A 25 year journey from personal pain to revolutionary understanding

A woman walks into my London clinic, clutching a thick folder of medical reports and test results. She's been to countless specialists, had invasive procedures, tried multiple medications. Her bladder controls her life—constant pain, urgent trips to the bathroom, sleepless nights. She describes feeling like she's "living in a prison."

But here's what strikes me most: it's not just her symptoms, it's her story. Time and time again, patients trace their bladder problems back to a period of intense stress—a messy divorce, losing a parent, redundancy, or memories of childhood trauma suddenly resurfacing.

After 15 years of practice and treating hundreds of patients with interstitial cystitis (IC) and overactive bladder (OAB), I've reached a conclusion that's changing how I approach these conditions entirely. Some may see this as controversial but as a clinician I follow the evidence I see in my practice.

My Own Journey: From Patient to Practitioner

This work is deeply personal to me.  My own struggle with IC began in my teenage years, and it was this personal healing journey through acupuncture that not only resolved my symptoms but completely changed my career path. I decided to become and acupuncturist, completing another degree and year of clinical supervision in the process of gaining my licence.

Having walked in my patients' shoes, I understand the frustration, the way these symptoms can make you feel like your body has betrayed you. But I also know there's hope—real, lasting hope—when we start looking in the right place for answers.

The Childhood Trauma Connection: What the Numbers Tell Us

Over the past three years, I've systematically assessed all my patients using something called the Adverse Childhood Experiences (ACE) questionnaire. ACEs measure exposure to childhood trauma—not just severe abuse, but things like parental divorce, emotional neglect, having an emotionally unavailable parent, or growing up with family mental illness or addiction.

When I finally analysed the results - It stopped me in my tracks. 

While the average person in the UK has an ACE score of 1, my patients with bladder symptoms averaged 4, with the most common score being 4.8. This aligns perfectly with research showing that 78% of patients with chronic pelvic pain syndrome have experienced at least one adverse childhood experience (Schrepf et al., 2018), and women with IC have significantly higher rates of childhood sexual trauma compared to healthy women (Nickel et al., 2011).

We are already aware that severe shock or psychological trauma can result in loss of bladder control in both humans and animals and the pathway from extreme psychological stress to bladder irritation had always seemed plausible to me.

But here's what most people don't realise: when we think of trauma, we often picture war zones or severe abuse. The truth is, a child's nervous system can be deeply affected by much more common experiences. Feeling unsafe in your own home due to constant arguing, having parents who were emotionally distant, being consistently criticised, or dealing with family chaos due to addiction or mental and physical illness—these all register as threats to a developing nervous system.

Most significantly, when I ask patients directly, the vast majority tell me they never truly felt safe as children or that love and affection were conditional or inconsistent.

I believe this is a key factor and the foundation for an imbalanced nervous system.

The Science: How Trauma Lives in Your Body

So how does childhood trauma end up as adult bladder symptoms? The answer lies in understanding what trauma does to your nervous system.

Dr. Stephen Porges' groundbreaking polyvagal theory explains how we respond to threats through a hierarchy: first trying to connect socially, then fight or flight, and finally—when escape seems impossible—we go into what's called a "freeze response" (Porges, 2007).

In my practice, most patients with IC and OAB report that their symptoms started after events that triggered this freeze response—feeling trapped in impossible situations with no way out. Often the person is not actually stuck in their life but the perception of being trapped is enough- perhaps in a job, marriage, fincancial or family dynamic.

This freeze state isn't just psychological—it creates profound biological changes:

Your Stress System Goes Haywire

Early life stress fundamentally alters your hypothalamic-pituitary-adrenal (HPA) axis—your body's main stress response system (van Bodegom et al., 2017). This creates a cascade where normal life stresses trigger overwhelming physical responses, including increased bladder sensitivity.

Your Nervous System Gets Stuck "On"

Research shows that 65% of studies on conditions like fibromyalgia, chronic fatigue, IBS, and IC found evidence of sympathetic nervous system overdrive (Martínez-Martínez et al., 2014). Essentially, these patients' nervous systems are stuck in chronic alert mode. This explains why psychological stress correlates so strongly with bladder symptom severity (Lai et al., 2015).

Your Pain Processing Changes

Trauma creates something called "central sensitisation"—where your nervous system becomes hypervigilant and amplifies pain signals from normal bodily sensations (Grundy et al., 2018). This means you can experience severe pain from a normally full bladder or feel desperate urgency from minimal bladder filling.

Your Gut-Brain-Bladder Connection Breaks Down

The freeze response doesn't just affect your brain—it fundamentally changes your gut bacteria and digestive function (Farzi et al., 2018). Through something called the gut-brain axis, this disruption extends to affect the mucosal lining of your bladder, creating inflammation and sensitivity.  I think this is where food sensitivities come into play.  The bladder becomes inflamed and sensitive.  People often have irritable bowel syndrome (IBS) alongside IC or OAB and in the same way I believe that the bladder is also irritable.

Your Pelvic Floor Holds the Freeze State

Trauma creates chronic muscle tension, especially in the pelvic floor. Studies show women with abuse histories have significantly higher rates of pelvic floor problems (Cichowski et al., 2015; Beck et al., 2009). Often there is chronic tension in the pelvic floor in my patients. This chronic tension contributes directly to urinary retention and pain—your body literally holding the protective stance long after the danger has passed.

The PTSD Connection: When Past and Present Collide

Here's a staggering statistic: 42% of IC patients meet the criteria for PTSD—that's five times higher than the general population and twice as high as other chronic pain conditions (McKernan et al., 2019).

Patients with both IC and PTSD show significantly higher pain levels, more widespread symptoms, and poorer quality of life. This isn't coincidence—it's evidence that these bladder conditions are often manifestations of unresolved trauma living in the body.

Why This Changes Everything

If IC and OAB are primarily nervous system disorders rather than bladder diseases, everything changes. It explains:

1. Why bladder biopsies often show minimal abnormalities

2. Why conventional treatments have limited long-term success

3. Why these conditions commonly occur with fibromyalgia, IBS, and other "unexplained" syndromes

4. Why symptoms often get worse during stress

5. Why many patients can pinpoint exactly when their symptoms started

Most importantly, it explains why addressing the nervous system can lead to rapid, lasting recovery.

The Treatment Revolution: Healing the Nervous System

According to the NHS patient information website  “Treatments for Interstitial Cystitis” (September 2025)

“No single treatment works for everyone, and there is no conclusive evidence they work. You may need to try several treatments to find one that works for you.”

So far, this is the best that conventional medicine has to offer. However I believe this is because it is viewing these conditions in isolation as a bladder problem.

My holistic method

Over the past three years, using a holistic framework that addresses nervous system Imbalance:

94% of my patients have shown symptom improvement,

with

59% achieving complete resolution of symptoms within just 12 weeks.

Nervous systems can rebalance relatively quickly when given the right support.

The Three Tools I recommend for Recovery

1. Nervous System Regulation

The cornerstone involves helping patients move from the freeze response into a state of safety. This isn't achieved through talk therapy alone—nervous system imbalance creates biological changes that require body-based interventions including:

• Identifying personal safety cues

• Learning to recognise nervous system states

• Learning how to process emotional blocks

• Developing tools to self-regulate

This is the most important step towards recovery.  Learning how to train your nervous system can be achieved in person or via online appointments.

2. Acupuncture for Neurological Reset

Research shows acupuncture directly modulates nervous system function, affecting both sympathetic and parasympathetic branches (Li et al., 2013). It works by promoting adenosine release, which binds to receptors producing natural pain relief (Goldman et al., 2010). Rather than just managing symptoms, acupuncture helps reset the dysregulated nervous system patterns underlying these conditions.

Acupuncture is not essential to heal.  It just makes the process faster. (Not all acupuncturists are trained in how do do this. Make sure the person you see is fully qualified and insured.)

3. Trauma-Informed Pelvic Floor Work

Instead of traditional strengthening exercises (which often worsen these conditions), treatment focuses on releasing chronic tension through breathing techniques, conscious relaxation, and gentle manual therapy.

Pelvic floor therapy by a practitioner is not essential however learning exercises how to relax and retrain the pelvic floor is important for optimal recovery.

The Mind-Body Connection in Action

Research supports these body-based approaches. Carrico et al. (2008) found that guided imagery—a simple relaxation technique—significantly improved both pain and urinary symptoms in IC patients. This demonstrates how directly addressing nervous system regulation can create rapid physical improvements.

A Message of Hope

If you're reading this and recognising yourself in these descriptions, please know: your body isn't broken. It's not "all in your head." Your symptoms are real, valid responses to real experiences. Your nervous system has been trying to protect you, but it's become stuck in old patterns that no longer serve you.

The trauma-informed model recognises your symptoms as adaptive responses to adverse experiences. And here's the beautiful truth: nervous systems can heal. With the right support and approach, your body can learn to feel safe again.

This doesn't mean dismissing conventional medical care—always work with qualified healthcare providers. But it does mean expanding our understanding of what these conditions truly represent: not diseases of the bladder, but cries for help from a nervous system stuck in survival mode.

Looking Forward

This paradigm shift is just beginning. As more research validates trauma-informed approaches to IC and OAB, we're moving towards more effective, compassionate treatment that addresses root causes rather than just managing symptoms.

For the healthcare community, this means incorporating trauma screening, understanding nervous system physiology, and creating treatment environments that promote safety and healing rather than retraumatisation.

For patients, it means hope. Real, tangible hope for recovery and reclaiming your life.

Your healing journey might start with understanding that your symptoms make perfect biological sense given your experiences. From there, with the right support, your nervous system can learn new patterns—patterns of safety, regulation, and peace.

If this resonates with you, consider working with practitioners who understand the trauma-nervous system connection. Your body has been holding your story—now it's time to help it write a new chapter.

Esther Holford (BSc (Hons), BA (Hons), MBAcC, Lic Ac) has practiced acupuncture in London for over 15 years, specialising in chronic pain and trauma-related conditions. 

This article represents clinical observations and should not replace professional medical advice. Always consult with qualified healthcare providers before making treatment decisions.

References

Anderson, R.U., Orenberg, E.K., Chan, C.A., Morey, A. and Flores, V. (2009) 'Psychometric profiles and hypothalamic-pituitary-adrenal axis function in men with chronic prostatitis/chronic pelvic pain syndrome', The Journal of Urology, 181(6), pp. 2466-2472.

Beck, J.J.H., Elzevier, H.W., Pelger, R.C.M. and Putter, H. (2009) 'Multiple pelvic floor complaints are correlated with sexual abuse history', The Journal of Sexual Medicine, 6(11), pp. 3176-3184.

Carrico, D.J., Peters, K.M. and Diokno, A.C. (2008) 'Guided imagery for women with interstitial cystitis: results of a prospective, randomized controlled pilot study', Journal of Alternative and Complementary Medicine, 14(1), pp. 53-60.

Cichowski, S.B., Dunivan, G.C., Komesu, Y.M. and Rogers, R.G. (2015) 'Sexual abuse history and pelvic floor disorders in women', Obstetrics & Gynecology, 125(2), pp. 399-406.

Farzi, A., Fröhlich, E.E. and Holzer, P. (2018) 'Gut microbiota and the neuroendocrine system', Neurotherapeutics, 15(1), pp. 5-22.

Goldman, N., Chen, M., Fujita, T., Xu, Q., Peng, W., Liu, W., Jensen, T.K., Pei, Y., Wang, F., Han, X., Chen, J.F., Schnermann, J., Takano, T., Bekar, L., Tieu, K. and Nedergaard, M. (2010) 'Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture', Nature Neuroscience, 13(7), pp. 883-888.

Grundy, L., Caldwell, A. and Brierley, S.M. (2018) 'Mechanisms underlying overactive bladder and interstitial cystitis/painful bladder syndrome', Frontiers in Neuroscience, 12, p. 931.

Lai, H., Gardner, V., Vetter, J. and Andriole, G.L. (2015) 'Correlation between psychological stress levels and the severity of overactive bladder symptoms', BMC Urology, 15(1), p. 14.

Li, Q.Q., Shi, G.X., Xu, Q., Wang, J., Liu, C.Z. and Wang, L.P. (2013) 'Acupuncture effect and central autonomic regulation', Evidence-Based Complementary and Alternative Medicine, 2013, p. 267959.

Martínez-Martínez, L.A., Mora, T., Vargas, A., Fuentes-Iniestra, M. and Martínez-Lavín, M. (2014) 'Sympathetic nervous system dysfunction in fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and interstitial cystitis: A review of case-control studies', Journal of Clinical Rheumatology, 20(3), pp. 146-150.

McKernan, L.C., Johnson, B.N., Reynolds, W.S., Williams, D.A., Cheavens, J.S., Dmochowski, R.R. and Crofford, L.J. (2019) 'Posttraumatic stress disorder in interstitial cystitis/bladder pain syndrome: Relationship to patient phenotype and clinical practice implications', Neurourology and Urodynamics, 38(1), pp. 353-362.

Nickel, J.C., Tripp, D.A., Pontari, M., Moldwin, R., Mayer, R., Carr, L.K., Doggweiler, R., Yang, C.C., Mishra, N. and Nordling, J. (2011) 'Childhood sexual trauma in women with interstitial cystitis/bladder pain syndrome: a case-control study', Canadian Urological Association Journal, 5(6), pp. 410-415.

Porges, S.W. (2007) 'The polyvagal perspective', Biological Psychology, 74(2), pp. 116-143.

Schrepf, A., Naliboff, B., Williams, D.A., Stephens-Shields, A.J., Landis, J.R., Gupta, A., Mayer, E., Rodriguez, L.V., Lai, H., Luo, Y., Bradley, C., Kreder, K. and Lutgendorf, S.K. (2018) 'Adverse childhood experiences and symptoms of urologic chronic pelvic pain syndrome: A multidisciplinary approach to the study of chronic pelvic pain research network study', Annals of Behavioral Medicine, 52(10), pp. 865-877.

van Bodegom, M., Homberg, J.R. and Henckens, M.J.A.G. (2017) 'Modulation of the hypothalamic-pituitary-adrenal axis by early life stress exposure', Frontiers in Cell Neuroscience, 11, p. 87.