Post on 25-Jun-2020
AASCIT Journal of Medicine
2018; 4(1): 1-13
http://www.aascit.org/journal/medicine
ISSN: 2381-1420 (Print); ISSN: 2381-1447 (Online)
The Pathophysiology of Fibromyalgia: Diagnosis and Treatment
Hamidreza Shirzadfar*, Aida Mohammadi, Mehrnaz Sadeghi
Department of Biomedical Engineering, Sheikhbahaee University, Esfahan, Iran
Email address
*Corresponding author
Citation Hamidreza Shirzadfar, Aida Mohammadi, Mehrnaz Sadeghi. The Pathophysiology of Fibromyalgia: Diagnosis and Treatment. AASCIT
Journal of Medicine. Vol. 4, No. 1, 2018, pp. 1-13.
Received: February 22, 2018; Accepted: March 12, 2018; Published: April 27, 2018
Abstract: Fibromyalgia (FM) is a chronic disease with unexplained pain in the muscles and joints of the patient. In other
words, the fibromyalgia is a connective tissue rheumatoid arthritis. In most cases, women aged 20 to 50 years are more likely
to suffer from fibromyalgia than man. The main cause of fibromyalgia is not known but the various reasons that can cause the
fibromyalgia are genetics, infection and physical or emotional shock. One of the important symptoms of the fibromyalgia is
widespread pain throughout the body such as shoulder, head, arms, abdominal areas and etc. The fibromyalgia syndrome can
affect all systems of the body including the bladder. Patients especially women who suffering from the fibromyalgia experience
a painful bladder syndrome and problems with chronic bladder infection. Some of the urinary and pelvis disorders in patients
with fibromyalgia are bladder incontinence, urinary frequency, dysuria, painful sexual intercourse and interstitial cystitis. The
physician can just find the origin of fibromyalgia with the blood test and it's not easy to diagnose this disease. The main
symptoms of the fibromyalgia are pain and fatigue and these are common symptoms of other diseases including chronic
fatigue syndrome, hypothyroidism and arthritis so there are no laboratory tests or X-rays to diagnose the fibromyalgia.
Fibromyalgia treatment can be divided into four general categories include: the medicinal therapies such as lyrica, cymbalta,
savella, anti-inflammatory drugs, anti-depressants, etc. Non-pharmacological treatment of fibromyalgia such as biofeedback,
cognitive behavioral therapies, physiotherapy, electromyogram, etc. The third group of treatment is the alternative treatment of
fibromyalgia such as chiropractic, deep tissue massage, meditation, etc. The last group of treatment is the electrical treatment
of fibromyalgia such as the systolic extinction training, transcutaneous electrical nerve stimulation and cranial electrotherapy.
Some of the effective treatment for urinary incontinence include: physiotherapy for muscle straddle pelvis, kegel exercises, an
electrical stimulator, surgery, bladder training, pessary, catheterization and etc.
Keywords: Fibromyalgia, Diagnosis and Treatment Fibromyalgia, Urinary and Pelvic Symptoms, Urinary Incontinence,
Painful Bladder Syndrome
1. Introduction
The fibromyalgia is a connective tissue rheumatoid
arthritis and is present in all countries, races, and in all clime
areas. About 10% to 12% of the population suffer from this
disease. The main cause of fibromyalgia is not known. The
people suffering from fibromyalgia have a low pain
threshold.
The fibromyalgia has many symptoms that vary from
person to person. One of these symptoms is widespread pain
throughout the body. The fibromyalgia syndrome can affect
all systems of the body including the bladder. Patients
suffering from fibromyalgia experience a painful bladder
syndome (PBS) and problems with chronic bladder infection.
There are no laboratory tests or X-rays to diagnose the
fibromyalgia. For the treatment of fibromyalgia, the drug
helps reduce pain, exercise regularly, stretching, walking,
swimming, cycling and water sports reduces the symptoms of
fibromyalgia. Some electrical stimulation used to treat
fibromyalgia such as cranial electrotherapy stimulation
(CES) and transcutaneous electrical nerve stimulation.
Physiotherapy for muscle staddle pelvis, kegel exercises,
an electrical stimulator, surgery, bladder training, botox and
catheterization are effective treatments for urinary problems.
2 Hamidreza Shirzadfar et al.: The Pathophysiology of Fibromyalgia: Diagnosis and Treatment
2. History of Fibromyalgia
Although fibromyalgia is known as fad diagnosis or new
disease, it is not really a new disease. While in the medical
community is still not accepted and its acceptance is still not
universal, fibromyalgia has taken a long way and recent
research has shown that physiological illness is very real [1-
4].
Fibromyalgia
The fibromyalgia (FM) is a chronic disease with
unexplained pain in the muscles and joints of the patient. The
fibromyalgia is a connective tissue rheumatoid arthritis. This
condition often causes pain at certain points on the body by
pressing.
About 10% to 12% of the population suffer from this
disease. Unfortunately, no structural or inflammatory causes
have been found for this disease.
In most cases, women aged 20 to 50 years are more likely
to suffer from fibromyalgia than man. Fibromyalgia is less
common in younger adults and occurs between the ages 25
and 55.
The people suffering from fibromyalgia have a low pain
threshold and the reason is due to increased sensitivity of the
brain to pain symptoms [5-8].
2.1. Epidemiology of Fibromyalgia
The fibromyalgia is present in all countries, races and in
all clime areas. The prevalence of this disease in the United
States was reported in the 1990s by the diagnostic criteria of
the American Rheumatology Association (ACR), 3.4% in
women and 0.5% in mans. The fibromyalgia can be seen
alone and can also be associated with another disorders
including hypothyroidism, chronic headache, multiple drug
allergies and premenstrual syndrome. Another rheumatologic
disorders are rheumatoid arthritis (RA), systemic lupus
erythematosus (SLE) or Sjögren syndrome (SS) [9-11].
2.2. Clinical Symptoms Related to
Fibromyalgia
The main features of fibromyalgia disease are pain
released in the soft tissue, which is mainly expressed by
symptoms such as irritation, itching, etc. Symptoms of
fibromyalgia are often accompanied by emotional stress and
physical injury such as a car accident or an illness such as
viral or bacterial infections which is associated with
extensive musculoskeletal pain, fatigue, sleep disorders, and
mood problems. It should be noted that some times,
fibromyalgia begins without any symptoms. The
fibromyalgia has many symptoms that vary from person to
person. One of these symptoms is widespread pain
throughout the body such as shoulder, head, arms, abdominal
areas, etc. About 1 in 5 people suffering from fibromyalgia
have restless legs syndrome. Another symptoms of
fibromyalgia are urinary frequency, lyme disease (a bacterial
arthritis disease), numbness and tingling of the hands and
feet, throbbing and palpitation, sensitivity to smell and
sound, paresthesia caused by numbness in hands and foot
fingers, autonomic system disorders (low blood pressure as
getting up from the ground, confusion and syncope) and
endocrine system problems (See figure 1). The symptoms of
fibromyalgia may be severe and weak depending on the time.
Some cases such as fatigue, hormonal fluctuations such as
premenstrual changes or during menopause, cold and climate
changes, inactivity or excessive pressure on the body, stress,
anxiety and emotional factors can exacerbate the symptoms
of the disease. [12-16]
Figure 1. The sympotoms of fibromylagia [17].
3. Causes of Fibromyalgia
There is still no specific cause or in other words, the main
cause of fibromyalgia is not known and unfortunately it has
caused the disease to not be taken very seriously. The various
reasons that can cause the disease include:
A. genetics: the fibromyalgia is commonly seen in the
family.
B. infection: apparently, some of the symptoms are a start
factor or an exacerbation factor of fibromyalgia.
C. physical or emotional shock such as accidental injury
(accidental driving) and frequent abnormalities, post-
traumatic stress disorder is associated with
fibromyalgia. [18-21]
The researchers believe that the brain of people suffering
from the fibromyalgia changes with a neurostimulation. This
change requires an increase in the level of certain chemicals
that signal the pain in the brain (neurotransmitters).
Apparently, nociceptive in the brain also become more
susceptible to pain memory, which means they can show a
high sensitivity to the pain signals.
Risk factors of fibromyalgia include:
1. gender: the fibromyalgia in women is diagnosed more
often than men. The women aged 20 to 50 years are the
most affected.
2. family history: the possibility that your family has an
illness and you are more likely to have it.
AASCIT Journal of Medicine 2018; 4(1): 1-13 3
3. rheumatism disease: if you suffer from rheumatism such
as rheumatoid arthritis or lupus erythematosus
(tuberculosis), the risk of fibromyalgia may be greater.
Diagnosis of Fibromyalgia:
Unfortunately, it takes years for some people with
fibromyalgia to be properly identified. This may happen for
several reasons. The main symptoms of this disease are pain
and fatigue. These are common symptoms of other diseases,
including chronic fatigue syndrome, hypothyroidism and
arthritis (joint inflammation).
At present, there are no laboratory tests or X-rays to
diagnose the fibromyalgia. It may take time for your doctor
to understand all the symptoms and refuse other health
problems, and can give you a correct diagnosis. As part of
this process, your doctor may consult with a rheumatologist.
The physician with the blood test that include blood cell
count, erythrocyte sedimentation rate (RBC), thyroid
function test can find the origin of fibromyalgia.
Radiologic and laboratory tests are not generally reliable,
but they are helpful in dispensing other disorders. The main
tests are CBC, ESR, standard biochemistry tests, and thyroid
function tests.
Due to the possibility of multiple mendacious positive
cases as a result of the test, RF, ANA and lyme antibodies
should be investigated only in patients with high clinical
suspicion. Radiological studies should also be performed in
patients with evidence of arthritis or radiculopathy [22-24].
4. Fibromyalgia Treatments
Fibromyalgia treatment can be divided into four general
categories. The first group of treatment is the medicinal
therapies, three types of medicine used to treat fibromyalgia
by US Food and Drug Administration include: lyrica
(pregabalin), cymbalta (duloxetine), savella (milnacipran).
These types of medications may be expensive and also have
side effects, including psychological problems. In other
words, treatment of fibromyalgia is not just a medication, it
depends on a kind of life.
Furthermore, anti-inflammatory drugs, anti-depressants
include:
a) Elavil (amitriptyline),
b) Duloxetine (cymbalta),
c) Milnacipran can help to reduce the pain and fatigue
associated with fibromyalgia. Analgesics, CNS stimulants,
gabapentin (neurontin, gralice) are used to treat fibromyalgia.
Ataractic, over-the-counter prescription drugs such as
acetaminophen, ibuprofen or naproxen sodium can be helpful
for treatment fibromyalgia. Anticonvulsants, often medicines
used anticonvulsants to treat epilepsy and it is effective in
reducing certain pains. The doctor may also prescribes
amitriptyline or fluoxetine (prozac) to help improve sleep
condition of patients [25, 26].
Perhaps the doctor may want to prescribes ataractic such
as tramadol (ultram), it is not recommended to use narcotic
drugs as it may be addictive and may be exacerbate the pain
for a long time [27-28].
The second group of treatment is the non-pharmacological
treatment of fibromyalgia. Non-medical therapies for
fibromyalgia that have been examined in controlled studies
include: biofeedback, cognitive behavioral therapies (CBT),
physiotherapy, electromyogram, increasing muscle strength,
exercise, activity and balneotherapy.
Physiotherapy affects muscle cramp and pain in
fibromyalgia. Patients with regular referral to a
physiotherapist can increase self confidence by exercise.
Physiotherapy also makes the muscles relax and provides
more information for patient about the body.
Exercise is essential for maintaining the strength and
flexibility of the muscles, control the weight and help with the
continuation of activities in other areas of life. In fact, exercise
and activity allow patients to control fibromyalgia and pain
sensation. The patient should consider three different types of
exercise include: stretching exercises, endurance or positional
exercises and strength exercises [29-33].
The third group of treatment is the alternative treatment of
fibromyalgia.
Some people suffering from fibromyalgia feel relaxed with
alternative therapies. These treatments include:
a. Acupuncture: based on some research findings,
acupuncture can change brain chemistry and help
increase pain tolerance. Acupuncture causes changes in
blood circulation and the amount of neurotransmitters in
the brain and spinal cord and affects the improvement
of patients.
b. Chiropractic: to help pain levels improvement, relieve
back pain and effects on increasing the waistline
movement amplitude and neck.
c. Deep tissue massage: stimulates circulation and releases
chronic muscle tension patterns.
d. Neuromuscular massage: this type of massage helps to
reduce muscle pain or facial muscle (soft tissue) and is
a combination of the main basic of ancient oriental
treatment such as acupuncture and shiatsu.
e. Biofeedback: according to National Health Institutions
using electronic devices to measuring body stress
responses helps a lot of patients control the response to
stress and relieve chronic pain.
f. Meditation: studies have shown that meditation
produces brain waves in a relaxed and joyful manner,
which helps reduce anxiety.
g. Herbal medicines: few studies have been conducted on
herbal remedies and fibromyalgia. Some people who eat
herbal supplements like echinacea purpurea, black
cohosh, lavender, silybum marianum, and group B
vitamins have seen an improvement in sleep condition
or increased energy.
h. Natural supplements: some people with consumption
normal supplementation such as amino acids HTP-5
increase the production of serotonin, a kind of
neurotransmitter that acts as a natural healing agent in
the body. Some studies show that this supplement can
eliminate symptoms of fibromyalgia.
i. Melatonin: this substance is effective for the better
4 Hamidreza Shirzadfar et al.: The Pathophysiology of Fibromyalgia: Diagnosis and Treatment
sleep. Patients suffering from fibromyalgia say that their
pain also decreases with melatonin consumption.
j. St. John's wort, L-carnitine, SAM-e and probiotics also
feeling calm to the patients. It should be noted that
many supplements such as St. John's wort have drug
interactions, so if prescription drugs or multiple
supplements are available to the patient, patient should
avoid from using this supplements [34-37].
The fourth group of treatment is the electrical treatment of
fibromyalgia.
Recent studies which done by a research team have shown
that a specific cardiac cycle triggered electrical stimulation in
conjunction with operant-behavioral pain treatment (OBT) can
regulate the abnormal relationship between blood pressure (BP)
and pain in patients with fibromyalgia and chronic pain. This
group presents the systolic extinction training (SET) electrical
stimulation design that is performed during the diastolic or
systolic cycles of the heart. According to this research the goal
of the stimulation is to effect the connection between triggered
pain-stimuli and blood pressure. For the SET stimulation the
complex trigger processes the ECG signal and predicts when
the minimum and maximum blood pressure pulse wave at the
arterial baroreceptor using a 3-lead derivation by Einthoven,
there are lead systems that make up the standard ECG (see
figure 2) [38, 39].
Figure 2. The simulation setup [38].
Occasionally, a remedy for local or regional pain is
transcutaneous electrical nerve stimulation (TENS). Since the
fibromyalgia pain is not limited to a specific region and area,
TENS therapy is commonly not used as a treatment, but
some studies have shown that TENS may be effective for
reducing pain in people suffering from fibromyalgia,
especially in combination with other treatments such as
exercise. Pending TENS therapy, electrodes which can help
control or reduce some types of pain, deliver electrical
impulses to nearby nerve pathways [40-43].
Electrotherapy is often recommended to treat the
numerous fibromyalgia symptoms. Electrotherapy is a
therapeutic method that uses electrical impulses to improve
symptoms of pain, reduce muscle pain and depression in
patients. Electrotherapy gives a small pulsating current to the
muscles and the nerve ending. This current causes the
muscles to be contract and then calm down and relax.
Repetitive irritations cause muscles to be strengthened, relax
and less pain [44].
The use of electrical stimulation to relieve physical and
emotional distress is not a new phenomenon. Electric
stimulation treatments are new technologies that are safe and
easy to use. Cranial electrotherapy stimulation (CES) and
micro-current electrotherapy (MET) are some example for
electric stimulation treatments. CES devices deliver modified
square wave biphasic stimulation through electrodes placed
on the patient's ear lobes. A CES session lasts between 20
and 60 minutes. The CES reduced the average pain and
decreased activity in the regions of the pain processing in the
brain [45-47].
Food and Useful Vitamins in Fibromyalgia:
Note that nutrients and beneficial vitamins should be taken
under the supervision of a doctor.
GABA neurotransmitter: used for better sleep.
Malic acid: which exists in apple, fatigue and muscle aches
annihilator.
Magnesium: to generate energy and eliminate fatigue.
Vitamin D: to strengthen the muscles and reduce muscle
pain.
Vitamin B3: to improve blood circulation and reduce pain.
AASCIT Journal of Medicine 2018; 4(1): 1-13 5
Vitamin B12: fatigue annihilator.
Coenzyme Q10: improve immune system function and
deliver oxygen to tissues and reduce pain.
Capsaicin: the combination that exists in chili pepper and
similar plants. Patients who suffering from fibromyalgia
should not use nourishment that can cause swelling, but
capsaicin is an exception, because it reduces the pain of the
joints and lowers the swelling. It can be used primarily to
reduce pain in the form of ointment.
Paprika: to improve blood flow and reduce pain.
5. Symptoms Related to Fibromyalgia
The fibromyalgia syndrome can affect all systems of the
body including the bladder. Patients suffering from
fibromyalgia experience the condition which may be
recognized as a painful bladder syndrome (PBS) and
problems with chronic bladder infection.
As noted, the main symptoms of this disorder are: muscle
and joint pain, chronic fatigue, depression and etc. People
with fibromyalgia syndrome are prone to get a wide range of
other symptoms, such as bladder problems and pelvic area.
These symptoms may exist for patients all day long or
through menstrual cycles, stress or a diet may be triggered.
5.1. Urinary and Pelvic Symptoms in
Fibromyalgia
The complaints of fibromyalgia patients from urinary and
pelvis problem are common symptoms of fibromyalgia,
especially in women suffering from fibromyalgia (see figure
3). The bladder incontinence, urinary frequency, dysuria and
painful sexual intercourse are just a few of the urinary and
pelvis disorders in patients suffering from fibromyalgia [48-
50].
Figure 3. The male and female bladder [51].
Some common urinary problems that affect people
suffering from fibromyalgia include:
a) urinary Frequency: the urinary frequency and abdominal
distension are very common among patients suffering from
fibromyalgia, especially among the women. As mentioned,
some people suffering from fibromyalgia syndrome find they
should usually wake up during the night to go to the
bathroom and get to the toilet regularly throughout the day.
Some of these patients find that they need to urinate every 20
minutes that they go to the bathroom. Urinary frequency
causes a disorder in Patients sleep patterns, because it usually
causes that patient to wake up and go to the bathroom.
Symptoms of urinary frequency that is seen among
patients suffering from fibromyalgia include: feeling the need
for urination constantly, problem in keeping urine, going to
the bathroom to urinate more than once during the night,
pelvic pain or pain during urination and urgent urination.
This sign often coincides with the urinary tract infection and
urinary frequency [52, 53].
b) urinary urgency: urinary urgency means urgent need to
urinate. Symptoms of urinary urgency include: urinary
frequency, sudden and urgent need for urination, pain or
pelvic discomfort and incontinence [54].
c) urinary incontinence: urinary incontinence is a term that
describes any condition that makes bladder control difficult.
Obviously life is not easy in this situation. Urinary
6 Hamidreza Shirzadfar et al.: The Pathophysiology of Fibromyalgia: Diagnosis and Treatment
incontinence is usually thought to be something that causes a
person suddenly urinate or wet his/her trousers, but it's not
exactly right. Urinary incontinence is more like a weak
control of the muscles that control the bladder.
Figure 4. Different kinds of urinary incontinence [57].
There are different kinds of incontinence include the
following (see figure 4):
1) Overflow incontinence: urine drips constantly from a
bladder that is overfilled. This condition occurs in people
with bladder obstruction (benign prostatic hyperplasia,
prostate cancer or urinary tract constriction) or when the
muscle that urine draws from the bladder is too weak to
empty the bladder normally. Excessive incontinence may be
a side effect of certain medications [55-57].
2) Urge incontinence: this is when the urge to urinate
happens only seconds before urinating. Urgency incontinence
(overactive bladder) is more common in older women. In
addition to the overflow urine has a sense of urgency in
urinating, meaning that it does not have the ability to keep
urine for even a few moments (See figure 5).
Figure 5. The difference between normal and overactive bladder [58].
3) Stress incontinence: when there is pressure to the lower
abdomen that causes urine to leak out. Stress incontinence is
affiliated with activity and is the most common type of
incontinence among women, especially young women. When
the abdominal pressure is increased by the events, the bladder
is pressurized and the urethra does not hold on to the urine
and the urine overflows unaware (see figure 6). Cough,
sneezing, laughter and activities such as long jumping and
long walking are events that make this kind of incontinence
(See figure 7) [55-57].
AASCIT Journal of Medicine 2018; 4(1): 1-13 7
Figure 6. The difference between normal and stress incontinence [59].
Figure 7. The stress incontinence and the effect of some activities that cause it [60].
4) Neurogenic incontinence: the volume is high, the
pressure is low and there are no contractions. It may result
from peripheral nerve damage or spinal cord injury.
neurogenic incontinence is due to impaired functioning of the
nervous system.
5) Blurred incontinence: when the person has both stress
incontinence symptoms and urgency incontinence
Symptoms. This type of incontinence is more common in
older women.
6) Functional and transient incontinence: this is normal
bladder control but the person just cannot get to the bathroom
in time as the result of illness or age. It is more common in
older women. Factors such as a decrease in muscle, bone,
muscle pain and vision weakness are involved in this and can
be easily treated with the drug.
The cause of transient incontinence includes: intense
confusion, urethra infection, atrophic Vaginitis (in
menopausal women due to decreased estrogen hormone),
taking some medications, psychopathy, excessive urine
production (bladder filling), limitation on movement and
stool density.
7) Incontinence out of urethra: urinary excretion from the
pores except urinary meatus.
The Cause of incontinence out of urethra is congenital,
there is less prevalence in which the urethra is usually placed
in the vagina incorrectly. Mostly during infancy, mother
declares that her baby’s diapers are always wet and is
detected in this way.
Causes that increase Occurrence of urinary incontinence
include the following:
I. Increasing the age,
II. pregnancy and accouchement (especially in the young
8 Hamidreza Shirzadfar et al.: The Pathophysiology of Fibromyalgia: Diagnosis and Treatment
age),
III. Overweight (increased pressure on the bladder),
IV. Bladder disorder (such as cytosol and ureterocele),
V. Taking some Medications-Diabetes (drink a lot and
frequent urination),
VI. Stroke and spinal cord injury (do not keeping urine).
5.2. Effective Treatment for Urinary
Incontinence
The patient should not live with urinary incontinence.
Effective treatments for urinary problems include:
a. Physiotherapy for muscle straddle pelvis.
b. Kegel exercises, which augment pelvic floor muscle.
c. Regular physical activity to augment the bladder
muscles.
d. An electrical stimulator, if these methods are not used
effectively the doctor may use an electrical stimulator
(see figure 8), which uses mild alcohol pulses in order
to mitigate and augmentation the bladder muscles.
e. Surgery may also be delayed in the excretion of urine
and better bladder protection to prevent incontinence.
f. Bladder training can be used for stress and incontinence.
The purpose of bladder training is to increase the amount
of urine and improve control on the urge to urinate.
g. Botox can be injected into the bladder muscle with the aim
of calming the muscle and increasing its storage density.
h. Pessary device (see figure 9), a plastic device that enters
the vagina and can help prevent leakage of the urine by
supporting the bladder neck.
i. Catheterization (see figure 10), if the bladder is not
empty due to nerve damage you may need to use a
catheter. The catheter is a thin tube that is inserted into
the urethra from the Bladder to drain urine. You can use
a catheter once at a time, several times a day, or all the
time [61-63].
Figure 8. The electrical stimulator for mitigate and augmentation the
bladder muscles [64].
Figure 9. A pessary device to help prevent leakage of the urine [65].
Figure 10. Catheterization to drain urine [66].
d) Dysuria: sting sensation and pain during urination.
Various causes can cause dysuria. The causes of these
diseases are urinary tract infections and cystitis, kidney
stones, bladder and prostate stones.
e) Interstitial cystitis (painful bladder syndrome):
interstitial cystitis is also known as painful bladder syndrome
(PBS). Fibromyalgia syndrome, chronic fatigue syndrome, as
well as interstitial cystitis (IC) often accompany each other.
Interstitial cystitis has many limitations in your life and
similar to fibromyalgia syndrome (FMS) and chronic fatigue
syndrome (CFS) associated with depression. The cause of
urinary incontinence with fibromyalgia may be due to fatigue
or weakening of the bladder muscle. unfortunately, the main
cause of bladder problems in people with fibromyalgia and
interstitial cystitis such as cause of fibromyalgia syndrome, is
still unknown. Anyone can suffer from interstitial cystitis, but
it is more common in women of different ages with
fibromyalgia or without it. Most women with fibromyalgia
have a chronic urinary infection that may lead to
incontinence. Symptoms of interstitial cystitis are similar to
bladder infections, but there is no sign for infection. The
interstitial cystitis is not bladder infection or urinary infection
and it's not even become better when you take antibiotics
(see figure 11).
AASCIT Journal of Medicine 2018; 4(1): 1-13 9
In the interstitial cystitis, the signals that send the pelvic
nerves to the brain are disturbed and with the smallest
amount of urine in the bladder, it needs to be evacuated and
the patient get frequent urination (see figure 12).
People suffering from interstitial cystitis may become
incontinent, which in turn can be unpleasant and shameful
and the patient needs to use protective clothing or special
clothing.
Signs of interstitial cystitis include: pain and pressure in
the pelvic, frequent urination sometimes 80-60 times a day,
feeling that the bladder is not completely empty, pain during
intercourse, sometimes pain in the genital and rectum, the
urge to urinate even when the bladder is empty, vaginal or
penis pain and metatarsus disorders [67, 68].
Figure 11. The urinary tract infection [69].
Figure 12. The relationship between brain and bladder [70].
10 Hamidreza Shirzadfar et al.: The Pathophysiology of Fibromyalgia: Diagnosis and Treatment
5.3. Diagnosis the Interstitial Cystitis
Primarily interstitial cystitis is diagnosed on the basis of
symptoms. Before diagnosing, the doctor should discontinue
any other possible symptoms.
Common tests for diagnosing the interstitial cystitis
include:
a. Bladder biopsy.
b. Cystoscopy (bladder endoscopy).
c. Urine analysis (urinalysis).
d. Urine cytology, in order to diagnosis of cancer and
inflammatory diseases in the urinary system.
e. Hydraulic pressure, the doctor may need to confirm the
diagnosis an IC, by performing hydraulic pressure in
which your bladder is full of water this allows the
doctor to see the bladder walls to check for possible
hemorrhage in people with IC [70].
5.4. Treatments for Interstitial Cystitis
Some of the effective treatments for interstitial cystitis are
Kegel training or pelvic diaphragm training which is called a
continuous contraction of the pelvic floor muscle and
promotes the electrical stimulation of the pelvic floor muscle
and other muscles and helps to urinary problems (see figure
13).
Another methods of treatment are change dietary patterns,
weight loss especially in the abdomen, use of adult diapers
and protective pads, some people use broccoli or cranberry
extract.
Figure 13. The difference between strong and weak pelvic floor muscles [71].
Figure 14. CPAP therapy: flow generator, hose, full face mask [72].
AASCIT Journal of Medicine 2018; 4(1): 1-13 11
Other way to treat interstitial cystitis is to use an elmiron
capsule (pentosan poly-sulfate sodium) that protects the
bladder wall and pentosan is used to eliminate bladder
discomfort symptoms, known as interstitial cystitis. Other
medications that doctors prescribe include antidepressants,
muscle relaxant, antispasmodic (to reduce bladder spasms)
and analgesics, antihypertensive drugs, diuretics,
antidepressants, contraceptives, sleep medications, and oral
estrogens. The fall of the oxygen level causes a respiratory
response to wake up and begin to breathe again. People who
suffering from sleep apnoea with a sudden movement often
begin to cough or shiver. This stress reaction may cause the
body to think that it is too fluid and makes urge to urination.
Up to 80% of people suffering from fibromyalgia syndrome
may have sleep apnoea. Treatment for sleep apnoea may be
easily as changing the sleep position (sleeping on one side
and not behind), weight loss or it may need to be treated with
a continuous positive airway pressure (CPAP) device (see
figure 14) which will operate the air under low pressure and
keeps open the airways [73-76].
6. Conclusion
The fibromyalgia (FM) is a chronic disease with
unexplained pain in the muscles and joints of the patient. The
fibromyalgia is less common in younger adults and occurs
between the ages 25 and 55 and in most cases, women aged
20 to 50 years are more likely to suffer from fibromyalgia
than man.
The main features of fibromyalgia are pain released in the
soft tissue. Symptoms of fibromyalgia vary from person to
person and often are accompanied by emotional stress and
physical injury which is associated with extensive
musculoskeletal pain, fatigue, sleep disorders, and mood
problems but sometimes, fibromyalgia begins without any
symptoms. People with fibromyalgia syndrome are prone to
get a wide range of other symptoms, such as bladder
problems and pelvic area. The bladder incontinence, urinary
frequency, dysuria and painful sexual intercourse are just a
few of the urinary and pelvis disorders in patients suffering
from fibromyalgia.
No structural or inflammatory causes have been found for
this disease. Genetics, infection and physical or emotional
shock are the various reasons that can cause fibromyalgia.
As it mentioned the main symptoms of fibromyalgia
disease are pain and fatigue, these are common symptoms of
other diseases such as chronic fatigue syndrome,
hypothyroidism and arthritis therefor it takes years for some
people with fibromyalgia to be properly identified. The
physician with the blood test can find the origin of
fibromyalgia.
Fibromyalgia treatment can be divided into three general
categories include: medicinal therapies such as anti-
inflammatory drugs, antidepressants, analgesics-CNS
stimulants and Over the counter prescription drugs, non-
pharmacological treatments such as biofeedback, Cognitive
Behavioral Therapies (CBT), physiotherapy,
electromyogram, exercise, activity and balneotherapy,
alternative treatments of fibromyalgia such as acupuncture,
chiropractic, deep tissue massage, neuromuscular massage,
biofeedback, meditation, herbal medicines, natural
supplements and probiotics. Another types of fibromyalgia
treatments are electrical stimulation such as transcutaneous
Electrical Nerve Stimulation (TENS), electrotherapy, Cranial
Electrotherapy Stimulation (CES), and Micro-Current
Electrotherapy (MET).
As it mentioned bladder problems and pelvic area are
another symptoms of fibromyalgia so effective treatments for
urinary problems are physiotherapy, Kegel exercises, surgery,
bladder training, pessary device and catheterization.
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