Interstitial Cystitis in Addition to the Therapeutic Essay

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Interstitial Cystitis

In addition to the therapeutic armamentarium, CAM reported to have a great role to treat interstitial cystitis (IC). It is multimodal and individualized and includes various treatment methods including: Neuromodulation, dietary modification, acupuncture, surgical methods, medications etc. The objective of this literature review is to discuss the possible causes of the IC, diagnosis, prevalence, the symptoms, and CAM treatment options.

Interstitial cystitis (IC) also called as painful bladder syndrome is an inflammatory disease of the bladder wall with typical ulceration of the urothelium. The interstitial cystitis (IC) is generally regarded as an elusive disease picture with inadequate therapeutic options. Critical to improving the prospects for therapy is the early diagnosis of the disease, which may involve only a careful history taking and clinical examination. CAM suggests multimodal treatment strategies in the early stage of disease (Abrams, Cardozo, & Fall, 2002).

Due to definition similarity, IC is often referred to as IC/PBS in the literature. It has been estimated that 1.2 million of 1.3 million Americans are women with IC, (Payne, Joyce, Wise, Clemens, 2007). Pain can start off in the urethra, lower back, abdomen, pelvis, or perineum. The pain experienced can be constant or intermittent, and its intensity may change as the bladder either fills or empties of urine. Men may experience pain in the scrotum, testicles, or penis, while women may feel pain in the vulva or vagina. Women may experience the symptoms during vaginal intercourse which often worsen during menstruation. Physical or mental stress as well as certain foods and beverages, can cause symptom to aggravate (Hall & Moldwin, 1995; Moldwin & Sant, 2002).

Causes and Prevalence

It is likely that the disease process is multi-factorial, and patients with one or more contributing factors. Among the causes hypothesized are mentioned but not confirmed infections, allergic responses, autoimmune disease, and heredity responses. One assumption is that the augmented permeability of the defensive glycosaminoglycan layer of the epithelium of the bladder results in the loss of potassium, contaminants and other materials into the interstitium urinary which activates mucosal mast cells and generates an automatically generated immune reaction. Mast cells generate immune reactive chemicals, which they consequently cause a generalized inflammation of the bladder and injury of the mucosa by the incidence of tachykinin and cytokines. Subsequently, they behave as mediators, histamine release tumor necrosis factor, chymase, tryptase, and prostaglandins. Lastly, the factors which cause inflammation sensitize neurons in the bladder causing pelvic pain and bladder (Smeltzer, Bare, Hinkle, Gheever, 2008).

The prevalence of IC varies according suspected precise geographical literature, which here make up the majority of socio-economic conditions, respectively, the diagnostic possibilities as well as the awareness of the disease among physicians and patients an important influence. In the U.S. It is estimated at 130 per 100,000 inhabitants in Finland even at 250 per 100,000. Interestingly, the presumed prevalence in the Asian and African-American population is 30 times lower (Smeltzer, Bare, Hinkle, Gheever, 2008). Women are 10 times more frequently affected by the disease than men. The IC can be manifested from youth to old age, but the diagnosis is most often between the ages of 40 and 50 years made. It should be noted that it takes from first symptoms to diagnosis an average of four to seven years. The genesis of the pathogenesis of IC plays the disturbed integrity of the urothelium a crucial role. Some patients experience aggravation of their indications after eating specific foods or drinks.

A research of people with IC, in which 90% of people had responded to the questionnaire mentioned that particular foods aggravate their signs and symptoms (Smeltzer, Bare, Hinkle, Gheever, 2008).Also asked patients about 175 items that could worsen, improve or have not affected their symptoms. It was found that Cranberry, orange, pineapple, and some other citrus containing fruits and juices, aggravate the symptoms of IC. Coffee, decaffeinated coffee, tea, cola, soda, decaffeinated cola, diet cola and some other alcoholic beverages also had scores considerably lesser than other beverages. This suggested that caffeinated, alcoholic and soft drinks aggravated the problem and symptoms (Rothrock, 2007).

The pathology of interstitial cystitis is not known, although quite a lot of theories have been suggested, including autoimmune disorder (the body attacking itself), genetic factors, allergy mechanisms, and neurologic mechanisms. Despite the cause, it is found that most people with BPS/IC suffer with a damaged bladder lining, often following several bladder infections, excess caffeine and soda intake, or past bladder injuries. This allows the chemicals in the urine to get into bladder muscle, causing swelling and pain.

Recently, it has been found that the FZD8 and PAND genes have a role in a small percentage of patients.

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The FZD8 gene causes production of a protein called ant proliferative factor that slows down the cells of the bladder lining to grow and repair. In patients with this gene, the bladder lining cannot form or repair itself normally.

Historically, the diagnosis of IC in a patient is determined on the basis of a multifaceted symptom such as soreness related to urinary bladder, the frequency of urinating and urgency, with no other definitive cause. even though cystoscopy with HIT can give knowledge about defect of the bladder-like glomerulations, lacerations of the mucosa, the low capacity of the bladder anesthetic and the presence of soreness or "patches." A demonstrative research of 80 patients successively found that the process does not exceed the value of the findings of history and physical examination.

Evaluation and Diagnosis

(Parsons, Parsons, 2004). Not recommended for bladder biopsy unless gross abnormalities in the bladder wall (Moldwin, Sant, 2002). Before diagnosing IC, it is important for other treatable conditions to be ruled out. A detailed medical history and physical examination are a crucial part of the diagnostic workup.

Diagnostic studies used to exclude other ailments include urine culture, urinalysis, cystoscopy, urodynamics, and hydrodistention. The patient suffering from IC may have scarring, stiffening, or pinpoint hemorrhaging caused by recurrent irritation, referred to as glomererulation, which can often be appreciated during the above mentioned studies. In addition, Hunners ulcers are present in about 10% of IC patients (Kochakarn, Lertsithichai, Pummangura, 2007). During urodynamics testing, patients with IC may display a small bladder capacity and can experience pain with the filling of the bladder. Treatment Options Medical and surgical interventions as highlighted in the case study of S.L. are included as treatment modalities for IC.

No single treatment is effective for all patients therefore generally they have to try different treatments. Initial therapy includes adjustments in diet and lifestyle, together with the use of oral medications. Recommended dietary adjustments include the exclusion of one or two foods from the individual's diet. Foods high in acid, potassium, caffeine and alcohol, should be avoided to see if IC symptoms get better. Hydrodistension is also used as a treatment for IC can be used as a diagnostic measure and can provide symptom relief for variable lengths of time (Granham, Glen, Keane, 2004). CAM provides a multimodal treatment options which help in treating the patients with IC. A combination of more than one treatment options are suggested in CAM, by the medical specialists.

Dietary Modifications

The establishment of therapy is changing the dietary habits to help patients stay away from foods that further aggravate the injured layer of the urinary bladder. The type of food intake by the patient plays a vital role in increasing or decreasing the symptoms of IC. In fact the diet is one reason why this syndrome is caused in the first place. The most common reason for causing intersticial cystitis is extremely spicy or acidic food which include alcohol, coffees, teas, all sodas, fruit juices, chocolate, potassium-rich foods such as bananas, tomatoes, citrus fruit, and cranberries. The trouble with diet that triggers this syndrome is that it differs from person to person. Since everyone's body reacts to different kinds of foods differently. The easiest way to find out which food causes this problem is to use the method of elimination in order to find out which food causes a negative reaction. List of diet or food options can be taken from medical specialists in order to find out which food or diet should be taken. One study does show chronic pelvic pain caused by celiac disease in a woman who was able to benefit from a gluten- free diet (Graham, Glen, Keane, 2004).

Medications

Oral medications, such as non-steroidal anti-inflammatory drugs, can be used to alleviate the pain associated with IC. Some patients suffering from intractable pain may require narcotic therapy. A number of adjunctive therapies may also be prescribed.

Pentosan Polysulfate Sodium

Pentosan polysulfate sodium (Elmiron®) was the foremost and the only oral drug developed for interstitial cystitis, and was granted by the FDA in 1996. It is theorized that the medication works by repairing defects in the lining of the bladder, protecting it from urine substrates that can cause irritation. The drawback to this medication is that relief of IC symptoms may take up to six months.

Pentosan polysulfate sodium (Elmiron) has not been….....

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