Local comedian Ms. Ashley Corby, 35, overshares with her audience as part of her standup routine, including a 5-minute bit about “shady” rest areas she has visited due to interstitial cystitis (IC), a bladder pain syndrome affecting 3 million to 8 million people in the United States.
She knows what the restroom experience will be like before she even gets out of her car, but she doesn’t have the choice to hold it and wait.
“I don’t want to use them because I know what those bathrooms are like and they never have toilet paper,” Ms. Corby said.
“But if you have IC you don’t have the choice to just wait until the next stop. You have to take that chance that you might not ever leave that bathroom.”
Ms. Corby was diagnosed with IC — a condition that mimics a chronic urinary tract infection — at age 19. It is not only debilitating but also incurable. Symptoms include urinary urgency, frequency and pressure and pain in the pelvic region.
Some patients may also struggle with associated conditions such as irritable bowel syndrome, chronic migraines or fibromyalgia.
“I had no idea what was going on and this wasn’t a known thing back when I was 19,” she said. “There was no internet research. There was no Facebook to talk to other people who had this condition. And we were so much more conservative as women, too, that we weren’t talking about our bladders.”
Ms. Corby is now a patient at Vanderbilt Health’s new IC clinic and is seen by a care team that includes a nurse practitioner, psychologist, urologist and physical therapist working in tandem on a treatment plan.
“I consider it a four-pronged approach — medical management, stress management, nutrition and physical therapy,” said Dr. Lindsey McKernan, assistant clinical professor of psychiatry and physical medicine and rehabilitation and co-founder of the clinic.
[Photo: Dr. Lindsey McKernan]
“This is a pretty new concept. I know a lot of people aim to have this approach, but it is very difficult to get providers in the same place. It saves time for the patient and it also allows us to stand in the room at the same time and work out a comprehensive treatment plan.”
An effective component of Ms. Corby’s treatment plan includes a clinical hypnosis program under Dr. McKernan’s direction at the Osher Center for Integrative Medicine at Vanderbilt.
“If you have ever seen the Adam Sandler movie ‘Happy Gilmore’ he has to go to his happy place because he is angry and then he sees the penguin. So it’s kind of like that, you imagine going to a happy place and everything is very calm there,” Ms. Corby said.
The hypnosis is intended to control bladder flares, which can be the beginning of a very unpleasant experience for IC patients.
“Whenever my bladder acts up I have a history of getting in my mind and saying everything is about to get really bad. I stress myself out because I have been traumatized through experiences I have had with this condition,” she said.
“The idea that Lindsey [McKernan] has is that there is a strong mind/body connection to IC and, if we can slow down our breathing and brain waves, it can stop our flares. And so when this situation happens it is not the end of the world as it was years ago.”
Dr. McKernan, who is treating local and regional patients from cities including Bowling Green, Kentucky, Memphis and Macon, Georgia, said it is important to focus on the mental aspects of the disease as much as the physical.
“People tend to get the sense that there is nothing they can do and that’s really not true because there are a lot of things you can do to help increase your sense of control over the pain,” Dr. McKernan said.
“This is really about learning skills to manage the condition, and then applying them when it does happen, so that you are on top of it instead of it being on top of you.”
Studies show that IC is associated with anxiety and depression, which can lead to being less likely to return to work and higher levels of pain, according to Dr. Roger Dmochowski, professor of urologic surgery.
“Painful bladder syndrome can be one of the most complex conditions that specialists in pelvic floor medicine confront. It is clear that a multimodal approach using a team of practitioners from different disciplines provides benefits not only for the condition symptoms and associated pain, but also from the standpoint of the sufferer’s psychologic health,” Dr. Dmochowski said.
“Extensive evidence is now accruing to support the value of interventions that help the individual cope and manage their condition with the assistance of their medical providers,” he said.
Dr. Dmochowski and Dr. Stuart Reynolds, associate professor of urologic surgery, see clinic patients along with Dr. McKernan and nurse practitioner Ms. Rochell Burton, who met Ms. Corby when she was originally diagnosed more than 15 years ago.
Ms. Burton said it has been rewarding to see these patients finally getting some relief.
“The opportunity for the medical side and the integrative side to work together has been very rewarding for not only myself but also the patients,” she said. “Patients living with chronic illness need other options besides medication to be able to deal with a lifelong disease.”
Ms. Corby said her quality of life today is much better than in her 20s and early 30s.
“It is incomparable. On a scale of 1-10 today I am an 8 or a 9. When things are good sometimes you forget just how bad they were,” she said.
“But now that my bladder is doing better I guess I am kind of reaching for material, because I did write a lot about it for my standup routine.”