Interstitial Cystitis Information

Jurige J, Current medical approaches for interstitial cystitis, Personal Communication, 2003

With regard to the triad usage of pharmaceutical agents Elmiron, Benadryl, and Elavil.  Dr. Jurige a Urologist in Louisville Kentucky notes: “The only FDA approved oral medication is Elmiron, which is related chemically to heparin and helps the bladder to form a new healthy lining over time.  Benadryl is useful because (interstitial cystitis) IC may have an allergy component in some patients.  Elavil cuts down on bladder spasms and pain. Other useful treatments include hydrodistention of the bladder under anesthesia with the instillation of dimethyl sulfoxide liquid into the bladder. Some patients also respond to bladder antispasmodics such as Detrol LA and Ditropan XL.  The key is that different things work for different patients and variants of the disease.  Above all, patients need an understanding and sympathetic urologist.”


Weiss JM.  Pelvic floor myofascial trigger points: manual therapy for interstitial cystitis and the urgency-frequency syndrome. J Urol. 2001 Dec;166(6):2226-31.
Pacific Center for Pelvic Pain and Dysfunction, San Francisco, California 94109, USA.

PURPOSE: The effectiveness of manual physical therapy was evaluated in patients with interstitial cystitis and the urethral syndrome, that is urgency-frequency with or without pelvic pain. The rationale was based on the hypothesis that pelvic floor myofascial trigger points are not only a source of pain and voiding symptoms, but also a trigger for neurogenic bladder inflammation via antidromic reflexes. MATERIALS AND METHODS: From September 1995 to November 2000, 45 women and 7 men, including 10 with interstitial cystitis and 42 with the urgency-frequency syndrome, underwent manual physical therapy to the pelvic floor for 1 to 2 visits weekly for 8 to 12 weeks. Results were determined by patient completed symptom score sheets indicating the rate of improvement according to outcome parameters, including 25% to 50%-mild, 51% to 75%-moderate, 76% to 99%-marked and 100%-complete resolution. In 10 cases these subjective results were confirmed by measuring resting pelvic floor tension by electromyography before and after the treatment course. RESULTS: Of the 42 patients with the urgency-frequency syndrome with or without pain 35 (83%) had moderate to marked improvement or complete resolution, while 7 of the 10 (70%) with interstitial cystitis had moderate to marked improvement. The mean duration of symptoms before treatment in those with interstitial cystitis and the urgency-frequency syndrome was 14 (median 12) and 6 years (median 2.5), respectively. In patients with no symptoms or brief, low intensity flares mean followup was 1.5 years. In 10 patients who underwent electromyography mean resting pelvic floor tension decreased from 9.73 to 3.61 microV., which was a 65% improvement. CONCLUSIONS: Pelvic floor manual therapy for decreasing pelvic floor hypertonus effectively ameliorates the symptoms of the urgency/frequency syndrome and interstitial cystitis.
 


Katske F, Shoskes DA, Sender M, Poliakin R, Gagliano K, Rajfer J.  Treatment of interstitial cystitis with a quercetin supplement. Tech Urol. 2001 Mar;7(1):44-6.
 Division of Urology, Harbor-UCLA Medical Center, UCLA School of Medicine, Torrance, California, USA.

PURPOSE: Interstitial cystitis (IC) is a disorder of unknown etiology with few effective therapies. Oral bioflavonoid therapy utilizing quercetin recently proved to be clinically effective in men with chronic pelvic pain syndrome, a disorder with similarities to IC. We therefore tested in an open-label trial a quercetin-based supplement in patients with clinically proven IC. MATERIALS AND METHODS: Twenty-two patients (5 men and 17 women; average age 53.1 years) with classically documented IC received one capsule of Cysta-Q complex (equivalent to 500 mg of quercetin) twice a day for 4 weeks. Symptoms were assessed before and after therapy by the IC problem and symptom indices as well as by global assessment of pain (range 0-10). RESULTS: Two patients did not complete the study. In the remaining 20 patients, improvement was seen in all three parameters tested. After 4 weeks of treatment, the mean (+/- SEM) problem index improved from 11.3 +/- 0.6 to 5.1 +/- 0.7 (p = .000001), the mean symptom index improved from 11.9 +/- 0.9 to 4.5 +/- 0.5 (p = .000001), and the mean global assessment score improved from 8.2 +/- 0.4 to 3.5 +/- 0.4 (p = .000001). None of the patients experienced any negative side effects, and all but one patient had at least some improvement in every outcome measure. CONCLUSION: Oral therapy with the quercetin supplement Cysta-Q was well tolerated and provided significant symptomatic improvement in patients with IC. Larger, randomized, placebo-controlled trials appear warranted based on these preliminary open-label results.


Zermann DH, Weirich T, Wunderlich H, Reichelt O, Schubert J. Sacral nerve stimulation for pain relief in interstitial cystitis. Urol Int.
Department of Urology, University Hospital, Friedrich-Schiller-University, Jena, Germany. dh.zermann@med.uni-jena.de

A 60-year-old woman was treated for severe interstitial cystitis pain using sacral nerve stimulation. Pain and accompanying bladder dysfunction were improved by temporary and permanent sacral nerve stimulation. Six months after implantation of a sacral neuromodulator the patient is pain free and significantly improved on bladder dysfunction. Interstitial cystitis may be an indication for functional electrostimulation. Copyright 2000 S. Karger AG, Basel
 

Allan E. Interstitial cystitis. Nurs Stand. 1998 Jun 10-16;12(38):43-6.

Interstitial cystitis (IC) is a serious debilitating disease often overlooked by medical and health professionals. This paper describes the elusive aetiology and the painful symptoms of IC and how it affects the patient's life. The author outlines the treatments available and offers guidelines for supporting patients with the disease.

 
Bade JJ, Peeters JM, Mensink HJ.  Is the diet of patients with interstitial cystitis related to their disease? Eur Urol. 1997;32(2):179-83.
Department of Urology, St. Anna Hospital, Oss, The Netherlands.

OBJECTIVE: The dietary habits of interstitial cystitis (IC) patients compared to the average food and fluid consumption of the general population were evaluated and any spontaneous preference or avoidance of specific foodstuffs and fluids of IC patients was investigated. METHODS: A verbal interview with 16 IC patients provided information on the consumption of foodstuffs and fluids as well as dietary habits. Prior to the dietary interview none of the IC patients were aware of any possible dietary measures in relation to their IC symptoms. The results were compared to the averages of the general population. RESULTS: IC patients consumed statistically significantly less calories and fat (p < 0.05), and statistically significantly more fibers (p < 0.01) than the general population. Among the IC patients there were significantly fewer consumers of coffee (p < 0.01) and significantly more consumers of (herbal) tea (p < 0.05). The difference in orange juice consumption was not significant. CONCLUSIONS: According to general standards, IC patients had a more healthy daily diet than the general population. The observation that IC patients consumed less coffee (caffeine) than the general population is consistent with previous reports on irritative IC symptoms exacerbating after caffeine consumption. No rationale for other dietary or fluid intake changes was found.



Webster DC, Brennan T.  Self-care strategies used for acute attack of interstitial cystitis. Urol Nurs. 1995 Sep;15(3):86-93.

OBJECTIVE: To determine the kinds of self-care used by women with interstitial cystitis and to find effective ways to manage symptoms of acute attack. STUDY DESIGN: One hundred thirty-eight women with interstitial cystitis completed a survey indicating how often they used and how effective they found strategies in four physical self-care subdomains (medication, treatment, diet, and body comfort) and three psychologic self-care subdomains (cognitive/stress reduction, distraction, and help-seeking). RESULTS: Descriptions of symptoms during an "acute attack" are more consistent with symptoms described "at onset" than symptoms experienced "currently." Physical strategies most used for acute attack included use of narcotics, antidepressants, and bladder analgesics, in addition to limiting the diet to bland or starchy foods, wearing loose clothing, taking hot baths, and using a heating pad over the pubis. Psychologic strategies most used included watching television, prayer, and seeking support from a significant other, family members, friends, and other patients with interstitial cystitis. CONCLUSIONS: Some psychologic and physical strategies found to be effective for other chronic pain conditions, such as biofeedback, alternating use of heat/cold, self-hypnosis, and redefining pain sensations were seldom used. Other nonmedical interventions such as massage and imagery, when used, were found to be more moderately to highly effective. Information about self-care and access to support groups may increase exposure to multiple ways of handling acute attacks.
 


Fall M, Lindstrom S.  Transcutaneous electrical nerve stimulation in classic and nonulcer interstitial cystitis. Urol Clin North Am. 2000;65(2):120-1. 1994 Feb;21(1):131-9.
Department of Surgery, Sahlgrenska University Hospital, University of Goteborg, Sweden.

Long-term treatment of interstitial cystitis by transcutaneous electrical stimulation provides a conservative means of bringing the disease to remission. The overall results are better in the classic than in the nonulcer subtype of interstitial cystitis. These findings are considered in relation to the role of neutral factors in the disease.