An Integrative Approach to the common inflammatory bladder condition from an East/West perspective.
Interstitial Cystitis is a chronic condition of the bladder discomfort and pain, can be debilitating and has no clear etiology. According to the Rand IC epidemiology study, it is estimated that approximately 3- 8 million women in the United States suffer from some form of interstitial cystitis. The symptoms of IC include painful difficult urination, pelvic pain, painful sex, burning urination among other associated inflammatory symptoms. Symptoms must persist for over six weeks and must not occur with any sign of infection or known cause to be diagnosed as interstitial cystitis. The diagnosis of this condition was originally based on the following symptoms: bladder pain, urinary urgency, and evidence of bladder pathology by cystoscopy under anesthesia. However, now the criteria for diagnosis varies and there is no uniform way to diagnose the disease. Physiological changes in the bladder, pelvis, and peripheral/central nervous system are often present. Structural pathology includes inflammatory infiltrate, granulation tissue, mastocytosis, intrafasicular fibrosis, reduced bladder capacity and Hunner’s Ulcers.
IC/PBS is not only a urological condition, but also a gynecological, neurogenic, and gastrointestinal related condition.
Common concurrent diseases include IBS, pelvic floor pathology, anxiety and depression, dyspareunia and fibromyalgia . Research done to identify the etiology of IC/PBS have led scientists to believe the disease is multifactorial and can include both genetic and environmental factors. The most definitive theory of the etiology of IC lies in the idea of bladder wall epithelial dysfunction, bladder sensory nerve dysfunction and the activation of mast cells resulting in the condition. Changes in the urothelial surface and alteration in it’s permeability leads to the activation of mast cells, increased urea absorption, changes in the barrier function of the urothelium and the overall weakening of the bladder function. In many cases, prior bacterial infection leads to bacteria becoming sequestered within urothelial cells causing further impairment of permeability. Interstitial cystitis is also classified as a neuro-inflammatory condition. Mastocytosis occurs in 30-65% of IC patients and many patients present with increased levels of histamine, histamine metabolites and tryptase. IC/PBS also has many features of an autoimmune disease in terms of chronicity, flare ups, remissions, positive response to steroids, and high anti- nuclear antibodies.
There are a number of pharmacological treatments used for this condition, with limited success. These treatments include:
Tricyclic Antidepressants-( Most commonly prescribed) Taken in low doses, it can relax the bladder and intercept neuro-chemicals that cause bladder pain.
Pentosan Polysulfate (Elmiron)- The only oral medication approved by the FDA to treat IC. Can potentially improve the bladder lining, reduce inflammation. Must be taken for 3-6 months to possibly take full effect yet statistically proves to be ineffective in many patients.
Antihistamines- Interfere with the mast cell’s release of histamine, relieve inflammation.
Pain Medication ( NSAID/ Acetaminophen) - Temporarily relieve mild to moderate pain.
Dimethyl Sulfoxide- An intravesical therapy/ bladder instillation in which the exact mechanism of action remains largely unknown. It is thought to reduce bladder inlammation, act as anti spasmodic, and relieve pain. Because of its ability to penetrate the bladder lining, it can also aid in the delivery and absorption of other bladder instilled medication such as steroids, heparin, and analgesics.
Hyaluronic Acid ( Cystistat)- Administered in instillations intravesicularly weekly for four weeks or until symptoms improve. It can act to reduce inflammation and improve the urothelium.
Vaginal Valium Suppository- Used to relax the muscles in the pelvic region.
Other treatments of Interstitial Cystitis( PBS) include:
Hydrodistention Therapy ( Also a diagnostic method) - Procedure performed with cystoscopy as an outpatient procedure under regional or general anesthesia. Bladder is filled to a high pressure with fluid causing the bladder wall to stretch. In this state, pathological changes can easily be inspected. This procedure may work to reduce pain and discomfort in some patients.
Transcutaneous Electrical Nerve Stimulation (TENS)- A device worn on the body producing electrical impulses delivered to the body through small adherent pads which is thought to modify pain pathways.
InterStim- Implantable device that directly stimulates the sacral nerves and improves bladder function while reducing pain
Dietary plans/ modifications - An Anti- inflammatory diet. Increasing the PH of the urine to reduce bladder irritation. Eliminating foods that cause a flare of symptoms. Reducing acidic foods and foods that are high is arylalkylamines.
Neutraceutical Therapy- Such as L- Arginine, Quercetin, Probiotics, Calcium glycerophosphate, and other herbal treatment
Bladder Training - self control techniques to suppress the urge to urinate and lengthening the time between the urge to void.
Full body Massage/ Transvaginal massage- focusing on the levator ani, obturator interns, piriformis muscles and trigger points to relax the muscular structure surrounding the bladder. Full body massage is also been pr