that certain diet and sleep factors affect bladder symptoms, there is a need to examine everyday life decisions and their impact on increasing PBS symptoms. The purpose of this research study was to examine specific daily activities and their effect on increasing symptoms in individuals with CPP. The research question was, What daily occupational decisions increase urinary urgency, frequency, and pain in women with painful bladder syndrome?

METHOD: A mixed-method design was used to gather information about individuals who self-identified as having PBS. Women answered a 14-question survey titled “Factors That May Increase IC/PBS Symptoms or Flares.” Participants rated how decisions regarding everyday occupations affected their urinary frequency, urgency, and pain. Survey questions asked about specific foods, drinks, allergies, pressure- or vibration-causing activities, clothing, and hormone use. Questions concerning participants’ overall level of exercise, sleep, stress, current symptoms, and general health were also included. Two open-ended questions encouraged participants to elaborate on what daily activities or occupations increased their pelvic pain and any other comments they wished to make associated with their PBS. A SurveyMonkey (San Mateo, CA) link was posted on the Interstitial Cystitis Association website (http://www.ichelp.org). This website advocates for PBS research and serves as an information center for health care providers and patients. In 2016, from January to March, 579 women responded to the survey. IBM SPSS Statistics Version 23 will be used to analyze the quantitative research data. NVivo Version 10.2.1 (QSR International, Doncaster, Victoria, Australia) will be used for the qualitative data analysis.

RESULTS: Preliminary data analysis reveals the following descriptive statistics. The majority of participants with bladder pain avoided drinking caffeinated drinks, especially soft drinks. Foods with the ingredients of tomatoes, vinegar, or spices were the least tolerated. Allergies increased urinary symptoms in 20% of the research volunteers. Up to 60% of respondents noted that vibration- or pressure-causing activities such as driving, riding in buses or airplanes, or sitting in a hard chair adversely affected their CPP. 70% of women either did not wear restrictive clothing or experienced an increase in flares when doing so. 74% of women experienced an increase in symptoms with sexual relations. Overall, participants with PBS rated consuming irritating foods and drinks as the most frequent everyday decision increasing their pelvic pain. Stress was ranked as the third mostly likely trigger of increased pelvic pain. Statistical techniques exploring the relationships among the variables have yet to be completed.

CONCLUSION: The decisions women with CPP make regarding everyday occupations can increase urinary urgency, frequency, and pain. Specifically, ingestion of bladder-irritating foods and drinks, along with emotional stress, can exacerbate CPP, making it difficult to continue engaging in daily activities. This research provides direction to occupational therapy practitioners working with women with CPP. The preliminary results of the study suggest that educating CPP clients in health behaviors such as dietary changes, activity adaptations, and stress reduction techniques can improve their management of CPP and assist with reengagement in daily occupations.

References

Bassaly, R., Downes, K., & Hart, S. (2011) Dietary consumption triggers in interstitial cystitis/bladder pain syndrome patients. Female Pelvic Medicine and Reconstructive Surgery, 17, 36–39. https://doi.org/10.1097/SPV.0b013e3182044b5c

Martin, E., Sheaves, C., & Childers, K. (2015). Underlying mechanisms and optimal treatment for interstitial cystitis: A brief overview. Urologic Nursing, 35, 111–116. https://doi.org/10.7257/1053-816X.2015.35.3.111

Veasley, C., Clare, D., Clauw, D., Cowley, T., Nguyen, R. H., Reineke, P., . . . Williams, D. A. (2015). Impact of chronic overlapping pain conditions on public health and the urgent need for safe and effective treatment: 2015 analysis and policy recommendations. Milwaukee, WI: Chronic Pain Research Alliance. Retrieved from http://www.chronicpainresearch.org/public/CPRA_WhitePaper_2015-FINAL-Digital.pdf