Interstitial Cystitis
Interstitial cystitis (IC) is a chronic inflammatory condition of the bladder that causes frequent, urgent and painful urination with or without pelvic discomfort. The natural lining of the bladder (epithelium) is protected from toxins in the urine by a coating of enzymes (mucopolysaccharides) called the GAG (glycoaminoglycan) layer. In IC, this protective layer is defective, causing severely irritating voiding symptoms and bladder pain. No infectious agent has been found in IC.
Classic symptoms include urinary frequency, pelvic or abdominal pain and urinary urgency. For men, symptoms may include pain and inflammation of the prostate (e.g., prostatitis). Women may suffer increased vulvar pain, which is thought to be of neurogenic origin. Both men and women may experience pain in the perineum (space between the vagina or scrotum and the anus) and painful or uncomfortable sex, including intercourse and touching. For some men, ejaculation may be painful. Patients with IC typically experience periods of symptom flare-ups, or intensification, followed by periods of remission, when symptoms abate but rarely disappear.
Unfortunately, there is no cure for IC; the goal of treatment is to relieve symptoms. Often, trial and error with medications are warranted. However, IC is treatable and most patients find relief with complementary treatments and lifestyle changes.
Behavioral Treatments for Interstitial Cystitis
Self-care practices and behavioral modifications that can improve symptoms should be discussed and implemented as feasible. Patients will be encouraged to implement stress management practices to improve coping techniques and manage stress-induced symptom exacerbations.
Physical Therapy for Interstitial Cystitis
Appropriate manual physical therapy techniques (e.g., maneuvers that resolve pelvic, abdominal and/or hip muscular trigger points, lengthen muscle contractures, and release painful scars and other connective tissue restrictions may be offered to patients who present with pelvic floor tenderness. Pelvic floor strengthening exercises (e.g., Kegel exercises) should be avoided.
Physical therapy for IC is offered at RWJ University Hospital Somerset.
Surgery for Interstitial Cystitis
Cystoscopy under anesthesia with short-duration, low-pressure hydrodistentsion (filling the bladder with water) may be undertaken if conservative treatments have not provided acceptable symptom control and quality of life or if the patient’s presenting symptoms suggest a more invasive approach is appropriate.
Major surgery (e.g., substitution cystoplasty, urinary diversion with or without cystectomy) may be undertaken in carefully selected patients for whom all other therapies have failed to provide adequate symptom control and quality of life.
Additional Treatments for Interstitial Cystitis
A trial of neurostimulation may be performed and, if successful, implantation of permanent neurostimulation devices may be undertaken if other treatments have not provided adequate symptom control and quality of life or if the physician and patient agree that symptoms require this approach.
Intradetrusor botulinum toxin A (BTX-A) may be administered if other treatments have not provided adequate symptom control and quality of life. Patients must be willing to accept the possibility that post-treatment intermittent self- catheterization may be necessary.
Philip M. Hanno, David Allen Burks, J. Quentin Clemens, Roger R. Dmochowski, Deborah Erickson, Mary Pat FitzGerald, John B. Forrest, Barbara Gordon, Mikel Gray, Robert Dale Mayer, Robert Moldwin, Diane K. Newman, Leroy Nyberg Jr., Christopher K. Payne, Ursula Wesselmann, Martha M. Faraday. “Interstitial Cystitis/Bladder Pain Syndrome: American Urological Association.” Interstitial Cystitis/Bladder Pain Syndrome: American Urological Association. N.p., n.d. Web. 18 Aug. 2016.
MEDICATIONS FOR INTERSTITIAL CYSTITIS
Hydroxyzine (Vistaril®, Atarax®) is an antihistamine and mild anti-anxiety drug. It prevents mast cell degranulation, which is thought to play a role in IC, particularly in patients who have a history of allergies, migraine, and irritable bowel syndrome. Hydroxyzine decreases nighttime urination (nocturia), frequency, pain, and bladder pressure. Side effects include dry mouth and sedation.
Overactive bladder medications such as Oxybutynin chloride (Ditropan XL®), Detrol®, and Urised (combination of atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid) may reduce bladder spasms that cause frequency, urgency, and nighttime urination.
Pentosan polysulfate sodium (Elmiron®) to help rebuild the epithelium by coating the bladder wall. It may take up to 6 months to provide relief from symptoms, although 25% of patients experience significant symptom relief in as few as 4 weeks. Elmiron must be taken on a long-term basis to keep symptoms from recurring. Side effects include gastrointestinal discomfort and reversible hair loss, but these are uncommon.
Amitriptyline (Elavil®) is a tricyclic antidepressants that help to block pain, calm bladder spasms, and reduce inflammation; they may be useful in small doses. Valium and other muscle relaxants may also be used to reduce spasms associated with IC.
Dimethyl Sulfoxide (DMSO, Rimso-50®) 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.
FOOD PRECAUTIONS FOR INTERSTITIAL CYSTITIS
- 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
Some find that over-the-counter dietary aids such as Prelief®, which helps to make food less acidic, allow them to eat many foods that would otherwise be intolerable.
- 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, tomatoes
- 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 (Nutrasweet®), saccharine, artificial ingredients and colors
- Vegetables – fava beans, lima beans, onions.
Most IC patients have the least amount of trouble with rice, potatoes, pasta, vegetables, and chicken.
- Smoking worsens symptoms for some people; symptoms improve for many after quitting smoking.
RESPECTED BOOKS ABOUT IC
- Along the Healing Path: Recovering from Interstitial Cystitis by Catherine M. Simone
- Solving the Interstitial Cystitis Puzzle: A Guide to natural healing by Amit Willis
- Recipe Book for I.C. by E. Murphy
- A Taste of the Good Life: A Cookbook for an Interstitial Cystitis Diet by Beverly Laumann
RESPECTED WEBSITES ABOUT IC
Adapted from www.urologychannel.com
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