The Pathophysiology of Fibromyalgia: Diagnosis and...

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


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.


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


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].


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


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).


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].


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].


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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The Pathophysiology of Fibromyalgia: Diagnosis and...

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