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Interstitial Cystitis: Nutritional Medicine Solution
Ronald Grisanti D.C., D.A.B.C.O., M.S.
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Interstitial cystitis (IC) is a chronic painful urinary bladder disorder distinguished by thinning or ulceration of the lining of the bladder.

The classic symptoms include urinary frequency and pain above the pubic region. People may experience mild discomfort, pressure, tenderness, or intense pain in the bladder and pelvic area.

Symptoms may include an:

  • urgent need to urinate (urgency)
  • frequent need to urinate (frequency)
  • or a combination of these symptoms.

    In IC, the bladder wall may be irritated and become scarred or stiff. A common diagnostic procedure called cystoscopy will frequently find Hunner's ulcers or glomerulations (pinpoint bleeding). These are present in 90 percent of patients with IC.

    Some people with IC find that their bladders cannot hold much urine, which increases the frequency of urination.

    People with severe cases of IC may urinate as many as 60 times a day.

    What are some of the types of IC?

    IC symptoms and severity vary greatly. It is believed that it may be several diseases, not just one. Two types of IC are usually diagnosed and listed below:

    • Non-ulcerative IC: this is the most common type of IC, and usually affects young to middle-age women who have a normal, near normal, or increased bladder capacity. Glomerulations can be seen in the bladder wall.

    • Ulcerative IC: this type of IC tends to be found in middle-age to older women who have low bladder capacity (less than 1 1/2 cups). The decrease is thought to result in part from fibrosis, which makes the bladder stiff and small. Cracks, scars, and Hunner's ulcers (star-shaped sores) in the bladder wall may bleed when the bladder is filled to capacity during a cystoscopy.

      Ruling out other Conditions

      Because symptoms are similar to those of other disorders of the urinary system and because there is no definitive test to identify IC, doctors must rule out other conditions before considering a diagnosis of IC. Among these disorders are:

    • urinary tract infections
    • vaginal infections
    • bladder cancer
    • bladder inflammation or infection caused by radiation to the abdomen
    • eosinophilic and tuberculous cystitis
    • kidney stones
    • endometriosis
    • neurological disorders
    • sexually transmitted diseases
    • low-count bacteriuria
    • in men, chronic bacterial or non-bacterial prostatitis

      What causes IC?

      One theory being studied is that IC is an autoimmune response following a bladder infection.

      Another theory is that a bacteria pathogen may be present in bladder cells but not detectable through routine urine tests. Three such bacteria are Chlamydia, Enterococcus and Micrococcus.

      Another Major Discovery

      Medical studies have discovered that the bladder cells of IC patients contain a toxin called APF, or antiproliferative factor. APF appears to decrease levels of HB-EGF, a growth factor that helps to repair a damaged bladder lining.

      start quoteMedical studies have discovered that the bladder cells of IC patients contain a toxin called APF, or antiproliferative factor. APF appears to decrease levels of HB-EGF, a growth factor that helps to repair a damaged bladder lining.end quote
      -- BMC Urol. 2004 Apr 06;4(1):3

      How is IC diagnosed?

      Medical tests that help identify other conditions often include:

    • urinalysis and urine culture - tests that can detect and identify the most common organisms in the urine that may be causing symptoms.

    • cystoscopy - use of a cystoscope -- an instrument made of a hollow tube about the diameter of a drinking straw with several lenses and a light -- to see inside the bladder and urethra to detect inflammation; a thick, stiff bladder wall; Hunner's ulcers; and glomerulations (pinpoint bleeding) that may be seen only after the bladder is stretched.



    • biopsy of the bladder wall - for a microscopic examination of tissue to rule out bladder cancer and confirm bladder wall inflammation.

      What are the treatments for IC?

      Conventional Medical Approach

      Bladder Distention
      Because many patients have noted an improvement in symptoms after a bladder distention has been done to diagnose IC, the procedure is often thought of as one of the first treatment attempts.

      Researchers are not sure why distention helps, but some believe that it may increase capacity and interfere with pain signals transmitted by nerves in the bladder. Symptoms may temporarily worsen 24 to 48 hours after distention, but should return to predistention levels or improve after 2 to 4 weeks.

      Bladder Instillation

      Bladder instillation (may also be called a bladder wash or bath) - the bladder is filled with a solution that is held for varying periods of time, from a few seconds to 15 minutes, before being drained through a catheter. The only drug approved by the US Food and Drug Administration (FDA) for bladder instillation is dimethyl sulfoxide (DMSO, RIMSO-50).

      Oral Drugs Pentosan polysulfate sodium (Elmiron)

      This first oral drug developed for IC was approved by the FDA in 1996. In clinical trials, the drug improved symptoms in 38 percent of patients treated. Doctors do not know exactly how it works, but one theory is that it may repair defects that might have developed in the lining of the bladder.

      Documented Side Effects:

      Alopecia, diarrhea, nausea,headache, rash, dyspepsia, abdominal pain, liver function abnormalities, dizziness, vomiting, mouth ulcer, colitis, esophagitis, gastritis, flatulence, constipation, anorexia, gum hemorrhage, anemia, ecchymosis, increased prothrombin time, increased partial, thromboplastin time, leukopenia, thrombocytopenia, allergic reaction, photosensitivity, pharyngitis, rhinitis, epistaxis, dyspnea, pruritus, urticaria, conjunctivitis, tinnitus, optic neuritis, amblyopia, retinal hemorrhage.

      Deaths occurred in 6 out of 2627 (0.2%) patients who received the drug over a period of 3 to 75 months.

      Transcutaneous Electrical Nerve Stimulation

      With transcutaneous electrical nerve stimulation (TENS), mild electric pulses enter the body for minutes to hours two or more times a day either through wires placed on the lower back or just above the pubic area, between the navel and the pubic hair, or through special devices inserted into the vagina in women or into the rectum in men.

      Although scientists do not know exactly how TENS relieves IC pain, it has been suggested that the electrical pulses may increase blood flow to the bladder, strengthen pelvic muscles that help control the bladder, or trigger the release of substances that block pain.

      It has been most helpful in relieving pain and decreasing frequency in patients with Hunner's ulcers. Smokers do not respond as well as nonsmokers. If TENS is going to help, improvement is usually apparent in 3 to 4 months.

      Bladder Training

      Bladder Training bladder training - patient voids at designated times and uses relaxation techniques and distractions to help keep to the schedule. Gradually, the patient tries to lengthen the time between the scheduled voids.

      Surgery

      Many approaches and techniques are used, each of which has its own advantages and complications that should be discussed with a surgeon. Surgery should be considered only if all available treatments have failed and the pain is disabling.

      Two procedures--fulguration and resection of ulcers--can be done with instruments inserted through the urethra. Fulguration involves burning Hunner's ulcers with electricity or a laser. When the area heals, the dead tissue and the ulcer fall off, leaving new, healthy tissue behind.

      Resection involves cutting around and removing the ulcers. Both treatments are done under anesthesia and use special instruments inserted into the bladder through a cystoscope. Laser surgery in the urinary tract should be reserved for patients with Hunner's ulcers and should be done only by doctors who have had special training and have the expertise needed to perform the procedure.

      Another surgical treatment is augmentation, which makes the bladder larger. In most of these procedures, scarred, ulcerated, and inflamed sections of the patient's bladder are removed, leaving only the base of the bladder and healthy tissue. A piece of the patient's colon (large intestine) is then removed, reshaped, and attached to what remains of the bladder. After the incisions heal, the patient may void less frequently. The effect on pain varies greatly; IC can sometimes recur on the segment of colon used to enlarge the bladder.

      Alternative Medical Treatment Solutions:

      Avoidance of Aggravating Food

      For some people, the pain and other negative effects of the condition may be aggravated by a variety of foods. The list can be very long but some of the commonly mentioned ones include tomatoes, spices, chocolate, caffeinated and citrus beverages, high-acid foods and artificial sweeteners.

      Arginine

      Arginine is well documented amino acid found to be quite effective in reducing symptoms of IC. The body uses arginine to make nitric oxide, which helps to relax smooth muscles like those found in blood vessels and the bladder.

      Now's L-Arginine Free Form Vegetarian 1Lb

      Now's L-Arginine Free Form Vegetarian 1Lb

      L-Arginine Powder is a 100% pure, free form, pharmaceutical grade amino acid.



      An Alkalkizing Diet:

      In his book “Solving the Interstitial Cystitis Puzzle: My Story of Discovery and Recovery” Amrit Willis states that people suffering with IC are commonly intolerant of acidic foods and beverages.

      In discovered in his research that alkali-forming diet can neutralize the acid load in one’s body and assist in reducing symptoms.

      Another excellent on the same topic is “You Don’t Have to Live With Cystitis written by urologist, Larrian Guillespie, MD. In this breakthrough book, she discusses the value of alkalizing the diet and avoiding asparatates.

      Many people find that certain foods increase their symptoms.

      The most frequently noted problem foods include: coffee, chocolate, alcohol, carbonated drinks, citrus fruits and tomatoes.

      The following two books are highly recommended.



      start quoteDr. Fugazzotto found that two main bacteria are found in interstitial cystitis patients. These were an Enterococcus and a Micrococcus. He found that when these people were treated with culture specific antibiotics that they got better.end quote
      -- J Urol. 1993 Jul;150(1):199-200


      Antibiotic Therapy

      In a published medical study, Dr. Fugazzotto found that two main bacteria are found in interstitial cystitis patients. These were an Enterococcus and a Micrococcus.

      He found that when these people were treated with culture specific antibiotics that they got better. He pointed out that these bacteria are gram positive bacteria and that most physicians will treat a UTI with antibiotics for gram negative bacteria, such as Bactrim.

      He added that if he only treated with antibiotics, patients did get better, however once the patients stopped taking the antibiotics, they frequently relapsed. On the other hand, if he treated with antibiotics in conjunction with the other treatments such as diet, biofeedback, pelvic floor rehabilitation, trigger points, exercises and treatment of yeast, his patients got a 90 to 95% improvement.

      His preference was Nystatin in oral powder or oral tablets.

      Dr. Grisanti's Comments:

      Review of the medical literture revealed a number of potential treatments for those suffering with IC. I found it quite disturbing that the popular drug Elmiron has a success rate of only 38%.

      In addition, deaths occurred in 6/2627 of the people studied. Although this may not represent a high number of deaths for the medical reseachers, it is my professional opinion that even one death in the sake of medical science is too much.

      I would suggest giving the amino acid, Arginine and the alkalkizing diet and fair try for at least 90 days. In addition, I would strongly suggest having your physician order a PCR blood test to rule out the bacteria Chlamydia, Enterococcus and Micrococcus. If found, your physician would then be wise to prescribe a bacterial agent to eradicate the bacteria.

      References:

      Keay SK, Szekely Z, Conrads TP, Veenstra TD, Barchi JJ Jr, Zhang CO, Koch KR, Michejda CJ. An antiproliferative factor from interstitial cystitis patients is a frizzled 8 protein-related sialoglycopeptide. Proc Natl Acad Sci U S A. 2004 Aug 10;101(32):11803-8. Epub 2004 Jul 28.

      Selo-Ojeme DO, Onwude JL. Interstitial cystitis. J Obstet Gynaecol. 2004 Apr;24(3):216-25.

      Rashid HH, Reeder JE, O'Connell MJ, Zhang CO, Messing EM, Keay SK. Interstitial cystitis antiproliferative factor (APF) as a cell-cycle modulator. BMC Urol. 2004 Apr 06;4(1):3.

      Appleton J. Arginine: Clinical potential of a semi-essential amino. Altern Med Rev. 2002 Dec;7(6):512-22.

      Ho MH, Bhatia NN, Khorram O. Physiologic role of nitric oxide and nitric oxide synthase in female lower urinary tract. Curr Opin Obstet Gynecol. 2004 Oct;16(5):423-9.

      Brown TM. Re: A randomized double-blind trial of oral l-arginine for treatment of interstitial cystitis. J Urol. 2000 Nov;164(5):1666.

      Cartledge JJ, Davies AM, Eardley I. A randomized double-blind placebo-controlled crossover trial of the efficacy of L-arginine in the treatment of interstitial cystitis. BJU Int. 2000 Mar;85(4):421-6.

      Korting GE, Smith SD, Wheeler MA, Weiss RM, Foster HE Jr. A randomized double-blind trial of oral L-arginine for treatment of interstitial cystitis. J Urol. 1999 Feb;161(2):558-65.

      Smith SD, Wheeler MA, Foster HE Jr, Weiss RM. Improvement in interstitial cystitis symptom scores during treatment with oral L-arginine. J Urol. 1997 Sep;158(3 Pt 1):703-8.

      Theobald RJ Jr. The effect of NG-monomethyl-L-arginine on bladder function. Eur J Pharmacol. 1996 Sep 5;311(1):73-8.

      Sun Y, Chai TC. Effects of dimethyl sulphoxide and heparin on stretch-activated ATP release by bladder urothelial cells from patients with interstitial cystitis. BJU Int. 2002 Sep;90(4):381-5.

      Fugazzotto P. Re: Diagnosis of interstitial cystitis. J Urol. 1993 Jul;150(1):199-200.

      Warren JW. Interstitial cystitis as an infectious disease. Urol Clin North Am. 1994 Feb;21(1):31-9.