Interstitial cystitis (IC) is a clinical syndrome characterized by daytime and nighttime urinary frequency, urgency, and pelvic pain that resembles bacterial cystitis, but is not related to bacterial infection. The course is often variable and specific symptoms vary from patient to patient. More than 90% of cases are found in women, and symptoms are often worse after sexual intercourse and during menstruation. (Rovner 2005; Frassetto 2005; Berkow 1992).
In IC, the bladder wall may be irritated and become scarred or stiff. Pinpoint areas of bleeding called glomerulations or Hunner’s ulcers caused by recurrent irritation appear on the bladder wall, and are present in the vast majority of cases. Many patients find that they cannot hold much urine, increasing the frequency of urination. In severe IC, the patient may need urinate as much as 60 times a day. (Rovner 2005; Frassetto 2005; Berkow 1992)
Despite years of research, no specific diagnostic criterion has been identified for IC, and is thus a diagnosis of exclusion, only appended after other diseases have been ruled out, including infection, malignancy, endometriosis, inflammatory bowel disease, neurological causes (e.g. Parkinson’s, multiple sclerosis), or congenital abnormalities. (Rovner 2005; Frassetto 2005; Berkow 1992).
The condition has long been described in the medical literature, beginning with the identification of the inflammation and ulceration of the bladder by Dr. Alexander Skene in the late 19th century in his book Diseases of Bladder and Urethra in Woman (1887). Later, another physician named Guy Hunner popularized the disease with a more comprehensive description of the characteristic bladder wall ulcers, which have since borne his name, i.e. “Hunner’s ulcers.” (Rovner 2005; Frassetto 2005; Berkow 1992)
The prevalence of IC indicates that it is by and large a disease of the Western world, with rates in the United States as high as 60-70 cases per 100,000 women, whereas in Japan the incidence between 3-4 cases per 100,000 women. The vast majority of patients are white and has a slightly higher prevalence in Jewish women. The average age at presentation is about 40 years, although the condition is also found in children. Patients with IC are more likely to have undergone prior gynecologic surgery and/or have a history of recurrent UTI and childhood bladder problems. (Rovner 2005; Frassetto 2005; Berkow 1992)
A variety of theories exist to describe the etiology of IC. Due to the association between IC and diseases such as inflammatory bowel disease, systemic lupus erythematosus, irritable bowel syndrome, fibromyalgia, and atopic allergies, the most prominent theories relate to IC to an autoimmune disorder. (Rovner 2005; Frassetto 2005; Berkow 1992)
Medical treatment
Although no cause has yet been identified, there are a variety of medical treatments for IC, including bladder distention, bladder instillation, transcutaneous electrical nerve stimulation and pharmacotherapy.
Bladder distension is both a diagnostic and medical procedure in which the bladder is filled to a pressure of 80 cm of water and kept distended for 5-10 minutes, under a general anaesthetic. While under pressure a cystoscope is introduced into the bladder to identify the glomerulations. The procedure may also help break up the scar tissue within the bladder wall and bring a short term improvement in the symptoms, although may increase the risk of infection. Bladder instillation is a procedure in which the bladder is filled via a catheter with a solution such as dimethyl sulfoxide (DMSO). DMSO exhibits an anti-inflammatory activity and is given every few weeks over a 6-8 week period. Transcutaneous electrical nerve stimulation (TENS) is another potentially beneficial medical procedure in which a weak electric pulse is discharged through electrodes placed on the lower back, just above the pubic area, or in the vagina or rectum. Pharmacotherapy consists of drugs such as pentosan polysulfate sodium, aspirin, ibuprofen, acetaminophen, and codeine. Antidepressants or antihistamines are also recommended. (Rovner 2005; Frassetto 2005; Berkow 1992).
Holistic treatment
Given the very high prevalence of IC in the Western world the condition suggests that environmental factors such as diet and industrial pollutants such as xenoestrogens are an important factor, as well overt iatrogenic alterations in the body ecology from the overuse of antibiotics to treat recurrent cystitis, as well as from medical instrumentation (e.g. cystoscopy, D&C etc). Portal congestion that allows the pelvis to be congested is another important factor at play in IC, and thus addressing liver function is an important part of resolving this pattern. Symptoms that worsen with menstruation can be seen to be part of a PMS (P) pattern, which relates to a relative estrogen excess and the release of proinflammatory prostaglandins: the latter issue is particularly germane if the patient also display atopic allergies.
At one time IC was simply viewed as a neurogenic condition, tiresome complaining “hysterical” women on the threshold of menopause, and thus referred to psychiatrists and appropriate medications that would shut them up. Indeed, IC does appear to have a strong neurogenic component that needs to be taken into consideration along with environmental factors, but the underlying emotional mechanisms that cause IC need to be examined. IC often occurs as part of a complex of other disorders such as fibromyalgia. In many respects such diseases can be viewed as a kind of spiritual sickness, and IC specifically, a condition in which a woman internalizes an urgent need to resolve her anger (i.e. being “pissed off”), resulting in urinary urgency and pain. Social situations in which the woman feels unloved and unsupported, angry and upset at not having her needs met, can begin to manifest as urinary symptoms. This concept very much correlates with Chinese medical theory that suggests that feelings of suspicion and the holding grudges can affect the bladder, or begin to manifest when the bladder is diseased, creating a viscous cycle pattern. The holding of such patterns often exhibits other negative effects upon the body, especially affecting neuroendocrinal function
The holistic treatment of IC is orientated towards addressing dietary and environmental factors, correcting hepatic and menstrual functions, modulating the immune system, supporting the neuroendocrinal systems, correcting essentially fatty acid deficiencies, restoring the body ecology, and treating emotional and mental factors.
1. Dietary changes. Initiate an elimination diet, removing all potential allergens, e.g. the Paleolithic diet. Increase fiber to promote alterations in gut flora and the inhibition of deconjugating enzymes. Emphasize live-culture fermented foods.
2. Tone the bladder wall, heal ulcerations and hemorrhages.
- antihemorrhagics: Shepherd’s Purse (Capsella bursa-pastoris), San Qi (Panax notoginseng), Beth root (Trillium erectum)
- urinary tonics: Mullein (Verbascum thapsus) root, Pipsissewa (Chimaphila umbellata), Shepherd’s Purse (Capsella bursa-pastoris)
- demulcents and vulneraries: Marshmallow (Althaea officinalis), Slippery Elm (Ulmus fulva), Plantain (Plantago spp.), Marigold (Calendula officinalis), Comfrey (Symphytum officinale)
3.Address hepatic function and correct pelvic circulation
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cholagogues: Dandelion (Taraxacum officinale), Barberry (Berberis vulgaris), Boldo (Peumus boldo), Yellow Dock (Rumex crispus),Radish (Raphanus spp.), Chai Hu (Bupleurum falcatum),Turmeric (Curcuma longum)
4.Modulate immune function.
- immunomodulants: Huang Qi (Astragalus membranaceus), Ashvagandha (Withania somnifera), Schizandra (Schizandra sinensis), Reishi (Ganoderma lucidum), Bhumyamalaki (Phyllanthus amarus)
- antiinflammatories: Turmeric (Curcuma longum), Devil’s Claw (Harpagophytum procumbens), Bhumyamalaki (Phyllanthus amarus), Huang Qin (Scutellaria baicalensis),Feverfew (Tanacetum parthenium), Shatavari (Asparagus racemosa)
5. Correct menstruation.
- progesterogenics: Nirgundi (Vitex negundo), Bai Shao (Paeonia lactiflora),Vervain (Verbena officinalis)
- uterine tonics: Blue Cohosh (Caulophyllum thalictroides), Black Cohosh (Cimicifuga racemosa), Unicorn Root (Aletris farinosa), False Unicorn Root (Chamaelirium luteum), Dong Gui (Angelica sinensis), Raspberry (Rubus idaeus)
6.Support neuroendocrinal function, reduce spasm.
- relaxing nervines: Skullcap (Scutellaria lateriflora), Hops (Humulus lupulus), Catnip (Nepeta cataria),
- adrenal trophorestoratives: Licorice (Glycyrrhiza glabra), Ashvagandha (Withania somnifera), Siberian Ginseng (Eleuthrococcus senticosis), American Ginseng (Panax quinquafolium), Damiana (Turnera diffusa)
- thyrotropics:Guggulu (Commiphora mukul), Bladderwrack (Fucus vesiculosis), Blue Flag (Iris versicolor), Barberry (Berberis vulgaris)
- antispasmodics: Wild Yam (Dioscorea villosa), Kava (Piper methysticum),Black Cohosh (Cimicifuga racemosa), Valerian(Valeriana officinalis), Lobelia (Lobelia inflata), Henbane(Hyocyamus niger), Marijuana (Cannabis spp.)
7.Supplements.
- Vitamin A, 20,000 IU daily
- Vitamin C, 2-3 g daily
- Vitamin E, 600-800 IU daily
- Zinc, 15-30 mg daily
- EPA/DHA,1000 mg each daily
- Synbotics:6-8 billion bacteria (e.g. a mixture of Lactobacillus acidophilus, Bacillus bifidum and Staphylococcus faecium),thrice daily, with meals
8.Spiritual counseling. Assess patient for long-standing issues of unresolved anger, grudges, and suspicion. Encourage communication and resolution, trusting a higher power. Flower Essences can be helpful on this spiritual journey:
- for repressed anger: Black-eyed Susan, Fuschia, Scarlet Monkeyflower, Willow
- for frustration: Blackberry
- for making positive changes, enhancing self-esteem: Crab Apple, Centaury, Gentian, Larch
- for menopause: Aloe, Sage, Walnut