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Treatment - Non-Surgical
There is no cure for IC; the goal of treatment is to relieve symptoms. Often, treatment effectiveness wanes and a replacement must be found through trial and error. Most patients who suffer from IC find relief, usually with multiple, complementary treatments.
Types of treatment include the following:
Biophysical Techniques -- behavioral changes, stress management, dietary changes;
Medications;
Surgery.
Biophysical Techniques
Biophysical techniques used to control IC symptoms include bladder retraining, transcutaneous electrical nerve stimulation (TENS), stress reduction with biofeedback, diet modification, and exercise. Physical therapy for the pelvic floor muscles may help decrease pain and spasms. Bladder retraining is a self-help process in which patients learn to control their urge to urinate. The theory behind bladder retraining is that the bladder muscle actually weakens with frequent urination because it is not allowed to distend fully. Patients with IC experience the impulse to urinate frequently because they have pain or urgency as the bladder fills. Bladder retraining programs vary. Generally, the patient schedules times for urination (a voiding schedule) and uses a series of relaxation techniques and distractions to help keep the schedule. The interval is progressively lengthened, thus strengthening the bladder muscle. Bladder retraining may be complicated by severe pain.
Bladder Retraining or Bladder Training with Timed Voiding
The patient keeps a voiding diary of all episodes of urination and leaking, and the physician analyzes the chart and identifies the pattern of urination. The patient uses this timetable to plan when to empty the bladder to avoid accidental leakage. In bladder training, biofeedback and Kegel exercise help the patient resist the sensation of urgency, postpone urination, and urinate according to the timetable.
Transcutaneous Electrical Nerve Stimulation (TENS) TENS involves the application of mild electric pulses to the body for minutes or hours a day. It is believed that the electric pulses increase blood flow to the bladder, strengthen pelvic muscles that aid in control, and trigger the release of pain-blocking hormones. TENS therapy may help with IC pain, though it may take a couple of months before any benefit is realized. A TENS device is worn outside of the body, usually near the sacral nerve.
Sacral Nerve Stimulation
The InterStim device, used traditionally to treat bladder-control problems, is being used experimentally in pre-clinical trials to evaluate its effects on IC. It is implanted under the skin of the lower back, near the sacral nerve, where it delivers electrical pulses to the nerves involved in bladder function. It may help control frequency and urgency associated with IC, although the Food and Drug Administration (FDA) has not approved it for IC therapy.
Stress Reduction Techniques, Biofeedback, and exercise may reduce the occurrence of flares by strengthening the muscles of the pelvic floor. For some, exercise exacerbates symptoms by irritating an already tender bladder or sore abdomen.
Diet Modification
Many people find that eliminating acidic, spicy, and sugary foods, as well as dairy products from their diet helps to control symptoms. The Interstitial Cystitis Association (ICA) provides a list of foods that may be problematic:
Beverages hard liquor, beer, wine, carbonated drinks, coffee, tea, cranberry juice
Carbohydrates and grains rye and sourdough bread
Condiments seasonings, mayonnaise, miso, soy sauce, salad dressings, vinegar
Dairy products aged cheese, sour cream, yogurt, chocolate, milk
Fruits apples, apricots, avocados, bananas, cantaloupes, citrus fruits, cranberries, grapes, nectarines, peaches, pineapples, plums, pomegranates, rhubarb, strawberries, fruit juices
Meats and fish aged, canned, cured, processed, or smoked meats and fish, anchovies, caviar, chicken liver, corned beef, meats containing nitrates or nitrites (e.g., ham, bacon)
Nuts
Others substances tobacco, caffeine, diet pills, junk food, cold and allergy medication containing ephedrine or pseudoephedrine, vitamins that contain fillers (especially aspartate), tofu
Preservatives and additives benzol alcohol, citric acid, monosodium glutamate, aspartame (Nutrasweetฎ), saccharine, artificial ingredients and colors
Vegetables favabeans, lima beans, onions, tomatoes
Most IC patients have the least amount of trouble with rice, potatoes, pasta, vegetables, and chicken. Foods from the above groups that may be tolerable include the following:
Beverages decaffeinated and acid-free coffee and tea, certain herbal teas;
Carbohydrates and grains breads other than rye and sourdough, rice;
Condiments garlic;
Dairy products cottage cheese, white chocolate;
Fruits melon other than cantaloupe, pears;
Nuts almonds, cashews, pine nuts;
Vegetables fresh, homegrown potatoes and tomatoes.
Some find that over-the-counter dietary aids such as Preliefฎ, which helps to make food less acidic, allow them to eat many foods that would otherwise be intolerable. Smoking worsens symptoms for some people; symptoms improve for many after quitting.
Medication
Medications used to treat IC are administered by different methods. They include:
Local medication medication instilled directly into the bladder via a catheter
Systemic medication drugs taken orally
Chronic pain medications
Local Medication
Dimethyl Sulfoxide (DMSO, Rimso-50ฎ) Dimethyl sulfoxide may be instilled (intravesical) through the urethra and directly into the bladder via a catheter. It is the only FDA-approved instillation treatment for IC. It enters the bladder wall and reduces inflammation, pain, and painful muscle contractions; it may be mixed with heparin, steroids, or other local anesthetics. It may leave a garlicky taste and smell on the skin and in the breath for up to 72 hours. Heparin is similar to GAG and may help to repair problems caused by GAG deficiency in the bladder.
Blood, liver, and kidney tests are required every 6 months during DMSO therapy.
Hyaluronic acid(Cystistatฎ) and Bacille Calmette-Gu้rin (BCG) These treatments are undergoing clinical trials for IC treatment and are not widely available in the United States. Similar to heparin and GAG, Cystistat may help to repair a deficient bladder lining. BCG is a weakened form of cow tuberculosis (Mycobacterium bovis), which is used in tuberculosis vaccine in some European countries. Research shows that it may stimulate the immune system and improve the cellular makeup of the epithelium. The risk factors of BCG treatment are not fully understood, but may include inflammatory response in the bladder, tuberculosis-like chest infection, and the development of fibrous lumps (granulomas) in the bladder.
Silver nitrate and sodium oxychlorosene (Clorpactinฎ) were once used for instillation but are now considered outdated, because they cause irritation and greater risk for complications in abdomen.
Temporary worsening of symptoms can occur up to 36 hours after any instillation treatment. Chemical cystitis is also a possible side effect.
Naturopathic Treatment
Interstitial cystitis (IC) is a chronic inflammation of the urinary bladder; therefore, treating IC naturopathically involves inhibiting the inflammatory process by removing inflammatory and irritating foods from the diet, taking nutritional supplements, and using herbal support.
Nutrition
The importance of nutrition cannot be overstated. Changing to a healthy diet often helps ease symptoms.
Eliminate food sensitivities which are often the cause of chronic inflammatory conditions. To determine food sensitivities, use an elimination and challenge diet.
Eat whole, fresh, unrefined, and unprocessed foods. Include fruits, vegetables, whole grains, soy, beans, seeds, nuts, olive oil, and cold-water fish (salmon, tuna, sardines, halibut, and mackerel).
Avoid sugar, dairy products, refined foods, fried foods, junk foods, and caffeine. Coffee, chocolate, alcohol, carbonated drinks, citrus fruits, and tomatoes often worsen symptoms.
Drink ฝ of your body weight in ounces of water daily (e.g., if you weigh 150 lbs, drink 75 oz of water daily).
Supplements
Calcium citrate alkalinizes the urine, which decreases irritation to the bladder.
Bromelain provides anti-inflammatory action. Take away from food.
Herbal Medicine
Herbal medicines rarely have significant side effects when used appropriately and at suggested doses. Occasionally, an herb at the prescribed dose causes stomach upset or headache. This may reflect the purity of the preparation or added ingredients, such as synthetic binders or fillers. For this reason, it is recommended that only high-quality products be used. As with all medications, more is not better and overdosing can lead to serious illness and death.
The following herbs are used to treat IC:
Gotu kola (Centella asiatica) Take 30 mg standardized extract triterpenes 3 times a day. It enhances the integrity of connective tissue by stimulating production of glycosaminoglycans, which are an integral component of the protective mucous layer in the bladder.
Herbs to consider as a tea:
Buchu (Barosma betulina) A soothing diuretic and antiseptic for the urinary system.
Cleavers (Galium aparine) Traditionally used as a urinary tract tonic.
Corn silk (Zea mays) Has soothing and diuretic properties.
Horsetail (Equisetum arvense) An astringent and mild diuretic with tissue-healing properties.
Marshmallow root (Althea officinalis) Has soothing demulcent properties. It is best taken as a cold infusion; soak the herb in cold water for several hours, strain, and drink.
Usnea (Usnea barbata) Has soothing and antiseptic properties.
Homeopathy
A trained homeopathic practitioner is needed to diagnose and prescribe a deep-acting, constitutional remedy. The standard dosage for acute symptom relief is 3 pellets of 30C every 4 hours until symptoms resolve. Lower potencies, such as 6X, 6C, 30X, may be given every 2 to 4 hours. If the right remedy is chosen, symptoms should improve shortly after the second dose. If there is no improvement after 3 doses, a different remedy is given.
The following remedies have been shown to be effective in treating IC:
Apis mellifica Indicated for stinging pain that is worse with heat.
Cantharis Indicated for intolerable urgency with burning, scalding urination.
Staphysagria Indicated for a urinary tract infection that is the result of sexual intercourse.
Sarsaparilla Indicated for pain that burns after urination has stopped.
Physical Medicine
Castor oil packs can be applied for IC that has associated bladder cramping or pelvic discomfort.
Treatment - Surgical
Surgery is typically performed only when other treatments fail to provide relief. It may be ineffective and may worsen IC symptoms.
Fulguration (laser burning) and resection (surgical removal) are two methods used to remove Hunners ulcers from the bladder in ulcerative IC. They are performed with a cystoscope inserted through the urethra under general anesthesia.
Urostomy involves creating a tube in the abdomen from intestinal tissue, rerouting the ureters (which transport urine from the kidneys) to the tube, and connecting it to an opening (stoma) in the abdomen. Urine then drains continuously into a collection bag that can be emptied as necessary. Alternatively, an internal pouch, known as a Koch, Florida, or Indiana pouch, may be constructed from intestinal tissue to hold urine from the ureters. The person periodically drains the pouch through the stoma with a self-administered catheter.
Bladder removal (cystectomy) may be performed with urostomy and internal pouch procedures.
Augmentation cytoplasty is performed rarely in cases where heavily scarred portions of the bladder need to be removed, though it is not considered a standard treatment. A section of intestinal tissue may be cut and shaped to replace the damaged portion of the bladder. It is attached to the remainder of the natural bladder so that urine can be stored and expelled through the urethra.
A relatively new procedure known as orthotopic diversion involves the removal of the entire bladder and the creation of a new one from intestinal tissue. The new bladder is connected to the urethra and works like a natural bladder. This allows people to urinate through the urethra without the use of catheters or collection devices.
Urgency, frequency, and phantom pelvic pain may remain following surgery, even if the bladder is removed. Possible risk factors and side effects, combined with the irreversible nature of these procedures make many surgeons reluctant to perform them and many patients wary of their effects. There is a risk for IC to develop in transplanted intestinal tissue, including that used to create an internal pouch. Normal urination may be impossible or difficult and self-catheterization may be necessary. Also, there is a risk for urinary incontinence (involuntary urination), especially with orthotopic diversion.
Some research suggests that putting urine in contact with intestinal tissue is risky. Infections, disturbances in metabolism, and problems with the mucosal lining of the bowel tissue may occur. Long-term kidney damage is also associated with these procedures.
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