Interstitial Cystitis (IC) or Painful Bladder Syndrome

Interstitial cystitis affects 500,000 people in the UK, who are told that there is no cure for it and that they must live with it.

Patients have often been on an exhausting route visiting GPs, urologists and gynaecologists.

What is Interstitial Cystitis (IC)?

Interstitial cystitis is a very uncomfortable and stressful disorder, which is characterized by chronic urinary urgency (feeling the need to urinate immediately) and frequency (frequent urination) with or without pelvic pain. Symptoms of interstitial cystitis may vary among individuals and may even vary with time in the same individual. Many people have to live life around their bladder because of the unpleasant symptoms. The term "cystitis" refers to any inflammation of the bladder. In contrast to bacterial cystitis, which results from an infection in the bladder, no infectious organism has been identified in people with interstitial cystitis. Interstitial cystitis is diagnosed when the symptoms occur without evidence for another cause of the symptoms.

Certain chronic illnesses have been described as occurring more frequently in people with interstitial cystitis than in the general population:

• Systemic lupus erythematosus (Lupus or SLE)
• Irritable bowel syndrome (IBS)
• Allergies
• Endometriosis
• Vulvodynia (chronic discomfort in the vulvar area)
• Fibromyalgia

Interstitial cystitis has been classified into two forms, ulcerative and non-ulcerative, depending on the presence or absence of ulcerations in the bladder lining. Star-shaped ulcerations in the bladder wall are known as Hunner's ulcers. The ulcerative (classic type) of interstitial cystitis is found in less than 10% of cases. Scarring and stiffening of the bladder wall may occur as a result of the long term inflammation, leading to a decrease in bladder capacity. Areas of pinpoint bleeding may be seen on the bladder wall.

The Orthodox Approach

Medication

The principal type of oral medication is Elmiron, which is chemically similar to the substance that lines the bladder. It is believed that Elmiron assists in the repair of the bladder. Even after therapy has begun, patients may still experience symptoms for some time because the sensory nerves in the bladder have been hyperactive, and it takes time for the nerves to return to their normal state of activation. Doctors recommend giving up to one year of this treatment in mild interstitial cystitis and two years in severe interstitial cystitis before deciding if the drug is effective or not. Between one-third and two-thirds of patients will improve after three months of treatment. Other oral medications that may be used to treat interstitial cystitis along with Elmiron include antidepressants, aspirin and ibuprofen.

Bladder Distension

Bladder distension helps reduce symptoms in approximately 20-30% of people with interstitial cystitis. When it is effective, the relief of symptoms persists for three to six months after the procedure.

Bladder Instillation (Intravesical therapy)

This procedure may also be called a bladder wash or bath. During a bladder instillation, the bladder is filled with a solution that is held for varying periods of time, from a few seconds to 15 minutes, before being drained through a narrow tube called a catheter.

In severe cases of interstitial cystitis, intravesical solutions may be administered along with Elmiron to provide relief until the oral medication has had time to take effect. Other drugs that have been used for bladder instillations include dimethyl sulfoxide (DMSO, RI)

Other Surgical Procedures for Interstitial Cystitis

In severe cases of interstitial cystitis that do not respond well to oral medications or to bladder distension or instillation, more invasive surgical procedures may be attempted. A procedure known as sacral neuromodulation has been shown to be effective in controlling symptoms in some people with interstitial cystitis. The term "neuromodulation" refers to an alteration of the nervous system. In sacral neuromodulation, a device is implanted that allows for electrical impulses to stimulate the nerves in the sacral (lower back) area. Sacral neuromodulation is believed to work by inhibiting the hyperactive signals from the sensory nerves within the bladder wall. For sacral neuromodulation, a wire from an electrical impulse generator is implanted in the sacral region of the spinal column. If there is relief of symptoms, the impulse generator can be implanted beneath the skin in the region of the buttocks. A remote control programmer allows the patient to adjust the impulse frequency and power to provide optimal relief of symptoms.

Therapies that also have been used include transcutaneous electrical nerve stimulation (TENS), a form of neuromodulation that does not involve surgical placement of wires or an impulse generator. With TENS, mild electric pulses enter the body for minutes to hours two or more times a day either through wires placed on the surface of the lower back or the suprapubic region, between the navel and the pubic hair, or through special devices inserted into the vagina in women or into the rectum in men. It is believed that the electric pulses may increase blood flow to the bladder, strengthen pelvic muscles that help control the bladder, and trigger the release of hormones that block pain. TENS is generally more effective in reducing pain than in reducing urinary frequency.

Other surgical procedures that may rarely be performed to treat severe interstitial cystitis include peripheral denervation (disrupting the nerves to the bladder wall), bladder augmentation to increase bladder capacity, and cystectomy (bladder removal) with diversion, or re-routing, of urine flow.

The Hale Approach

Herbal Medicine

The aim of the treatment is not only to alleviate the symptoms but, where possible, to find any underlying issues, which may be fuelling the IC. By taking a very detailed history, the practitioner can better understand the pathology of each patient’s IC and thereby address the underlying issues. Every patient’s experience of IC is different and must be treated accordingly rather than with a set protocol or a one-size-fits-all approach. The whole person is treated and not just the symptoms.

Interstitial Cystitis is a very complex and debilitating condition. It probably takes a long time, perhaps years, for the body to reach the point, where IC becomes inevitable. This could be for a variety of reasons with several body systems involved. The bladder, damaged by the chronic inflammation, is the most challenging part of the body to repair as it is always in constant use. The complexity of this illness dictates that treatment is given in stages, addressing both the underlying weaknesses in the body and the symptoms. The treatment for IC takes both trust and dedication to achieving a good clinical outcome.

Patients, who start this treatment within a year of diagnosis, usually report that their pain becomes more manageable after six weeks. Where patients have experienced IBS type symptoms, there is usually an improvement within this initial period. Patients also report an improvement in general health, whilst the treatment progresses. They say they have less achiness, less headaches, less menstrual or menopausal symptoms. For patients, who have had IC for more than a year, it takes longer to notice the gradual improvement. It is very much team work with the patient working with the practitioner to successfully get through the various stages of treatment, which address underlying issues and strengthen body systems.

To help prevent flares, patients are advised to follow a strict diet. Every patient’s experience of IC is different so there are no set treatments. Instead, treatments are tailored to meet each patient’s unique needs. The practitioner formulates a personalised herbal prescription for each patient. This approach gets the best results and is far more effective than a one-size-fits-all approach.

The stress and depression that this condition causes are also treated, which again usually leads to less pain and better control of symptoms. Within the first six weeks of treatment, it is not unusual for patients to report that they feel calmer, with their mood better than before. At this stage in the treatment patients may see an improvement in their sleep. Some report that they are sleeping deeper and so have more energy. For others it can take longer to feel comfortable at night.

Every patient responds differently to herbal medicine. Some patients may react very quickly to it, whilst others may take longer. It is therefore impossible to estimate how long treatment will take. However, in most cases it takes around a year. Patients do suffer setbacks from time to time and this can be brought on by stressful situations in their life. When this happens, the herbal prescription can be modified to give the patient more support. Patients report that this flexibility in the treatment is extremely beneficial. They also report feeling more in control of their health.