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
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 (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).
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 - 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.
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 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.
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.
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.
-- J Urol. 1993 Jul;150(1):199-200
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.
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