Treating Interstitial Cystitis/Bladder Pain Syndrome as a Chronic Disease
In 2011 the American Urological Association (AUA) provided guidelines for the diagnosis and treatment of Interstitial Cystitis and Bladder Pain Syndrome. The guidelines provide great insight into pharmaceutical interventions but missed out on a lot of the contributing factors. Treating any chronic disease requires discussion regarding social, environmental, dietary factors which contribute to both prevention and treatment of a condition. This article will highlight those aspects of treating Interstitial Cystitis/Bladder Pain Syndrome.
Why is Treating Interstitial Cystitis Difficult?
There is no known cause, and therefore no definitive treatment, outcomes vary from person to person. In fact, there are a few types if Interstitial Cystitis with various theories (unproven) contributing factors. Depending on how your signs and symptoms present, the treatment may vary. Blood work, subjective findings while discussing your history and physical findings may all contribute to developing your ideal treatment plan.
Because of the unknowns surrounding Interstitial Cystitis, many people try various treatment options without optimal results.
Treat Interstitial Cystitis as a Chronic Disease
First line treatments must include everything ALL chronic diseases include: [1]
- Patient education
- Self care practises
- Behaviour modifications
- Dietary changes
- Supplement Interventions
- pharmaceutical interventions: most are used non-specifically, with varying results. Narcotics being the most commonly prescribed medication.
Patient Education
Normal bladder function: the bladder functions to store urine and periodically release it.
What is IC: IC is a disease caused by inflammation of the bladder, or pelvic pain related to the bladder. The pain can be described as a range from discomfort, to pressure. The pain is accompanied by increased and more frequent sensation of need to void (to urinate more). Pelvic pain can be in the bladder, urethra, vulva, vagina, male genitalia (yes men get it too), rectum or lower back [1].
Contributing factors of IC/BPS: leaky urothelium (with a possible potassium sensitivity), leaky gut, food reactions causing inflammation, hypertonic pelvic floor muscles and genetics all contribute to the pathogenesis of IC/BPS.
Physical Medicine
Pelvic Floor Physiotherapy: certain pelvic floor muscles exercise and relaxation techniques can be very helpful in both the urinary signs and symptoms as well as the pain.
Hot/Cold packs: applied to the suprapubic or perineal area or taking a warm sitz bath may relieve IC discomfort [1].
Dietary Modification
Fluid Intake: drinking liquids usually increases frequency of urination - so IC patients tend to limit fluid intake to decrease pelvic discomfort. However, adequate water intake dilutes irritants and toxins in the urine. Adequate fluid intake flushes the bladder and may help prevent urinary tract infections. So fluid intake is important, we must establish a good balance of fluid intake [1].
Reducing caffeine/coffee, citrus, chocolate, alcohol, spicy foods [1]: There are many foods proposed to contribute to IC in one way or another. This is a small list of things studied. For more talk to you naturopath.
Elimination diets: may be helpful to determine which foods of fluid affect the individual.
Stress Management
Stress is certainly a significant factor. It can serve to not only help when symptoms are present, but help for those in remission, to stay in remission.
Studies show stress levels are present with greater urgency and pain in IC patients [1]. Effective techniques include exercise, bathing, mediation, shortening work hours, creating a non-stressful environment at home, joining education programs and patient support groups.
Mindset
Negative thoughts can hurt a person too. Catastrophic thinking is one where someone believes the worst may happen and the result will not be tolerable. Patients who catastrophize feel helpless and obsess about their conditions. Greater catastrophizing by IC patients was associated with depression, greater pain, poorer social functioning [1]. Those who worked on this thought process felt better.
Summary
Interstitial cystitis or Bladder Pain Syndrome must be regarded as a chronic disease. That means preventative measures are important and contributing factors must all be considered.