What are natural treatments for interstitial cystitis?

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Treatment of severe and chronic inflammation of the bladder.
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Introduction

Interstitial cystitis (IC) is a severe, chronic inflammation of the bladder that is both disruptive and painful. Many more women than men have the condition. Of the 700,000 people with IC at any given time, 90 percent are female.

The symptoms of IC are notoriously variable and can differ from one person to another, or for one person from day to day. People with IC usually have an urgent and frequent need to urinate. They may experience recurring discomfort, tenderness, pressure, or intense pain in the bladder and surrounding pelvic area. This pain often intensifies as the bladder fills and may be exacerbated by sexual intercourse. Certain foods may trigger symptoms; the most commonly mentioned include tomatoes, vinegar, spicy foods, coffee, chocolate, alcohol, and fruits and vegetables.

IC is generally diagnosed after other conditions with similar symptoms, such as bladder infection, herpes, and vaginal infection, have been excluded. The cause of IC is unknown. Although its symptoms resemble a bladder infection, IC does not appear to be caused by bacteria. One theory proposes that IC is caused by an infectious agent that simply has not been detected. A different theory holds that IC is an autoimmune reaction; still another theory is that it is related to allergies. Because it varies so much in symptoms and severity, IC may be not one disease but several.

A variety of treatments are often tried alone or in combination before one is found that works. Oral antihistamines such as hydroxyzine (Atarax) and certirizine (Zyrtec) may provide relief, and the drowsiness they produce often wears off over time. Other medications used for IC include pentosan polysulfate sodium (Elmiron), pyridium, and anti-inflammatory drugs.

Distending the bladder by filling it to capacity with water for two to eight minutes is frequently useful, but although the beneficial effects may persist for months, symptoms usually return eventually. In some cases, medications such as dimethyl sulfoxide and heparin may be introduced into the bladder with a catheter; actual surgical alteration of the bladder is rarely used to treat IC.

Other Proposed Treatments

There are no well-documented natural treatments for interstitial cystitis, but a few supplements have shown promise.

Quercetin. Quercetin is a bioflavonoid that may have anti-inflammatory properties. A small, double-blind, placebo-controlled trial found that a supplement containing quercetin reduced symptoms of interstitial cystitis.

Arginine. The amino acid arginine helps the body make nitric oxide, a substance that relaxes smooth muscles like those found in the bladder. Based on this mechanism, arginine has been proposed as a treatment for IC.

A three-month double-blind trial of fifty-three persons with interstitial cystitis found only weak indications that arginine might improve symptoms of interstitial cystitis. Several participants dropped out of the study; when this was properly taken into account using a statistical method called ITT analysis, no benefit could be proven.

Glycosaminoglycans. There is some evidence that in interstitial cystitis, the surface layer of the bladder is deficient in protective natural substances called glycosaminoglycans. This in turn might allow the bladder to become inflamed; it might also initiate autoimmune reactions.

Based on these preliminary findings, the use of supplemental glycosaminoglycans in the form of mesoglycan or chondroitin sulfate has been suggested for interstitial cystitis. However, there is no reliable evidence that they really work.

Transcutaneous electrical stimulation. Transcutaneous electrical stimulation is primarily used (with mixed results) in the treatment of muscular pain. It has also been tried for interstitial cystitis, but the evidence that it works is preliminary.

Diet. Although there is no solid scientific evidence that dietary changes can relieve IC, many people find that certain foods increase their symptoms. The most frequently cited offenders are coffee, chocolate, ethanol, carbonated drinks, citrus fruits, and tomatoes. Based on these reports, it may be worthwhile to experiment with one’s diet.

Guided imagery. Preliminary evidence suggests that guided imagery may help some women with IC. In one study, listening to a script designed to focus attention on healing the bladder, relaxing the pelvic-floor muscles, and quieting the nerves specifically involved in IC showed some benefit. Without an adequate placebo comparison, though, it is questionable whether these improvements were significant.

Bibliography

Carrico, D. J., K. M. Peters, and A. C. Diokno. “Guided Imagery for Women with Interstitial Cystitis.” Journal of Alternative and Complementary Medicine 14 (2008): 53-60.

Cartledge, J. J., A. M. Davies, and I. Eardley. “A Randomized Double-Blind Placebo-Controlled Crossover Trial of the Efficacy of L-Arginine in the Treatment of Interstitial Cystitis.” BJU International 85 (2000): 421-426.

Palylyk-Colwell, E. “Chondroitin Sulfate for Interstitial Cystitis.” Issues in Emerging Health Technologies 84 (2006): 1-4.

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