No AccessJournal of UrologyInvestigative Urology1 Sep 2014

Alterations in Resting State Oscillations and Connectivity in Sensory and Motor Networks in Women with Interstitial Cystitis/Painful Bladder Syndrome

    View All Author Information


    The pathophysiology of interstitial cystitis/painful bladder syndrome remains incompletely understood but is thought to involve central disturbance in the processing of pain and viscerosensory signals. We identified differences in brain activity and connectivity between female patients with interstitial cystitis/painful bladder syndrome and healthy controls to advance clinical phenotyping and treatment efforts for interstitial cystitis/painful bladder syndrome.

    Materials and Methods:

    We examined oscillation dynamics of intrinsic brain activity in a large sample of well phenotyped female patients with interstitial cystitis/painful bladder syndrome and female healthy controls. Data were collected during 10-minute resting functional magnetic resonance imaging as part of the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network project. The blood oxygen level dependent signal was transformed to the frequency domain. Relative power was calculated for multiple frequency bands.


    Results demonstrated altered frequency distributions in viscerosensory (post insula), somatosensory (postcentral gyrus) and motor regions (anterior paracentral lobule, and medial and ventral supplementary motor areas) in patients with interstitial cystitis/painful bladder syndrome. Also, the anterior paracentral lobule, and medial and ventral supplementary motor areas showed increased functional connectivity to the midbrain (red nucleus) and cerebellum. This increased functional connectivity was greatest in patients who reported pain during bladder filling.


    Findings suggest that women with interstitial cystitis/painful bladder syndrome have a sensorimotor component to the pathological condition involving an alteration in intrinsic oscillations and connectivity in a cortico-cerebellar network previously associated with bladder function.


    • 1 : Prevalence of symptoms of bladder pain syndrome/interstitial cystitis among adult females in the United States. J Urol2011; 186: 540. LinkGoogle Scholar
    • 2 : Male and female pelvic pain disorders—is it all in their heads?. J Urol2008; 179: 813. LinkGoogle Scholar
    • 3 : Functional pain disorders: time for a paradigm shift?. In: Functional Pain Syndromes: Presentation and Pathophysiology. Seattle: IASP Press2009. Google Scholar
    • 4 : Brain functional and anatomical changes in chronic prostatitis/chronic pelvic pain syndrome. J Urol2011; 186: 117. LinkGoogle Scholar
    • 5 : Validation of a modified National Institutes of Health chronic prostatitis symptom index to assess genitourinary pain in both men and women. Urology2009; 74: 983. Google Scholar
    • 6 : DPARSF: a MATLAB toolbox for “pipeline” data analysis of resting-state fMRI. Front Syst Neurosci2010; 4: 13. Google Scholar
    • 7 : REST: a toolkit for resting-state functional magnetic resonance imaging data processing. PLoS One2011; 6: e25031. Google Scholar
    • 8 : The oscillating brain: complex and reliable. Neuroimage2010; 49: 1432. Google Scholar
    • 9 : Neuronal oscillations in cortical networks. Science2004; 304: 1926. Google Scholar
    • 10 : An improved approach to detection of amplitude of low-frequency fluctuation (ALFF) for resting-state fMRI: fractional ALFF. J Neurosci Methods2008; 172: 137. Google Scholar
    • 11 : Sex-related differences of cortical thickness in patients with chronic abdominal pain. PLoS One2013; 8: e73932. Google Scholar
    • 12 : The neural control of micturition. Nat Rev Neurosci2008; 9: 453. Google Scholar
    • 13 : Brain activity during bladder filling and pelvic floor muscle contractions: A study using functional magnetic resonance imaging and synchronous urodynamics. Int J Urol2014; 21: 169. Google Scholar
    • 14 : A PET study on brain control of micturition in humans. Brain1997; 120: 111. Google Scholar
    • 15 : Voluntary pelvic floor muscle control—an fMRI study. Neuroimage2006; 31: 1399. Google Scholar
    • 16 Brett M, Anton JL, Valabregue R et al: Region of interest analysis using an SPM toolbox. Presented at International Conference on Functional Mapping of the Human Brain, Sendai, Japan, June 2-6, 2002. Google Scholar
    • 17 : Significance of the insula for the evolution of human awareness of feelings from the body. Ann N Y Acad Sci2011; 1225: 72. Google Scholar
    • 18 : Central autonomic innervation of the lower urinary tract—a neuroanatomy study. World J Urol1998; 16: 417. Google Scholar
    • 19 : Extrapyramidal inhibition of the urinary bladder. Brain Res1967; 4: 301. Google Scholar
    • 20 : Nerve growth factor of red nucleus involvement in pain induced by spared nerve injury of the rat sciatic nerve. Neurochem Res2009; 34: 1612. Google Scholar
    • 21 : The cerebellum and pain: passive integrator or active participator?. Brain Res Rev2010; 65: 14. Google Scholar
    • 22 : The primate cortico-cerebellar system: anatomy and function. Nat Rev Neurosci2006; 7: 511. Google Scholar
    • 23 : Gating of sensory information differs in patients with interstitial cystitis/painful bladder syndrome. J Urol2010; 184: 958. LinkGoogle Scholar
    • 24 : Anatomical and Functional Assemblies of Brain BOLD Oscillations. J Neurosci2011; 31: 7910. Google Scholar
    • 25 : Distinct superficial and deep laminar domains of activity in the visual cortex during rest and stimulation. Front Syst Neurosci2010; 4: 31. Google Scholar
    • 26 : Prevalence of pelvic floor dysfunction in patients with interstitial cystitis. Urology2007; 70: 16. Google Scholar
    • 27 : Myofascial pain and pelvic floor dysfunction in patients with interstitial cystitis. Int Urogynecol J2011; 22: 413. Google Scholar
    • 28 : Alterations in the pelvic floor musculature on pelvic MRI in patients with interstitial cystitis. J Urol2012; 187: e337. LinkGoogle Scholar
    • 29 : Randomized multicenter clinical trial of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome and pelvic floor tenderness. J Urol2012; 187: 2113. LinkGoogle Scholar