Edith Cowan University Research Online Theses: Doctorates and Masters Theses 1-1-2005 Fibromyalgia and bladder irritability Carolyn K. Brand Edith Cowan University Follow this and additional works at: https://ro.ecu.edu.au/theses Part of the Medicine and Health Sciences Commons Recommended Citation Brand, C. K. (2005). Fibromyalgia and bladder irritability. https://ro.ecu.edu.au/theses/626 This Thesis is posted at Research Online. https://ro.ecu.edu.au/theses/626 Edith Cowan University Copyright Warning You may print or download ONE copy of this document for the purpose of your own research or study. The University does not authorize you to copy, communicate or otherwise make available electronically to any other person any copyright material contained on this site. You are reminded of the following: Copyright owners are entitled to take legal action against persons who infringe their copyright. A reproduction of material that is protected by copyright may be a copyright infringement. 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USE OF THESIS The Use of Thesis statement is not included in this version of the thesis. --··-··--, i &DITHCOWAN Uf ;iVEH3iTY UBf\AfW FIBROMYALGIAAND BLADDER IRRITABILITY Carolyn Kaye Brand Dip Physiotherapy, Grad Dip Physiotherapy (Womens' Health), MSc (Public Health) Faculty of Communications, Health and Science h 141 January 2005 - 2 - ABSTRACT Urinary tract sensory symptoms provide an additional symptomatic burden for women with fibromyalgia. The urogenital symptoms of both fibromyalgia and interstitial cystitis have been described as non-infective sensory disorders, suggesting the existence of substantial clinical overlap between the two conditions. Research suggests that although interstitial cystitis has been treated as a specific bladder condition, it may be part of the disorder of central processing of sensory information as seen in fibromyalgia. The interstitial cystitis symptom index and problem index (ICSI/ICPI) have been used to measure lower urinary tract symptoms and to examine the impact of these symptoms in patients with interstitial cystitis. This current two phase study was designed to test the ICSI/ICPI for use within a population of women diagnosed with fibromyalgiaknown to be experiencing sensory bladder symptoms. Phase I involved focus group interviews and discussions with women who reported fibromyalgia and bladder irritability (N=lO). This phase was designed to identify whether the key indicators and the way in which women experienced bladder irritability were indexed by the ICSI/ICPI instrument. The second phase of the study tested the ICSI/ICPI within the fibromyalgia population for reliability and validity. Phase II data was derived via a self-administered questionnaire issued to women (N=90) who had been diagnosed with fibromyalgia by a rheumatologist and who were experiencing lower urinary tract sensory symptoms. Data analysis revealed two separate components in urinary symptom/problem combinations within the fibromyalgiapopulation. These components were distinct from those described in the ICSI/ICPI. Subsequently, two separate subscales were developed to form the Fibromyalgia Bladder Index (FBI). The development and testing of the FBI within the fibromyalgia population has provided an accurate measure for assessing the symptoms and symptom impact of urinary symptoms for women with this condition. The FBI has been developed as an adjunct to clinical assessment and as an outcome measure for intervention therapies for patients with fibromyalgia and bladder irritability. Outcomes of this study form the basis to the following recommendations: further refinement of the FBI; utilisation of the index in fibromyalgia assessments; development of fibromyalgia educational, support and self help programs; pelvic fitnessawareness and intervention studies. - 3 - DECLARATION I certifythat this thesis does not, to be best of my knowledge and belief' (i) incorporate without acknowledgement any material previously submitted for a degree or diploma in any institution of higher education; (ii) contain any material previously published or written by another person except where due reference is made in the text; or (iii) contain any defamatory material. - 4 - ACKNOWLEDGEMENTS The development and completion of this thesis has been a wonderfullearning curve forme over the past four years. From the initial concepts, preliminary research questions and background to the study, I have woven my way through literature reviews, theoretical frameworks and measurement models, considered different methodologies and recruited wonderful women as study participants from both the east and west coasts of Australia. This research trek has continued through software packages, data collection and analysis, biostatistics, formatting, findings, discussions and recommendations. Throughout this time I have been assisted, supported, educated and nurtured by my family, colleagues and friends. They have all played a part in my transition into a researcher. My gratitudeand thanks especially to • My beautiful family, my husband Maurice and children, Sascha, Simone, Gabrielle and Stefan for their love, support and encouragement. • Professor Linda Kristjanson, Associate Dean of Research and Higher Degrees, Faculty of Computing Health and Science, Edith Cowan University, Perth forher enthusiasm, capacity, tenacity, and friendship. • Associate Professor Geoffrey Littlejohn, Directory of Rheumatology, Monash Medical Centre, Melbourne for his advice and expertise in the area of fibromyalgia. • Mr Stan Wisniewski, Urological Surgeon, Hollywood Private Hospital, Nedlands, Perth for his generous hours of urological screening of study participants and urological expertise. • Dr Thomas Hassard, Biostatisician, University of Manitoba, Canada for his statistical brillance • Dr Anna Rosamilia, Urogynaecologist (Melbourne) for her enthusiasm for this research and her contribution in undertaking the urological screenings in Melbourne. • The women participants in this study for their capacity, their 'wellness in the foreground perspective' in dealing with the chronicity of fibromyalgia symptoms and fortheir contribution to this research. • My colleagues at Edith Cowan University "Thank you all" - 5 - TABLE OF CONTENTS FIB ROMYALGIA AND BLADDER IRRITABILITY .................................................................... 2 ABSTRACT .......................................................................................................................................... 3 DECLARATION .................................................................................................................................. 4 ACKNOWLEDGEMENTS ................................................................................................................. 5 TABLE OF CONTENTS ..................................................................................................................... 6 LIST OF T ABLES.................................................... .......................................................................... 10 LIST OF FIGURES...................................................................... ...................................................... 12 CHAPTER 1 ....................................................................................................................................... 13 INTRODUCTION ........................................................................................................................... 13 Background to the Study ............................................................................................................. 15 Urological Symptoms ............................................................................................................................ 16 Current Definition of Interstitial Cystitis ............................................................................................... 18 Commonalities between FM and IC ...................................................................................................... 19 Significance of the Study ............................................................................................................. 19 Current Bladder Research Emphasis............................ .......................................................................... 20 Social and Economic Impact ................................................................................................................. 21 Health Related Quality of Life............................... ................................................................................ 22 Health Outcome Measures ..................................................................................................................... 23 Purpose of the Study ................................................................................................................... 2 5 Research