Interstitial Cystitis

Allergy, Women's Health | October 22, 2016 | Author: Naturopath

Interstitial Cystitis

Interstitial cystitis (also called painful bladder syndrome) is a chronic condition causing inflammation of the bladder. The increase in bladder pressure can cause very frequent, painful urination. Bladder and pelvic pain can also be present which can range from mild discomfort to severe. It is differentiated from cystitis as infectious organisms are not usually found in the urine. Typically, middle-aged women are affected and the exact cause as to why it occurs is unknown. Naturopathic practices aim to reduce bladder inflammation, urinary frequency and pain levels and reduce common dietary irritants which are known to exacerbate the symptoms.

What are the symptoms?

The symptoms of interstitial cystitis can vary in severity from person to person. Some people report periods of time where they are symptom free. Common triggers such as sitting for long periods, exercise, menstruation, sexual activity, urinary tract infections, dietary irritants and stress can cause a flare up. Common symptoms include the following:

  • Chronic pelvic pain
  • A persistent, urgent need to urinate
  • Frequent urination, often of very small amounts
  • Pain or discomfort when the bladder fills with urine and relief after emptying
  • Pain during sexual intercourse

Risk Factors

The following factors are associated with an increase in risk of interstitial cystitis:

  • Gender: Women are often diagnosed more than males
  • Genes: Having fair skin, sensitive skin and red hair has been associated with a higher risk
  • Age: Most people are diagnosed in their 30’s or later
  • Accompanying disorders: Interstitial cystitis may be associated with other conditions including endometriosis, fibromyalgia, asthma, allergies, migraine headaches and irritable bowel syndrome

Causes of Interstitial cystitis

The exact cause of interstitial cystitis still remains unknown but researchers have identified a few factors that may contribute to its development. It is believed that a trigger such as bladder or spinal trauma, cystitis, bladder over-distention, autoimmune disorder, pelvic floor muscle dysfunction or hypersensitivity or inflammation of pelvic nerves may initially damage the bladder lining and lead to interstitial cystitis. Damage to the bladder wall then allows articles including potassium to leak into the bladder wall causing further damage and nerve pain. Further studies have identified that individuals with interstitial cystitis produce a protein called antiproliferative factor which prevents normal repair of the bladder lining.

How to get relief

Acupuncture can help improve the flow of energy through the body and reduce pain levels. 

During a session small needles are placed in your skin at specific points on your body.

Guided Imagery can be utilized by employing the power of one’s mind to promote repair, decrease pain and reduce urinary urgency.

The therapy involves visualization techniques and direct suggestion using imagery. A recent study found guided imagery a beneficial tool for women with interstitial cystitis, with more than 45% of participants having a moderate or marked improvement in their pain levels and episodes of urinary urgency.

Physical therapy may help to relieve pelvic pain that is associated with muscle tenderness, restrictive connective tissue or muscle abnormalities in your pelvic floor.

Myofascial physical therapy has been shown to reduce pain levels, urinary urgency and urinary frequency in women with interstitial cystitis.

Transcutaneous electrical nerve stimulation (TENS) machine uses mild electrical impulses to strengthen the muscles that control the bladder, reduce pain and in some cases reduce urinary frequency.

Bladder training techniques involve training the bladder to wait longer intervals between emptying. Start with every half hour and slowly increase the time between bathroom visits. Use relaxation and breathing techniques or distract yourself with other activities to reduce the feeling of urgency.

Other self-care activities include drinking 2L of filtered water daily, wearing loose clothing, exercise, avoid smoking and reduce stress.

Dietary Changes

Avoid common bladder irritants such as:

  • carbonated drinks
  • alcohol
  • caffeine
  • citrus
  • spicy foods
  • tomatoes 
  • vinegar

Arylalkylamine-containing foods have also been implicated in exacerbating the symptoms of interstitial cystitis and include:

  • bananas
  • cheese
  • beer
  • nuts
  • aspartame (an artificial sweetener)
  • onions
  • raisins
  • sour cream
  • wine
  • yoghurt
  • mayonnaise.

It might also be helpful to keep a diary of foods and drinks consumed to identify any food triggers.

For severe interstitial cystitis it may be advisable to embark on an elimination diet for a more thorough identification of foods that worsen symptoms.

Nutraceuticals

Substances that are naturally derived from food sources and provide extra health benefits by affecting the body’s physiology are referred to as nutraceuticals. The following nutraceuticals have been utilised in the treatment of interstitial cystitis.

Calcium Glycerophosphate helps to reduce the effects of acidic foods in the body. A prospective, nonrandomized study found that calcium glycerophosphate, when taken immediately before the ingestion of symptom exacerbaters, reduced urgency and pain levels in individuals with interstitial cystitis.

L-arginine is an essential amino acid that increases the production of nitric oxide and nitric oxide synthetase. Both these substances have antibacterial properties, relax smooth muscles and modulate the immune system. A randomized, double-blind trial of oral L-arginine in interstitial cystitis patients found a significant decrease in pain, urinary frequency and nocturia (frequent urination at night).

Mucopolysaccarides found in herbs may also benefit people with interstitial cystitis by replenishing the defective glycosaminoglycan layer at the mucosal surface of the bladder.

Naturally occurring mucopolysaccarides in herbs and foods include licorice, marshmallow, aloe vera, oats and slippery elm. In a small study, 12 patients with interstitial cystitis took three 600mg of freeze-dried aloe vera concentrate twice a day. 7 of the 8 patients who completed the trial after 3 months reported a significant reduction in their symptoms.

Glycyrrhizin (a compound extracted from licorice) has also been shown to reduce abdominal hypersensitivity, thus playing a role in reducing pain levels.

Quercetain, a bioflavanoid naturally found in foods, inhibits histamine release from mast cells and has anti-inflammatory and anti-oxidant properties. A small study found 57% of participants who took 500mg of quercetain twice a day for four weeks had a significant decrease in their symptoms and pain levels.

Turmeric also posseses strong anti-inflammatory and antioxidant properties which may be helpful in reducing bladder inflammation and the associated pain.

Conclusion

Alternative therapies are a quintessential addition to the treatment of interstitial cystitis by implementing

  • dietary changes
  • nutraceuticals
  • bladder training
  • acupuncture
  • neuromodulation
  • physical therapy.

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References

  • http://www.mayoclinic.org/diseases-conditions/interstitial-cystitis/symptoms-causes/dxc-20251948
  • http://www.ichelp.org/
  • Keay SK, Zhang CO. Abnormal Akt signalling in bladder epithelial cell explants from patients with interstitial cystitis/bladder pain syndrome can be induced by antiproliferative factor treatment of normal bladder cells. BJU Int. 2016 Jul;118(1):161-72
  • https://www.ncbi.nlm.nih.gov/pubmed/26919663
  • Carrico DJ, et al. Guided imagery for women with interstitial cystitis: results of a prospective, randomized controlled pilot study. J Altern Complement Med. 2008 Jan-Feb;14(1):53-60
  • https://www.ncbi.nlm.nih.gov/pubmed/18199015
  • FitzGerald MP, et al. Randomized multicenter clinical trial of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome and pelvic floor tenderness. J Urol. 2012 Jun;187(6):2113-8
  • https://www.ncbi.nlm.nih.gov/pubmed/22503015
  • Whitmore KE. Complementary and alternative therapies as treatment approaches for interstitial cystitis. Rev Urol. 2002;4(Suppl 1):S28-S35
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1476005/
  • Kouzoukas DE, et al. Protease-Activated Receptor 4 Induces Bladder Pain through High Mobility Group Box-1. PLoS One. 2016 Mar 24;11(3):e0152055
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4806866/
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