Interstitial Cystitis

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 and 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 (see The Human Flower: Reproductive Health and
Botanical Medicine).

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.
2. Tone the bladder wall, heal ulcerations and hemorrhages.
•antihemorrhagics: Capsella, Panax notoginseng, Trillium
•urinary tonics: Verbascum root, Chimaphila, Capsella
•demulcents and vulneraries: Althaea, Ulmus, Plantago, Calendula,
Symphytum

3. Address hepatic function and correct pelvic circulation
•cholagogues: Taraxacum, Berberis, Boldo, Rumex, Raphanus, Buplerum,
Curcuma

4. Modulate immune function.
•immunomodulants: Astragalus, Withania, Schizandra, Ganoderma,
Phyllanthus
•antiinflammatories: Curcuma, Harpagophytum, Phyllanthus, Scutellaria
baicalensis, Tanacetum, Asparagus

5. Correct menstruation.
•progesterogenics: Vitex, Paeonia, Verbena
•uterine tonics: Caulophyllum, Cimicifuga, Aletris, Chamaelirium,
Angelica, Rubus

6. Support neuroendocrinal function, reduce spasm.
•relaxing nervines: Scutellaria, Humulus, Nepeta,
•adrenal trophorestoratives: Glycyrrhiza, Withania, Eleuthrococcus,
Panax quinquefolium, Turnera
•thyrotropics: Commiphora, Fucus, Iris, Berberis
•antispasmodics: Dioscorea, Piper methysticum, Cimicifuga, Valeriana,
Lobelia, Hyocyamus, Cannabis

7. Supplements.
•Vitamin A, 20,000 IU daily
•Vitamin C, 2-3 g daily
•Vitamin D3, 2000-5000 IU 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