What is Interstitial Cystitis?
Interstitial cystitis (IC), also known as painful bladder syndrome, is a chronic, idiopathic condition of the bladder characterized by pelvic pain as well as excessive urinary urgency and frequency. This condition is often debilitating, interfering with daily activities, social functioning, and sexual activity. New research supports that IC is much more prevalent that originally thought. The total and the proportion of men with IC is also much higher than originally estimated. It is estimated that 3 to 8 million women in the US may have IC. That is about 3 to 6% of all women in the US! It is also estimated that 1 to 4 million men have IC as well. However, this number is likely lower than the true rate because IC in men may often be mistaken for another disorder, such as chronic prostatitis/chronic pelvic pain syndrome. It is important to note that many adults comment that their IC symptoms started in childhood. Pediatricians also diagnose children with this chronic condition. Unfortunately, epidemiology studies have not yet been done to estimate the true prevalence of children with IC.
Pelvic pain is the most prominent symptom of interstitial cystitis. It is often relieved upon urination but returns as the bladder fills. However, urinary urgency is not usually relieved with urination. Urinary frequency averages 16 times per day but can be as high as 60 times per day in some patients. This frequency can contribute to nocturia (urination at night), but usually does not include incontinence. Another symptom experienced by many patients is pain with sexual intercourse.
The clinical course of this disease usually involves flare-ups followed by periods of remission. In women, symptoms may worsen during ovulation or during the premenstrual period.
Symptoms may be exacerbated by acidic foods such as coffee, carbonated beverages, other caffeinated products, alcohol, citrus fruits, spicy foods, and tomatoes. Some patients are also sensitive to foods containing high levels of arylalkylamines (i.e. tryptophan, tyrosine, tyramine, phenylalanine) such as beer, cheese, bananas, chocolate, wine, and yogurt.
This condition is highly detrimental to one’s quality of life and may often be misdiagnosed or go undiagnosed. It is important to be aware of the symptoms surrounding this syndrome and to educate oneself about options in therapy. Contact Clinical Apothecaries if you have questions or would like additional information about IC.
Common Characteristics of Interstitial Cystitis
Presence of pelvic, suprapubic, perineal or bladder pain Presence of urinary urgency or frequency Pain with intercourse Bladder capacity of < 350 mL Negative urine culture 90% of affected patients have nonulcerous IC, whereas 10% present with the more serious, ulcerous form of IC in which Hunner’s ulcers are found upon cystoscopic examination.
What Causes Interstitial Cystitis?
Symptoms may present similarly to those of urinary tract infection, but this condition is not infectious in nature - urine cultures are negative for bacteria. One theory postulates that the chronic bladder inflammation and irritation is caused by a defect in the protective mucous layer of the bladder. This inner lining of the bladder has lower rates of glycosaminoglycan (GAG) excretion in patients with interstitial cystitis. Glycosaminoglycan protects the bladder from damage by maintaining a stable layer of water and by preventing invasion by bacteria and irritation from substances in the urine. In interstitial cystitis, the flawed defensive layer allows irritating substances to seep through the urothelium and lead to injury. The body responds to this injury by releasing inflammatory mediators and histamine, resulting in the symptoms associated with the disease.
In addition to conventional medications for interstitial cystitis, there are various natural products available that may help control symptoms. Methylsulfonylmethane (MSM), which is also known as dimethyl sulfone (DMSO2) has been used in practice as an alternative to DMSO. It can be administered intravesicularly, orally, topically, or intravenously. Often, a combination of these routes is used. MSM does not have the same garlicky odor as DMSO so it may be better tolerated, but it may also take longer for patients to experience improved symptoms. Another approach targets nitric oxide deficit observed interstitial cystitis patients and the symptom improvement associated with elevation of nitric oxide levels. Arginine is a natural precursor of nitric oxide and may be considered for treatment. Results from small trials have showed mixed results, but the trials may have been too small to detect statistical significance between different outcomes. Plant sterols can decrease inflammation through modulation of the immune response. Quercetin is a bioflavanoid found in red wine, onions, and green tea that reduces mast cell release of histamine and may relieve interstitial cystitis symptoms. Another promising supplement that is being studied is melatonin, which may stabilize and protect the urothelium - safety and efficacy must be established.
These statements have not been evaluated by the US Food and Drug Administration nor are intended to diagnose, treat, cure or prevent any illness.
Interstitial Cystitis Association
100 Park Ave. #108A
Rockville, MD 20850
Interstitial Cystitis Network
PO Box 2159
Healdsburg, CA 95448
Patient Assistance: (707) 538-9442
National Kidney Foundation
30 E. 33rd Street
New York, NY 10016