Interstitial Cystitis and the Autoimmune Connection – Naturopathic Doctor News and Review

Arlene B. Donar, ND

Interstitial cystitis (IC) is a chronic, debilitating, multifactorial syndrome characterized by excessive urgency and frequency of urination, suprapubic pain, dyspareunia and pelvic pain along with negative urine cultures. The course of the disease is usually marked by flare-ups and remissions. IC generally persists throughout the patient’s life. On clinical evaluation, patients presenting with IC should have no other definable pathology such as urinary infections, carcinoma or radiation-induced cystitis (Metts, 2001). This symptom complex has also been referred to as painful bladder syndrome, leaky bladder syndrome and irritative bladder syndrome (Marshall, 2003).

According to a 2001 Nurses’ Health Study, IC may affect as many as 700,000 women in the U.S., suggesting that the prevalence among women may be as high as 67 per 100,000. Women comprise up to 90% of patients with IC. Onset usually occurs between the ages of 30 and 70 years of age with a median age of 43 (Metts, 2001).

Most patients will consult at least five physicians, including psychiatrists, over a period of more than four years before IC is diagnosed (Metts, 2001).

Etiology

While the exact cause of IC is not known, it is most likely related to autoimmune and allergic etiologies. Numerous studies have demonstrated that symptoms originate from a defect in the glycosaminoglycan (GAG) component of the layer of mucin that covers and protects the bladder urothelium. This breakdown of the bladder protective layer leads to a hyperpermeable bladder wall, stimulation of pain receptors and inflammatory symptoms (Marshall, 2003).

Stress is also known to contribute to symptoms. Patients may report vasodilation, flushing and itching and general skin hypersensitivity in the genital area, upper thighs and abdomen. Corticotrophin-releasing hormone (CRH) secreted from non-CNS sites has proinflammatory actions that may be mediated via mast cell activation. Mast cells are also involved in autoimmunity (Sant et al., 2007). Mastocytosis has been reported in the bladders of 30%-65% of patients with IC. Further evidence of mast cell involvement comes from increased levels of histamine in bladder wall epithelium in IC patients (Marshall, 2003).

IC has the classic picture of autoimmune disease: symptom chronicity with exacerbations and remissions, organ-specific and non-organ-specific mononuclear cell infiltrates, the lack of a clearly defined pathogen and response to steroids or other immunosuppressants (Metts, 2001).

Autoimmune Connection

IC was first reported in 1915 when GL Hunner described two patients with “a rare type of bladder ulcer in women.” Researcher G.M. Fister, MD was among the first to demonstrate a link between autoimmune disease and IC in a patient with systemic lupus erythematosus (SLE). He suggested that patients with IC shared a clinical picture with autoimmune connective tissue disease (Fister, 1938). A 1983 study by Orth et al. confirmed Fister’s findings, and the term “lupus cystitis” was introduced (Orth et al., 1983). Histologically, no immune deposits of IgG, IgA, IgM or complement C1q were found in the mucosa and perivascular regions of urinary bladder specimens (Shibata et al., 2004).

Silk (1970) reported that he had found bladder-specific antibodies in IC patients. His findings indicated that IC belonged to the group of organ-specific autoimmune diseases (Silk, 1970). In a separate 1972 study by Jokinen et al., 31 of 33 (94%) patients with IC were found to have tissue autoantibodies against both non-organ-specific and organ-specific antigens.

On the basis of their findings, they stated that it seems probable that IC “belongs to the group of autoimmune diseases that lies between organ-specific and non-organ-specific systemic diseases. The disease is confined to one organ, but the tissue antibodies are non-organ-specific” (Jokinen et al., 1972).

A familial predisposition to IC was proposed after a report of IC in monozygotic female twins and a mother and daughter (Oravisto, 1980). A study by Christmas and Bottazzo demonstrated that IC is associated with HLA-DR6, and the allele seems to convey a relative risk factor of 4.91. There was evidence of HLA class I inappropriate hyperexpression in the urothelial cells; however, the most striking difference between the bladder tissue of IC patients and the normal control group was that the expression of HLA-DR molecules in the urothelium cells was positive for all three antibodies used in the study. In addition, large numbers of infiltrating cells expressing HLA class II CD3+T cells were evident within the submucosa. This class II expression along with class I hyperexpression in the urothelial cells allows them to activate CD4+ and CD8+ lymphocytes, which appear to be the main effector in the mechanism in destruction of the urothelial cells in IC (Christmas and Bottazzo, 1992).

Naturopathic Treatment

When considering an autoimmune etiology, an effective approach to treatment must address symptom relief, tissue repair and immune function.

• Nutrition       Dietary modification is the cornerstone of IC therapy. Between 53%-63% of IC patients can identify foods that exacerbate symptoms or cause a flare-up. High acidic foods such as alcoholic beverages, carbonated drinks, caffeine, spicy foods, tomatoes, vinegar, chocolate and citrus fruits are among the worst offenders. Arylalkylamines (tryptophan, tyrosine, phenylalanine and tyramine) have also been implicated as triggers, particularly those found in bananas, beer, mayonnaise, nuts, onions, raisins and yogurt (Marshall, 2003). Acid or potassium is often the suspected mechanism (Hudson, 2001). Since the response to these foods is highly variable, an elimination/challenge is quite useful to identify individual triggers. Essential fatty acids in the form of fish oil or flaxseed oil should be included, along with buffered vitamin C (non-citrus source) as both antioxidants and mast cell stabilizers. Pro-inflammatory saturated fats should be greatly reduced or eliminated from the diet, with a focus on anti-inflammatory fruits and vegetables tolerable by the patient.
• Herbal Supplementation Anti-inflammatory and anti-oxidative supplementation is essential in an autoimmune protocol. Botanicals to consider either in capsule or tincture form include, but are not limited to: Boswellia, Curcuma longa, Glycyrrhiza glabra, Camellia sinensis, pycnogenol, Vitis vinifera L. Quercetin should also be included as a mast cell stabilizer.

Botanical methyl donors such as onion and garlic have an anti-inflammatory and analgesic effect on damaged mucosal lining (Hudson, 2001) – again, only if tolerable by the patient.

Other herbs to consider are: 1) Those in the demulcent family for their ability to protect and soothe the damaged mucosal lining, such as Ulmus rubra, Althaea officinalis, Avena sativa, Symphytum officinale or Zea mays; and 2) anti-spasmodics for pain relief, including Viburnum opulus, Dioscorea villosa and Piscidia piscipula.

• Immune System Modulation of the immune system must be addressed when considering an autoimmune etiology. Plant sterols and sterolins in a ratio of 200:1 (beta-sitosterol:beta-sitosterolin) can selectively enhance the activity of T-helper 1 cells (Th-1) while leaving unchanged or inhibiting the T-helper 2 cells (Th-2). The stimulation of the Th-1 pathway leads to the destruction of inflammatory cells and a reduction in the resulting Th-2 mediated cytokines. Plant sterols can also maintain cortisol levels while elevating DHEA, thereby decreasing the cortisol:DHEA ratio and buffering a negative stress response (Bouic et al., 1996).

Proteolytic enzymes taken on an empty stomach provide a dual function in their ability to balance the immune system and act as a potent anti-inflammatory.

Patients should be willing to commit to a treatment program of a minimum of 3-6 months, with some level of symptom relief within the early stages of their protocol. An autoimmune approach to treatment must address inflammation, oxidative damage as well as modulation of the immune system. Therapy specific to IC includes healing of the bladder wall, histamine inhibition and anti-spasmodics for pain relief.

Arlene B. Donar, ND earned her naturopathic degree from the University of Bridgeport College of Naturopathic Medicine. She is board certified and licensed as an ND in Connecticut. Dr. Donar also holds a Master of Arts degree in speech and language pathology, and has worked as both a private consultant and adjunct professor in speech communications. Dr. Donar is the former medical director of the supplement manufacturer Heartguardian. She maintains a private practice in Manhattan, working primarily with clients with chronic health conditions, and lectures locally on prevention and treatment of disease using botanical medicine and clinical nutrition.

References

Metts JF: Interstitial cystitis: urgency and frequency syndrome, Am Fam Physician 64:1199-206, 2001.

Marshall K: Interstitial cystitis: understanding the syndrome, Altern Med Rev 8(4):426-437, 2003.

Sant GR et al: The mast cell in interstitial cystitis: role in pathophysiology and pathogenesis, Urology 69(4 Suppl):S34-S40, 2007.

Fister GM: Similarity of interstitial cystitis (Hunner’s Ulcer) to lupus erythematosus, J Urol (40):37-41, 1938.

Orth RW et al: Lupus cystitis: primary bladder manifestations of systemic lupus erythematosus, Ann Intern Med 98(3):323-6, 1983.

Shibata S et al: Severe interstitial cystitis associated with Sjogren’s syndrome, Intern Med 43:248-252, 2004.

Silk MR: Bladder antibodies in interstitial cystitis, J Urol 103(3):307-309, 1970.

Jokinen EJ et al: Antitissue antibodies in interstitial cystitis, Clin Exp Immunol 11:333-339, 1972.

Oravisto KJ: Interstitial cystitis as an autoimmune disease, a review, Eur Urol 6:10-13, 1980.

Christmas TJ, Bottazzo GF: Abnormal urothelial HLA-DR expression in interstitial cystitis, Clin Exp Immunol 87:450-454, 1992.

Hudson T: Interstitial cystitis: a new approach, Townsend Letter 211:172-173, 2001.

Bouic PJ et al: Beta-sitosterol and beta-sitosterol glucoside stimulate human peripheral blood lymphocyte proliferation: implications for their use as an immunomodulary vitamin combination, Int J Immunopharmacol 18:693-700, 1996.

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(PDF) Interstitial cystitis and systemic autoimmune diseases

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490 nAtUre clinicAl prActice UROLOGY vAn De meRWe septembeR 2007 vOL 4 nO 9

www.nature.com/clinic alpractice/uro

KEY POINTS

■ The association within patients and families

between interstitial cystitis (IC) and known

autoimmune diseases and a female

preponderance suggest an autoimmune nature

of IC, although direct evidence clearly showing

autoimmune mechanisms is lacking

■ The strongest association is between IC

and Sjögren’s syndrome, a disease in

which autoantibodies to the muscarinic M3

receptor on exocrine cells are important in the

pathogenesis

■ Muscarinic M3 receptors are also expressed

on detrusor smooth muscle cells, where they

mediate cholinergic contraction of the urinary

bladder

■ Autoantibodies that target muscarinic M3

receptors might therefore have a role in the

pathogenesis of IC

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© 2007 Nature Publishing Group

Autoimmunity to urothelial antigen causes bladder inflammation, pelvic pain, and voiding dysfunction: a novel animal model for Hunner-type interstitial cystitis

Recent evidence revealed that Hunner-type interstitial cystitis (HIC) is a robust inflammatory disease potentially associated with enhanced immune responses and histologically characterized by epithelial denudation and lymphoplasmacytic infiltration with frequent clonal expansion of infiltrating B cells. To date, few animal models that reproduce the histological and clinical correlates of HIC have yet been established. In the present study, we aimed to develop a novel animal model for HIC via autoimmunity to the bladder urothelium using the transgenic mouse model (URO-OVA) that expresses the membrane form of the model antigen ovalbumin (OVA) as a self-antigen on the bladder urothelium. OVA-specific lymphocytes (splenocytes) were generated by immunization of C57BL/6 mice with OVA protein and injected intravenously into URO-OVA mice. The splenocytes from OVA-immunized C57BL/6 mice showed increased interferon (IFN)-γ production in response to OVA stimulation in vitro. URO-OVA mice adoptively transferred with OVA-primed splenocytes developed cystitis exhibiting histological chronic inflammatory changes such as remarkable mononuclear cell infiltration predominantly composed of T and B lymphocytes, increased vascularity, and mucosal hyperemia in the bladder at days 7–28 with a peak at day 21 tested. No systemic inflammation was found in cystitis-induced URO-OVA mice, nor was any inflammation found in wild-type C57BL/6 mice adoptively transferred with OVA-primed splenocytes. Along with bladder inflammation, URO-OVA mice demonstrated significantly increased pelvic nociceptive responses, voiding dysfunction, and upregulated mRNA expression levels for IFN-γ, tumor necrosis factor-α (TNF-α), and substance P precursor in the bladder. This model reproduces the histological and clinical features of human HIC, providing a novel model for HIC research.

Interstitial cystitis and systemic autoimmune diseases

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Interstitial Cystitis (Painful Bladder Syndrome): Causes & Treatment

Overview

What is interstitial cystitis (IC)?

Interstitial cystitis (IC) or painful bladder (PBS) is defined as a pain, pressure, or discomfort in the suprapubic or bladder area which can cause urinary frequency or the urge to urinate that has been present for at least six weeks.

Who gets interstitial cystitis (IC)?

Men, women and children can all be diagnosed with IC. It is estimated that approximately 83,000 men and 1.2 million women in the US suffer from IC.

Symptoms and Causes

What causes interstitial cystitis (IC)?

The causes for IC are not completely understood. IC may be related to such medical conditions as:

• Autoimmune disease.
• Allergies.
• Defects in the lining of the bladder.
• Vascular (blood vessel) disease.
• Mast cell (cells that cause allergic symptoms) abnormalities.
• Presence of abnormal substances in the urine.
• Unidentified infections.

What are the symptoms of interstitial cystitis (IC)?

Symptoms of IC/PBS vary from case to case, and can be mild, severe, occasional or constant. The symptoms may be similar to those of a bladder infection. Women’s symptoms often get worse during menstrual periods.

Symptoms of interstitial cystitis (IC) include the following:

• Suprapubic or pelvic pain.
• Pressure or discomfort when the bladder is filling.
• Having to urinate frequently.
• Urinating small amounts.

Diagnosis and Tests

How is interstitial cystitis (IC) diagnosed?

There are no definitive tests to diagnose IC/PBS. It is important to rule out other infections and conditions so your doctor may run different tests, including:

• Urine sample and urinalysis: The patient provides a urine sample, and the doctor examines it with a microscope to learn if there are any organisms, germs, pus, or white blood cells, which could mean that there is an infection. The doctor can treat the infection with antibiotics. If the urine is sterile for weeks or months and the symptoms continue, doctors may make a diagnosis of IC.
• Biopsy of the bladder wall and urethra: A biopsy is a sample of tissue taken from the body in order to examine it more closely. This procedure will be done under anesthesia. Tissue may be taken from the bladder wall and urethra (the tube through which urine passes out of the body) to rule out other conditions. A biopsy can help rule out bladder cancer.
• Cystoscopy: The doctor may examine the inside of the bladder with an instrument called a cystoscope. This is a long, thin scope with an eyepiece on one end. The cystoscope is gently placed up the urethra and into the bladder. The doctor can see into the bladder by looking through the eyepiece. The patient is not under anesthesia during this procedure. A cystoscopy can rule out bladder cancer. If a bladder biopsy is also planned, the cystoscopy may be performed at the same time, but this may require anesthesia.
• Cystoscopy under anesthesia with bladder distension: A cystoscopy may also be done with bladder distention (stretching). The doctor will perform a cystoscopy as described above and will distend (stretch) the bladder to its maximum capacity by filling it with water. This procedure can reveal cracks in the bladder. This procedure requires anesthesia because the stretching is painful for people with IC. After this procedure, many IC/PBS patients experience temporary relief of their symptoms.

Management and Treatment

How is interstitial cystitis (IC) treated?

Although IC/PBS cannot be cured, there are many ways to treat it. There is no way to predict who will respond best to certain treatments. Symptoms of IC/PBS may become more severe, or may disappear. Even if symptoms disappear, they may return after days, weeks, months or years.

Treatments for IC/PBS are aimed at relieving symptoms. Doctors will help decide the appropriate treatment for the patient. For some patients, treatments are combined.

Interstitial cystitis/painful bladder treatments can include:

• Diet: Some people with IC/PBS find that certain foods or drinks make their symptoms worse. You may find it helpful to keep a diary of what you eat and drink to see if any foods or drinks cause symptoms and/or flare-ups. For patients who have IC/PBS, acidic foods may irritate the bladder. If this is the case, your doctor may recommend taking an antacid with meals to reduce the amount of acid that gets into the urine. You may also want to remove certain foods from your diet, such as:
  • Alcohol
  • Caffeine
  • Carbonated beverages
  • Chocolate
  • Tomatoes
  • Artificial sweeteners
• Physical activity: Exercise and physical activity may help relieve the symptoms of IC/PBS. Exercises can include:
  • Walking
  • Biking
  • Gentle stretching
• Reducing stress: Stress can trigger flare-ups and symptoms in someone who has IC/PBS. Learning stress reduction methods and setting aside time for relaxation may make living with IC/PBS easier.
• Physical therapy: The pelvic muscles hold the bladder in place and help control urination. Exercising these muscles may help reduce the symptoms of IC/PBS. Your doctor or physical therapist can help you perform this exercises correctly.
• Bladder retraining: A person who has bladder pain can get in the habit of using the bathroom as soon as he or she feels pain or urgency, even if the bladder is not full. As a result, his or her body may get used to going to the bathroom often. Bladder retraining is a treatment to try to overcome this habit by helping you hold urine for a longer period of time. To use bladder retraining, keep a diary of how often you urinate, and how often you have the urge to urinate. Use the diary to gradually increase the length of time between bathroom breaks.
• Oral medications: Pentosan polysulfate sodium (Elmiron®) is a medication approved for treating the pain of IC. This medication may have to be taken for up to six months before any improvement is noticed. Medicines that treat heartburn may help the symptoms of IC by reducing the amount of acid made by the body. Muscle relaxants can help relieve the symptoms by keeping the bladder from squeezing at the wrong time. Antidepressants can be used to relieve pain in patients with IC. Tricyclic antidepressants such as amitriptyline (Elavil) have been shown to improve pain and reduce frequent urination in patients with IC. Narcotic pain medications are not routinely used to treat pain in IC patients.
• Bladder instillations: Another treatment is to fill the bladder with a liquid medicine. You place a small catheter or tube in the urethra and fill the bladder with medicine.
• Bladder stretching/hydrodistension: Bladder stretching or hydrodistension is a procedure that is performed in the operating room under anesthesia. The bladder is filled with sterile water in order to distend the bladder and increase the amount of urine you can hold.
• Nerve stimulation: Nerve stimulation is a treatment that helps regulate the bladder. These treatments are more helpful in reducing urgency and urinary frequency but sometimes can help with the bladder/suprapubic pain.
• Surgery: Surgery to treat IC/PBS is used as a last resort. The surgery may remove parts of the bladder or even the entire bladder. If the patient has tried every other treatment option and pain is unbearable, surgery may be considered.

Interstitial Cystitis | Symptoms, Causes, Treatment & Living With IC

Interstitial cystitis can affect people of all ages, backgrounds and racial groups, but more adults than children get IC. According to the National Institute of Diabetes and Digestive Kidney Diseases, IC is more common in women than men.

fact

IC affects between 1 and 4 million men and between 3 and 8 million women.

Severe IC symptoms can affect quality of life and get in the way of daily activities. It’s important to see a medical professional such as a urologist or urogynecologist to rule out other conditions with similar symptoms, such as urinary tract infections.

While there is no cure for IC, the right treatment can help people with IC manage symptoms and improve quality of life.

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Interstitial cystitis causes inflammation and irritation in the bladder walls.

Symptoms

Symptoms of IC manifest differently from person to person. For example, symptoms in women may get worse right before their periods. Stress may also make symptoms more severe.

“IC begins primarily with [urinary] frequency and is intermittent in most patients with symptom flares associated with sexual activity. Pain and urgency incontinence tend to be later symptoms.”

Over time, the bladder may become scarred or stiff from inflammation. This makes it difficult for the bladder to fill with urine and bladder walls may bleed as it tries to expand.

Typically, common symptoms include bladder pain, discomfort or urinary urgency. Severe symptoms such as painful sexual intercourse, difficulty exercising or travel hesitancy can interfere with daily activities.

IC may cause the following symptoms:

• Urinary urgency during the night and day
• 
  Pain, pressure or tenderness in the pelvis, bladder and perineum that may increase when the bladder fills with urine
• 
  The bladder doesn’t hold as much urine as it used to
• 
  Painful sexual intercourse
• 
  Pain in the penis or scrotum in men
• 
  Pelvic floor muscle spasms in women

Download Your Free Elmiron Guide

Elmiron is the only FDA-approved oral medication used to treat the symptoms of IC. Learn about the drug and associated side effects.

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What Does IC Pain Feel Like?

Pain with pressure is the most common sign of IC. IC pain feels different for everyone, but the pain often gets worse as the bladder fills. It may be dull, stinging or burning.

In addition to the bladder, IC pain may affect the lower back, lower abdomen or pelvic area. Men may feel pain in the penis, scrotum or testicles and women may feel pain in the vagina or vulva.

Complications

IC symptoms can lead to complications and reduced quality of life. Complications are physical and emotional.

Like other people with chronic pain or illness, people with IC may struggle with depression, anxiety and difficulty sleeping.

IC complications include:

• Difficulties with sexual intercourse
• 
  Intimacy avoidance
• 
  Avoiding traveling or exercise
• 
  Painful pelvic exams and Pap tests in women
• 
  Bladder scarring and bleeding
• 
  Reduced bladder capacity
• 
  Sleep loss
• 
  Anxiety
• 
  Depression

Diagnosis

Currently, no definitive test shows if someone has IC or not. Instead, medical providers diagnose IC based on information on symptoms, a physical and neurological examination and some bladder tests.

The most common misdiagnosis is a urinary tract infection, according to Dr. C. Lowell Parsons, a professor and IC expert at the University of California, San Diego Medical Center.

Information a medical provider may use to diagnose IC includes:

• Symptoms
• 
  How severe symptoms are
• 
  How long a person has had symptoms
• 
  What is the patient’s family and medical history
• 
  Medications a patient is taking, over-the-counter and prescription
• 
  How much and what kind of liquids a person drinks
• 
  How symptoms affect daily activities

Physical Exam

In order to rule out other conditions and search for potential causes of symptoms, medical providers will conduct a physical and neurological exam.

For men, the exam will include the rectum, prostate and abdomen. For women, the exam will include the abdomen, rectum and organs in the pelvic area.

Doctors may also check a patient’s mental health because some people with IC have anxiety or other mental disorders occurring along with IC symptoms.

Doctors Who Treat IC

Urologists and urogynecologists are medical professionals who can help diagnose and manage IC symptoms.

Other Tests

In addition to physical exams, patients will fill out a questionnaire about the level of pain they experience. This is called a baseline pain value.

The provider may also perform a voiding test. This is a test to measure how often you urinate. People with IC urinate more often and have lower volumes of urine each time they void.

Urodynamic Evaluation

This test measures bladder pressure as the bladder is filled with water through a catheter. People with IC have a small capacity for liquid and there may be pain as the bladder is filled.

Cystoscopy

In this test, the health care provider will look inside the bladder with a special tool. While examining the inside of the bladder, the doctor can check for cancer, bladder stones or ulcers. He or she will also be able to take a bladder biopsy. A person with IC symptoms and ulcers most likely has IC.

Causes

No one knows exactly what causes IC. Researchers theorize that people with IC have a damaged bladder wall. This allows irritants from urine to leak into the bladder lining, causing pain and discomfort.

A few factors may lead to the development of the condition, according to the Interstitial Cystitis Association. These involve damage to the bladder or its lining.

Triggers for IC include:

• Pelvic floor problems
• 
  Autoimmune disorders
• 
  Trauma to the spinal cord
• 
  Defective bladder lining
• 
  Inflammation or hypersensitivity of the pelvic nerves
• 
  Overdistension of the bladder, such as when people hold their urine for too long
• 
  Trauma or injury to the bladder (from surgery or other injury)

Does a History of Abuse Cause IC?

The link between IC and sexual and physical abuse is controversial. Studies show mixed results, some show no connection, while others show a high rate of abuse among people with IC. So far, the medical community has not reached a consensus, according to the Interstitial Cystitis Association.

Treatment

Unfortunately, there is no cure for IC, and it doesn’t go away. It can go into remission for a long time, but symptoms may return.

The best treatment for IC varies from person to person. Sometimes, there may be a little trial and error involved in finding the best IC symptom relief. It’s important that patients be open and honest with their doctors about their experience and symptoms.

Treatment options for IC include lifestyle changes, medications, therapy and surgery.

Lifestyle Changes

Changes in behavior, diet and exercise are the first line of IC therapy. These changes can lessen symptoms.

Some patients see improvement in tenderness and pain after manipulative pelvic floor therapy. These exercises are different from Kegel exercises which are not recommended for people with IC.

While mental and emotional stress doesn’t cause IC, it can make symptoms worse. Patients can get counseling to help with strategies to deal with mental and emotional stress.

Foods that may exacerbate IC symptoms include:

• Tomatoes
• 
  Chocolate
• 
  Coffee
• 
  Alcohol
• 
  Caffeine
• 
  Spicy food
• 
  Carbonated drinks
• 
  Citrus

FDA-Approved Prescription Medications

If symptoms are still too bothersome after making lifestyle changes, doctors may recommend prescription drugs.

Elmiron (Pentosan Polysulfate Sodium)

Elmiron is the only oral medication approved by the Food and Drug Administration to treat the symptoms of IC. It’s been on the market since 1996. Researchers think the drug works by creating a barrier in the damaged bladder wall and preventing irritants from reaching the lining.

Common Elmiron side effects include stomach pain, nausea and diarrhea. In June 2020, the drug’s maker added a warning to the drug label that long-term use is linked to a degenerative eye disease called pigmentary maculopathy. This condition may get worse even after stopping the drug and may lead to long-term vision loss.

Elmiron Vision Damage

Some patients suffered vision damage after taking Elmiron to treat interstitial cystitis. Read more about the potential side effects of Elmiron.

Learn More

Dimethyl Sulfoxide (DMSO)

Doctors administer dimethyl sulfoxide (DMSO), another FDA-approved IC drug, directly into the bladder through a catheter. Therapy usually lasts six weeks. Researchers think the drug works by blocking inflammation and pain sensations.

Side effects include a garlic-like odor and pain when placing DMSO into the bladder.

Neuromodulation, Injections and Ulcer Cauterization

If drugs and lifestyle changes don’t provide enough relief, neuromodulation, injections and ulcer cauterization are the next options.

Neuromodulation passes electrical impulses into the nerves to help deal with pain. Botox injections may help with pain, but they may cause difficulty passing urine. Doctors may cauterize bladder ulcers and the procedure may provide relief for up to a year or more.

fact

Only patients with severe, treatment-resistant disease should discuss major surgery for IC with their doctor. Most patients don’t need it.

Living with IC

Living with IC can be difficult. Because there is no cure for IC, eating well and managing health is an important way to fend off flare-ups. Planning ahead for travel and other activities can make daily life easier as well.

The Interstitial Cystitis Foundation has some tips for eating, exercise and travel.

Least and Most Bothersome Foods

Helpful Supplements and Foods

Some studies have found some supplements useful for IC symptoms and flares. Some vitamins, minerals and antioxidants may be helpful in conjunction with other medications and treatments.

Make sure you discuss any supplements with your doctor before taking them.

Helpful supplements and foods include:

• Vitamin C
• 
  Vitamin D
• 
  Iron
• 
  Prebiotics/Probiotics (supplements or foods such as asparagus, garlic, leeks, oats, bananas, sourdough, kefir, milk enriched with probiotics)
• 
  Omega 3 Fatty Acids (supplements or foods such as milk, eggs, fish, beans, kale, parsley, squash, spinach)
• 
  Antioxidants (supplements or food such as apples, artichokes, broccoli, dates, pears, pumpkins, yams, watermelon, greens, apricots, blueberries)

Fitness and Exercise

Exercise is beneficial to the body. For people with IC, having good blood flow to the bladder and having good support muscles for organs is extra important.

Exercising with IC may be challenging, but sticking to more gentle, low-impact exercises can help symptoms. Avoid any jarring movements, heavy straining or excessive stretching. Always make sure to check with your doctor before trying any type of exercise.

Recommended exercises include:

• Yoga
• 
  Low impact aerobics
• 
  Pilates for IC
• 
  Walking
• 
  Tai Chi

Travel Tips

People with IC face travel challenges, especially those with severe disease. Urinary urgency and worries about finding bathrooms make travel difficult. But a little planning can make it easier.

IC travel tips:

• Don’t travel during peak seasons
• 
  Research the restrooms along your travel route
• 
  Restrict fluids before and after flights and arrange for an aisle seat
• 
  Take a portable potty or bedpan in the car
• 
  Wear absorbent pads (women) or condom catheters (men) when traveling where restroom access might be restricted

Restroom Laws and Airline Regulations

Interstitial Cystitis and Pregnancy

There isn’t much research about how IC affects pregnancy. Available research shows that patients who experienced moderate symptoms before pregnancy did not have an increase in pain. They only had a slight increase in urinary urgency, according to the Interstitial Cystitis Association.

Treating IC during pregnancy can be more difficult because certain medications may not be safe to take while pregnant. Your doctor may recommend discontinuing most medications.

One of the main medications for IC, Elmiron, hasn’t had adequate studies for pregnant women. But in animal studies, it did not impair fertility or harm the fetus.

Gentle exercise and physical therapy may help keep pregnant women with IC comfortable.

Make sure you talk to your doctor if you become pregnant or plan to become pregnant. Your doctor can help you plan for pregnancy and giving birth.

A Nationwide Population-Based Study in Taiwan.

Objective: The association between autoimmune diseases (ADs) and interstitial cystitis/bladder pain syndrome (IC/BPS) has long been investigated. However, the lack of comprehensive descriptions of patients in the literature has made comparison and evaluation impossible. We aim to investigate the risk of systemic ADs in patients with IC/BPS in Taiwan using a population-based administrative database. Methods: This study evaluated 1,095 patients newly diagnosed with IC/BPS between 2000 and 2013, using data from Taiwan’s National Health Insurance Research Database. These patients were randomly matched by demographic characteristics with a comparison cohort of individuals without IC/BPS at a ratio of 1:20. Cox proportional hazards regression analysis was used to analyze the risk of ADs, adjusting for age, sex, urbanization, length of hospital stay, and comorbidities adjustment. Sensitivity analysis by propensity score was used to adjust for confounding factors. Results: The adjusted Hazard Ratio (aHR) of ADs for IC/BPS patients was 1.409 (95% CI 1.152-1.725). The subgroup analysis indicated that female or 45-60 years of age had a greater risk of ADs. Furthermore, the subgroup analysis of primary outcomes indicated that IC/BPS had greater incidence with Hashimoto’s thyroiditis (aHR = 2.767, 95% CI 1.039-7.368), ankylosing spondylitis (aHR = 2.429, 95% CI 1.264-4.67), rheumatoid arthritis (aHR = 1.516, 95% CI 1.001-2.296), and Sjogren’s syndrome (aHR = 1.962, 95% CI 1.37-2.809). Conclusion: IC/BPS was associated with the development of ADs in our study population, especially Hashimoto’s thyroiditis, ankylosing spondylitis, rheumatoid arthritis, and Sjogren’s syndrome. Clinicians are recommended to be alert to the increased likelihood of developing ADs, particularly for middle-aged women.

Frontiers in medicine. 2021 Sep 20*** epublish ***

Hann-Ziong Yueh, Min-Hsin Yang, Jing-Yang Huang, James Cheng-Chung Wei

Department of Medical Education, Chung Shan Medical University Hospital, Taichung, Taiwan., Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan.

PubMed http://www.ncbi.nlm.nih.gov/pubmed/34616760

90,000 Interstitial cystitis | ECB | League of neurogenic bladder

Interstitial cystitis or “painful bladder syndrome”

Interstitial cystitis or “painful bladder syndrome” is a disease that, like neurogenic bladder, belongs to the competence of neuro-urologists. There are several reasons for this: the similarity of symptoms, the need for a comprehensive urodynamic study (CUDI), the presence of pelvic floor muscle dysfunction in many patients with interstitial cystitis, and the possibility of using botulinum therapy in the treatment of painful bladder syndrome.

The typical clinical picture of interstitial cystitis is well known to doctors, it includes: pain when filling the bladder, frequent urination due to a decrease in capacity, the presence of minor hemorrhages and Gunner’s ulcers during cystoscopy. However, the existence of different variants of the course of the disease with similar symptoms has led to the emergence of a more generalized and “vague” term – “painful bladder syndrome”.

“Painful bladder syndrome” unites many pathologies that have not yet been fully understood.

There are many different hypotheses explaining the cause of painful bladder syndrome:

Infection (so far no microorganism has been isolated using standard research methods that could cause the disease).

Inflammation (an essential part of classic interstitial cystitis).

Mast cell activation (mast cells are multifunctional immune cells containing potent inflammatory mediators such as histamine, leukotrienes, serotonin and cytokines, which, when released, can cause pain, urinary frequency, edema, fibrosis, and activation of blood vessel formation in the bladder mucosa).

Urothelium dysfunction / damage to the glycosaminoglycan (GAG) layer (bladder mucosa becomes thin and fragile, cracks and tears easily appear on it).

Autoimmune mechanisms (interstitial cystitis can be a manifestation of systemic autoimmune diseases, in particular, Sjogren’s syndrome)

Changes in nitric oxide metabolism (not proven).

Neurobiological mechanisms (increased activity of the sympathetic nervous system was revealed in patients with painful bladder syndrome).

The effect of toxic substances (toxic substances contained in the urine can cause damage to the bladder)

Hypoxia (deterioration of blood supply).

Complex pathogenic interaction (in recent years, special attention has been paid to the theory of complex multifactorial effects leading to the development of the disease).

Diagnosis of painful bladder syndrome is carried out by analyzing symptoms, conducting an objective examination, examining urine analysis, performing cystoscopy with hydro-stimulation and biopsy.

Usually, patients have characteristic pains, frequent urination, which is sometimes very pronounced, and nocturia (frequent nighttime urination) is always present.

The key symptom in the diagnosis is a specific pattern of pain:

• The severity of pain depends on the fullness of the bladder, usually the pain intensifies when it is full

• Pain is localized in the suprapubic region and sometimes radiates to the groin, vagina, rectum or sacrum

• Pain is relieved after urinating, but worsens rapidly again.

Cystoscopic picture

Classic interstitial cystitis is a disease that is accompanied by destructive inflammatory changes in the tissues of the bladder and leads to a decrease in its volume and obstruction of the bladder due to fibrosis. During endoscopic examination in patients with classical IC, the following picture is noted: purple-colored zones of the mucous membrane, in the center of which there is a scar, small vessels radiate from it; sometimes the lumens of the vessels are thrombosed.When the bladder is stretched, the scars rupture, a characteristic bleeding appears in the form of a cascade. The study is carried out under anesthesia.

Drug treatment:

Analgesics. Since pain is the main symptom of any disease, many patients at one of its stages take the most commonly used analgesics. However, due to the fact that pain in painful bladder syndrome is visceral, and analgesics practically do not affect this type of pain, the degree of their severity remains almost the same as before taking analgesics.

Corticosteroids. Effectiveness has not been proven, and the side effects of corticosteroid use can be very serious.

Antiallergic agents. There is information that mast cells may play a role in the development of interstitial cystitis. One of the substances that mast cells produce is histamine. In studies, patients with interstitial whistitis were prescribed antagonists of h2- and h3-histamine receptors, which in some cases facilitated the course of the disease.The histamine H1 receptor antagonist is hydroxyzine, which blocks neuronal activation of mast cells by inhibiting the secretion of serotonin by neurons and thalamic mast cells. The most common side effects are sedation and general weakness, which disappear some time after starting treatment.

Amitriptyline is a tricyclic antidepressant that can reduce the severity of symptoms, which is explained by the following properties of the drug:
1) Blocking of acetylcholine receptors
2) Inhibition of the reuptake of released serotonin and norepinephrine
3) Blocking of H1-histamine receptors.
Amitriptyline is also an anxiolytic.

Sodium Pentosan Polysulfate (PPN). It is believed that the PPN is capable of eliminating the defect of the GAG ​​layer. Not registered in Russia.

Antibiotic therapy. Antibiotics are rarely used to treat interstitial cystitis because the role of bacteria in its development has not been proven.

Immunosuppressants. When conducting open studies of cyclosporin A and methotrexate, it was found that these drugs are quite effective in the treatment of pain syndrome, but do not affect the frequency of urination and the severity of urge to urinate.Have serious side effects.

Gabapentin is an antiepileptic drug that is used as an adjunct in the treatment of pain syndromes. Gabapentin can be used to reduce the use of drugs such as opioid analgesics.

Intravesical therapy:

Intravesical administration of drugs (through a catheter) allows to achieve high local concentrations and reduce the frequency and severity of systemic side effects.

Local anesthetics such as lidocaine.

Sodium pentosan polysulfate (PPN) is a glycoprotein that eliminates the defect in the glycosaminoglycan (GAG) layer. Since the drug has low oral bioavailability, it is administered intravesically.

Intravesical heparin is used as a film-forming agent on the bladder mucosa.

Hyaluronic acid is a natural proteoglycan that is used to eliminate the defect in the GAG ​​layer.

Dimethyl sulfoxide (DMSO) is a chemical solvent, a water-soluble liquid that can penetrate through cell membranes into cells. DMSO has analgesic, anti-inflammatory, collagenolytic and muscle relaxant properties. It is also able to bind intracellular OH radicals, which are believed to be one of the main substances that trigger the inflammatory process. DMSO is currently the standard treatment for interstitial cystitis.Contraindications to the use of DMSO are: urinary tract infection and recent bladder biopsy. When DMSO is used, the urine smells like garlic for a while.

The anti-tuberculosis vaccine, bacillus Calmette-Guerin (BCG), has immunomodulatory properties and is therefore used in the treatment of superficial bladder carcinoma. There are conflicting data on efficacy for interstitial cystitis.

Vanilloids destroy sensory neurons.Resiniferatoxin (RTX) is a more potent analogue of Chilean pepper extract capsaicin. With the instillation of this substance, the soreness of the bladder decreases and the need for anesthetics is eliminated. There are conflicting data on efficacy for interstitial cystitis.

Modification of urine pH. There are no results confirming the effect of pH on the severity of pain syndrome in patients with interstitial cystitis.

Interstitial cystitis. Treatment in Krasnodar

Interstitial cystitis is a chronic inflammatory disease of the bladder of a non-infectious cause (etiology) and with an incompletely known pathogenesis.This condition is manifested by the classic triad of symptoms: “frequent urination – sudden urge – pain when filling the bladder.” Most often, pain is the main symptom . Sometimes, patients are forced to take drugs to reduce the intensity of the pain syndrome. In some cases, it is necessary to resort to cystectomy (removal of the bladder) and replacement enterocystoplasty (creation of a new bladder from the intestine).

The causes of interstitial cystitis are not entirely clear, but …

One of the main theories is the theory of glycosaminoglycan layer deficiency.Indeed, in the urine of patients with interstitial cystitis, the content of the main glycosaminoglycans – hyaluronic acid and chondroitin sulfate – is reduced.

This looks quite logical: due to the destruction of the protective layer of the bladder, chemically active substances in the urine (for example, potassium ions) fall on the exposed mucosa. The effect is similar to pouring saline over an open wound or skin with lye. That is, pain arises. But that’s not all: there is a chemical “burn” of the bladder mucosa and then, inflammation.Inflammation means the immune system is attacking the bladder wall in an attempt to kill bacteria (which do not exist). This is called an autoimmune process. As a result, due to the combined efforts of urine chemicals and the “tricked” immune system, the inner lining of the bladder is destroyed.

As a result, with an insignificant filling of the bladder, unbearable pain occurs, requiring immediate emptying. In severe cases, patients urinate more than 100 times a day.

Diagnostics

Diagnosis of interstitial cystitis (IC) is rather difficult. The European Society of Urology and ICS guidelines state that this is a diagnosis of exclusion. Those. if the patient urinates less than 8 times a day, if antibiotics help, if there is some kind of infection in the urine culture – this is NOT interstitial cystitis. In fact, antibiotics can help because of the “placebo effect” (self-hypnosis), and microbes in the culture can be from the skin or from somewhere else … Therefore, each doctor makes such a diagnosis in accordance with his experience and knowledge.

But again – the main symptom of interstitial cystitis,

is pain with a slight filling of the bladder , requiring immediate urination.

However, there are three more or less effective diagnostic methods: filling out diagnostic questionnaires, cystoscopy and a test with potassium chloride.

The O’Leary questionnaire is actively used in Europe for the diagnosis of interstitial cystitis.You can download it here and send it to the email address [email protected] or through the online consultation form.

Cystoscopy (examination of the bladder cavity through an endoscope) allows you to see the so-called. Gunner’s ulcers on the mucous membrane of the bladder. If there is such an ulcer – 100% that the patient has interstitial cystitis.

But not all patients with IC have ulcers. Cystoscopy for interstitial cystitis must be performed under general anesthesia, i.e.because it is necessary to fill the bladder as much as possible. This procedure is called Hydro-Boost Cystoscopy. During such cystoscopy, you can see glomeruliations – submucosal hemorrhages in the wall of the bladder that are not visible with conventional cystoscopy.

At this link you can watch a video of cystoscopy for interstitial cystitis .

As for the test with potassium chloride, its meaning is precisely in the diagnosis of damage to the glycosaminoglycan layer.If the layer is not broken, then the potassium ions will not reach the lamina propria of the bladder mucosa (urothelium) and will not irritate the nerve endings located there. Accordingly, administration of a potassium chloride solution will not cause pain. If the glycosaminoglycan layer is destroyed, partially or completely, then the KCl solution reaching its own plate will cause pain. Thus, the patient is injected with two solutions: NaCl (neutral saline) and KCl (painless for the patient with a preserved protective layer).If pain appears after the administration of potassium chloride, it means interstitial cystitis. Of course, such a test is only a link in the diagnosis of this complex disease. The diagnosis is made on the basis of the totality of the data obtained.

Also, for the diagnosis of interstitial cystitis, questionnaires are used:

Treatment of interstitial cystitis is an intractable task! Patients should understand that the disease is chronic and a complete cure is unlikely.However, it is possible to achieve remission – the absence of signs of the disease for several months or years.

There is no single drug or method, treatment is always complex, since the pathogenesis of interstitial cystitis consists of six components:

1. Destruction of the protective glycosaminoglycan layer of the bladder
2. Abacterial (non-infectious) inflammation in the epithelium of the urinary bladder (urothelia)
3. Increased sensitivity and number of nerve endings in the bladder mucosa – peripheral sensitization .
4. Increased sensitivity of nerve endings in other organs of the small pelvis (so-called mutual guidance or “cross-talking”).
5. Pelvic floor muscle spasm = “myofascial pain syndrome”
6. Increased sensitivity to pain of neurons of the central nervous system – syndrome of central sensitization or centralization of pain .

In most cases, treatment begins with the restoration of the protective layer of the bladder, as it protects the mucous membrane from urine exposure.Urine contains potassium ions that act on the nerve endings of the bladder – causing pain and frequent urination.

Drugs and methods used in the treatment of interstitial cystitis:

Non-steroidal anti-inflammatory drugs (NSAIDs) – celecoxib (Celebrex) is effective in some cases, mainly in the initial stages.

Antihistamines such as hydroxyzine (Atarax) reduce the autoimmune component of the disease.

Antidepressants are an obligatory component of treatment !!!
The European Society of Urology recommends amitriptyline, but more effective drugs such as duloxetine (Simbalta) and trazodone (Trittico) have appeared recently. Trazodone is very effective for nighttime urination (nocturia).
It should be understood that these drugs should be used for a long time, several months, and sometimes years.

Antidepressants are necessary because An important link in the pathogenesis of interstitial cystitis is syndrome of central sensitization or centralization of pain – a type of phantom pain when symptoms of interstitial cystitis persist even after the bladder mucosa is cured.

For the introduction into the bladder are used: Dimexide, hydrocortisone, lidocaine, heparin and PPS (pentosan polysulfate), BCG vaccine. Intravesical instillations of the so-called cocktails are widespread in Europe and the USA:

The effectiveness of intravesical administration of drugs increases with the use of intravesical inductothermophoresis or thermal irrigation of the bladder.

In addition, to restore the glycosaminoglycan layer , intravesical administration of hyaluronic acid in the form of sodium hyaluronate (Cystistat, UROLIFE ) is used.Hyaluronic acid has shown high efficiency in the complex treatment of interstitial cystitis, however, it should be understood that a complete cure is hardly possible, it would be more correct to speak of long-term remission.

Recently, oral (inside) administration of drugs to restore the protective layer of the bladder, for example “UROLIFE” in capsules, has been actively used.

In severe cases, it is possible to use independent instillations of sodium hyaluronate in syringes – “Urolife Express” (for quick “relief” of pain in the bladder area).

Bladder hydro-stimulation is one of the main treatments for classic interstitial cystitis. Under general anesthesia, 350-400 ml of saline is injected into the patient’s bladder through a cystoscope. This increases the capacity of the bladder and decreases the frequency of urination.

In our clinic, injections of botulinum neuropeptide (BOTOX) are actively used in the so-called. Lieto’s triangle is the area of ​​the bladder mucosa in which there are most pain receptors.Injection of BOTOX into the Lieto triangle is able to reduce the level of peripheral sensitization , that is, to reduce the sensitivity of the bladder receptors.

In case of ineffectiveness of conservative methods, surgical methods are used: from destruction of altered parts of the bladder with a holmium or diode laser to enterocystoplasty – a complete replacement of the bladder with an intestinal reservoir.

Quite often, with interstitial cystitis, myofascial pain syndromes of the pelvic floor muscles (m.levator ani, m.obturatorius int.) . In such cases, injections of botulinum toxin into these muscles are very effective.

Depending on the predominance of one or another link in the pathogenesis of interstitial cystitis, several types of interstitial cystitis are distinguished:

At the end of this section, let me give a clinical case:

Patient T., 37 years old, has been suffering from interstitial cystitis for 7 years. Exacerbation of the disease when drinking coffee, alcohol, spicy, after sexual intercourse.She was repeatedly treated with antibiotics. Urinalysis and urine culture are normal.
The psychological state is extremely serious, there are suicidal tendencies.
Treatment was prescribed: trazodone (Trittico) 150 mg. at night, duloxetine (Simbalta) 50 mg. 2 times a day. Instillation of hyaluronic acid ( “Urolife” ) 50 ml once a week, intravesical electrophoresis of hydrocortisone 2 times a week and lidocaine 2 times a week. An improvement was noted after 2 weeks. Currently (6 months have passed) he receives Trittico at night and instillations of hyaluronic acid ( “Urolife” ) once a month.Aggravations after taking alcohol, spicy, coffee practically disappeared. However, after intercourse, there are short-term episodes of pain in the bladder area. Control tests (general urine analysis, urine culture, PCR) are the norm. Nevertheless, after each intercourse, the patient takes Monural (just in case).
I am satisfied with my condition, because compares with the condition before treatment.

You can fill out the O’Leary questionnaire and urination diary for interstitial cystitis (below) and send the scan to the email address: krasnodar1 @ upclinic.ru marked “for the Clinic of Urogynecology and Neuro-urology”. Our specialists will process your data – perhaps we can help you!

Interstitial cystitis (painful bladder syndrome)

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<< Autoimmune diseases

Interstitial cystitis, also called painful bladder syndrome, is a chronic autoimmune inflammatory condition of the muscle and submucosal layers of the bladder.Because of the chronic condition, it is believed that the cause of this condition is autoimmune, that is, the body’s own antibodies attack parts of its own cells; in this case, in the bladder.

Symptoms of interstitial cystitis

The disease often causes symptoms associated with bladder problems, such as feeling the need to constantly go to the toilet, urinating frequently and waking up at night to go to the toilet – the patient may also experience painful sensations when urinating.As mentioned, symptoms can overlap with other known conditions, such as urinary tract infection, overactive bladder, urinary tract infection, and inflammation of the prostate.

The most common symptoms are bladder pain, frequent urination, painful intercourse, and sleep disturbance from getting up to go to the bathroom.

It has also been observed that people may have difficulty launching a stream of urine, which is associated with pelvic floor dysfunction and stress.Those who suffer from interstitial cystitis often find the pain worse when the bladder fills up and then improves with urination.

Clinical signs

As mentioned in the Symptoms section above.

Diagnosis and cause

Diagnosis is made through a series of examinations (including blood tests), laboratory tests, and a thorough medical history. Due to overlapping symptoms, interstitial cystitis is often misdiagnosed as a urinary tract infection.The exact cause of this condition is still unknown, but there are good indications that this is an autoimmune response.

Who suffers from this disease?

The condition affects both men and women of all ages. Research shows that between 1 in 100,000 and 5 in 1,000 are affected. Thus, interstitial cystitis is much more common than one might think.

Treatment

Patient education, nutritional counseling and stress therapy are the most common forms of treatment.This can also make a difference when specifically training the bladder and pelvic floor through physical exercise, and when taking medication if needed. If the condition does not improve, nerve block treatment, Botox injection, or even surgery may be required.

The most common form of treatment for autoimmune diseases included immune suppression that is, drugs and measures that limit and protect the body’s own defense system.Gene therapy, which limits inflammation in immune cells, has shown great progress in recent years, often in combination with increased activation of anti-inflammatory genes and processes.

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Treatment of cystitis in the clinic “Your Doctor”. Diagnostics. Sign up

Treatment of cystitis in Rostov in the center “Your Doctor”

Doctors of our center “Your Doctor” are engaged in the treatment of cystitis. Before starting the treatment of cystitis, you need to make an appointment with a doctor, carry out diagnostics, and get tested.After diagnosis and determination of the diagnosis – cystitis, the doctor will prescribe treatment. You can make an appointment with a doctor and find out the cost of an appointment by phone.

What is cystitis?

Cystitis is an inflammation of the bladder. The disease occurs as a result of exposure of the bladder to various pathological factors, the most common of which is infection. Treatment for inflammation is necessary.
In modern clinical practice, the classification of cystitis proposed by O.A. Tiktinsky in 984.In accordance with it, it is customary to distinguish cystitis by clinical manifestations (acute, chronic), course (primary, secondary), etiology and pathogenesis (infectious and non-infectious: the latter includes interstitial, allergic, autoimmune, chemical and radiation), the nature of morphological changes ( catarrhal, hemorrhagic, ulcerative, interstitial, gangrenous) and localization (diffuse, cervical, focal).

Primary cystitis is a disease that is much more common in women than in men, due to the anatomical and physiological characteristics of the female genitourinary system.According to research, about 35% of women experience symptoms of cystitis during their lifetime. For men, primary cystitis is an extremely rare disease. As a rule, cystitis in men is secondary in nature and is caused by an ascending infection from the urethra or prostate gland with urethritis and chronic prostatitis.

Interstitial cystitis occupies a special place among the diseases of the bladder. This is a non-infectious inflammation of the bladder. The exact cause of its occurrence is still under study, but it has been proven that the development of this disease is associated with a lack of glycosaminoglycans lining the epithelium of the bladder.In this case, the usual components of normal urine penetrate into the unprotected wall of the bladder and cause inflammation. Treating inflammation is essential for the body.

The main symptoms of cystitis are pain in the lower abdomen, in the bladder, frequent, painful urination, sometimes blood in the last portion of urine. With diffuse inflammation of the bladder, the pain increases when it fills and subsides after the bladder is empty. For inflammation in the neck of the bladder, an increase in pain at the end of the act of urination is characteristic.In acute cystitis, a fairly common symptom is an increase in body temperature.

Long-term chronic cystitis is characterized by symptoms of varying severity, ranging from the first sensation of discomfort in the lower abdomen, to a pronounced pain syndrome in the bladder with an imperative, sharply increased urge to urinate.

The wave-like symptoms of chronic cystitis create psychological, social, hygienic problems, and chronic pain and sleep disturbances can lead to depression.Since the symptoms of interstitial cystitis are similar to the clinical picture of ordinary bacterial cystitis, the diagnosis is made in many patients, as a rule, much later, while the patients are observed by two or more specialists.
Accurate diagnosis of cystitis for many medical institutions is a difficult problem. The exception is acute cystitis, the diagnosis of which is not difficult and is based on data from the clinical picture and laboratory studies.

Diagnosis of cystitis

The diagnosis of chronic cystitis requires the use of a number of clinical and special studies and is based on data from the patient’s complaints, anamnesis, the presence of past or existing sexually transmitted diseases.The patient must undergo urine and blood tests, bacteriological culture, according to the indications of UIF, PCR, NASBA – diagnostics, the results of ultrasound examination of the pelvic organs are evaluated, if necessary, hormonal blood tests are carried out. Quite often, for the diagnosis of chronic cystitis, combined urodynamic studies and endoscopic methods are used – cystoscopy, urethrocystoscopy.

Treatment of cystitis

Treatment of cystitis is a complex problem that should only be dealt with by a specialist.Treatment of bacterial cystitis is carried out only according to the results of an antibioticogram, using the most effective antibacterial agents. In case of destructive and ulcerative changes in the mucous membrane of the bladder, in parallel with antibacterial therapy, instillations of the bladder with drugs, antispasmodic and analgesic drugs are prescribed.

Over the years, the Vash Doctor Clinical Center has developed comprehensive programs for the treatment of inflammatory bacterial and non-bacterial cystitis.The main directions of drug therapy are antibacterial (for bacterial cystitis), general and local anti-inflammatory therapy using modern medical equipment, elimination of urodynamic disorders of the lower urinary tract, correction of hygienic and sexual factors, and immunocorrection.

Of great importance during the treatment process is the observance of the regime of work and rest, an appropriate diet with the exception of spicy and spicy dishes. Plentiful drinks, fruit drinks, alkaline mineral waters and juices, herbal preparations are used.Correctly carried out treatment with subsequent control leads to a complete restoration of the patient’s health.

autoimmune cystitis symptoms and treatment in women

autoimmune cystitis symptoms and treatment in women

autoimmune cystitis symptoms and treatment in women

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What are autoimmune cystitis symptoms and treatment in women?

Urinary meridian is a complex drug.The medicine quickly removes unpleasant symptoms, restores the functions of damaged organs. The tool helps men and women with cystitis, urethritis, enuresis, regardless of age and stage of development of the disease.

The effect of the use of autoimmune cystitis symptoms and treatment in women

Completed a course of treatment with Urinari Meridian. Relief came literally the next day. At first, she began to go to the toilet much less often, she stopped getting up at night every hour.Gradually, the urination schedule returned to normal, but it took a long time to heal, about 5 weeks. The course of treatment cannot be called cheap, but it is very effective, it allows you to completely get rid of this unpleasant ailment. After all, not only does a sick person constantly run to the toilet, often to the detriment of official duties, but also smells bad from him. Such a constant, indestructible “aroma” badly affects the already not the best state of health.

Expert opinion

Urinary meridian has a complex effect on the human genitourinary system, eliminating the cause of the disease.The main effects of taking the drug: Suppresses the frequent urge to urinate. Relieves inflammation in the groin area. Destroys harmful bacteria and removes them. Cleans the urinary tract.

How to order

In order to place an order for autoimmune cystitis symptoms and treatment in women, you must leave your contact information on the site. The operator will contact you within 15 minutes. Will clarify all the details with you and we will send your order. In 3-10 days you will receive the parcel and pay for it upon receipt.

Customer Reviews:

Vera

Treatment by Urinari Meridian helped to get rid of chronic cystitis, which exacerbated several times a year. I have been drinking the drug for 2 months. Improvements appeared after a few weeks. In 2 months, the health of the genitourinary system was fully restored. I was pleased with the effectiveness of the drug. The only thing I didn’t like was the need for a long reception. You need to immediately tune in to the course of treatment in order to get a stable result.Now the disease does not bother me, I feel good.

Elena

I had frequent urge to use the toilet and bought Urinary meridian. Helped me well, now everything is in order.

Treatment by Urinari Meridian helped to get rid of chronic cystitis, which exacerbated several times a year. I have been drinking the drug for 2 months. Improvements appeared after a few weeks. In 2 months, the health of the genitourinary system was fully restored.I was pleased with the effectiveness of the drug. The only thing I didn’t like was the need for a long reception. You need to immediately tune in to the course of treatment in order to get a stable result. Now the disease does not bother me, I feel good. Where to buy autoimmune cystitis symptoms and treatment in women? Urinary meridian has a complex effect on the human genitourinary system, eliminating the cause of the disease. The main effects of taking the drug: Suppresses the frequent urge to urinate. Relieves inflammation in the groin area.Destroys harmful bacteria and removes them. Cleans the urinary tract.

Symptoms of PBS. Most patients with interstitial cystitis report the following symptoms. The autoimmune phenomenon in the pathogenesis of this syndrome has not yet been determined. … Part 2. Treatment of interstitial cystitis – guidelines of leading urological associations. Although women are considered to be the weaker sex, their bodies are strong. What are the hardships of bearing, giving birth and feeding a child! However, unfortunately, the peculiarities of anatomy sometimes determine the adherence of women to certain diseases, in particular.An increase in the number serves as an indirect confirmation of the autoimmune genesis of cystitis. In women, the symptomatology of cystitis increases during ovulation. 2. Interstitial cystitis: pathogenesis, diagnosis and treatment / Mirkin YB, Karapetyan AV // Experimental and clinical. Symptoms and manifestations of interstitial cystitis vary greatly from patient to patient. … Symptoms include: pain in the pelvic area or between the vagina and anus in women and between the scrotum and anus in men (area. Signs and symptoms of interstitial cystitis…. Symptoms of interstitial cystitis in women include. Treatment of interstitial cystitis. Unfortunately, there is no treatment that would once and for all cure interstitial cystitis, and no. Chronic cystitis symptoms. Regardless of the cause, chronic cystitis has similar symptoms. In the sluggish phase, the signs are poorly expressed. There is no discomfort or pain. The symptoms of chronic cystitis worsen during periods of exacerbation. They may be. Interstitial cystitis: discussion of pathogenesis, diagnosis and treatment.Part 1 – pathogenesis. … In addition to the bladder, in the small pelvis in women is the uterus with appendages and the descending parts of the intestine. That is why such symptoms of interstitial cystitis as pain and. The autoimmune process is running, but in reality it only destroys. The main course of treatment begins with the elimination of the cause of the occurrence. Interstitial cystitis is the most common cause of chronic pelvic pain in women. … Before the patient learns about his true diagnosis – interstitial cystitis and begins to receive treatment, he goes a long way, lasting several years, which consists of.Interstitial cystitis: autoimmune or infectious? Cystitis is an inflammation of the bladder wall. … Symptoms that characterize interstitial cystitis include chronic pelvic pain, painful frequent urination, including at night.

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She underwent a course of treatment with Urinari Meridian. Relief came literally the next day. At first, she began to go to the toilet much less often, she stopped getting up at night every hour. Gradually, the urination schedule returned to normal, but it took a long time to heal, about 5 weeks.The course of treatment cannot be called cheap, but it is very effective, it allows you to completely get rid of this unpleasant ailment. After all, not only does a sick person constantly run to the toilet, often to the detriment of official duties, but also smells bad from him. Such a constant, indestructible “aroma” badly affects the already not the best state of health.

autoimmune cystitis symptoms and treatment in women

Urinary meridian is a complex drug. The medicine quickly removes unpleasant symptoms, restores the functions of damaged organs.The tool helps men and women with cystitis, urethritis, enuresis, regardless of age and stage of development of the disease.

Cystitis is an inflammation of the bladder. More often women suffer from it. Cystitis occurs as a result of the entry of pathogenic flora into the urethra and the multiplication of bacteria in the bladder. The best pills for cystitis in women, which are developed on the basis of the extract. A semi-synthetic antibiotic is the best medicine for cystitis in the composition. Cystitis is generally an acute and well-treatable disease.Pharmaceutical companies offer a large arsenal. Pyelonephritis medicines. How to treat cystitis. Preparations for urethritis. … More often they are recommended in the form of injections, tablets are used in the absence. Cystitis, but in the male version – the inflammatory process in the seminal vesicles – manifests itself in one- or two-sided form, can be acute. The drug Furagin is available in the form of capsules and tablets. A medicine containing furazidine is prescribed for urogenital and gynecological infections, infected burns, skin infections, for the prevention of.Only certified medicines, delivery to any pharmacy in Moscow around the clock. -Acute bacterial cystitis, acute attacks of recurrent bacterial cystitis; – bacterial nonspecific. Available in tablets, capsules, in the form of powders and ready-made solutions intramuscularly, for infusion. … When choosing tablets for the kidneys based on herbal ingredients, one should take into account the existence of the risk of allergic and adverse reactions. In cases where such an action. Antimicrobial drugs for cystitis.The action of drugs in the fight against microorganisms is. Monural is a broad-spectrum antibiotic that has proven to be effective against cystitis pathogens in clinical trials and in practice. Active substance c. Release form: capsules. Category: Antimicrobials. … Acute and chronic urinary tract infections (pyelonephritis, urethritis, cystitis, prostatitis, etc.). … On the map Hide the map. PILLS. Acute bacterial cystitis, acute attacks of recurrent bacterial cystitis; bacterial nonspecific urethritis; asymptomatic massive bacteriuria in pregnant women; postoperative urinary tract infections.

Autoimmune diseases

Autoimmune diseases (from the Greek αὐτός [authos] “himself; he himself”) is a class of diseases that are heterogeneous in clinical manifestations that develop as a result of pathological production of autoimmune antibodies or the multiplication of auto-aggressive clones of killer cells against healthy, normal tissues of the body, leading damage and destruction of normal tissues and the development of autoimmune inflammation. The production of pathological antibodies or pathological killer cells may be associated with the infection of the body with such an infectious agent, the antigenic determinants (epitopes) of the most important proteins of which resemble the antigenic determinants of the normal tissues of the host organism.It is by this mechanism that autoimmune glomerulonephritis develops after suffering streptococcal infection or autoimmune reactive arthritis after suffering gonorrhea. An autoimmune reaction can also be associated with the destruction or necrosis of tissues caused by an infectious agent, or a change in their antigenic structure so that the diseased tissue becomes immunogenic for the host organism. It is by this mechanism that autoimmune chronic active hepatitis develops after hepatitis B.

The third possible cause of an autoimmune reaction is a violation of the integrity of tissue (histo-hematological) barriers, which normally separate some organs and tissues from the blood and, accordingly, from the immune aggression of the host’s lymphocytes. At the same time, since normally the antigens of these tissues do not enter the blood at all, the thymus (thymus gland) normally does not produce negative selection (destruction) of autoaggressive lymphocytes against these tissues. But this does not interfere with the normal functioning of the organ as long as the tissue barrier separating this organ from the blood is intact.It is by this mechanism that chronic autoimmune prostatitis develops: normally the prostate is separated from the blood by the blood-prostatic barrier, antigens of the prostate tissue do not enter the bloodstream, and the thymus does not destroy “antiprostatic” lymphocytes. But with inflammation, trauma or infection of the prostate, the integrity of the blood-prostatic barrier is disrupted and auto-aggression against the prostate tissue can begin. According to a similar mechanism, autoimmune thyroiditis develops, since normally the thyroid colloid also does not enter the blood (blood-thyroid barrier), only thyroglobulin with associated T3 and T4 is released into the blood.There are cases when, after suffering a traumatic amputation of the eye, a person quickly loses the second eye: immune cells perceive the tissues of the healthy eye as an antigen, since before that they lysed the remains of the tissues of the destroyed eye.

Autoimmune infertility is caused by antisperm antibodies, which are formed when the blood-testicular barrier is damaged or during anal sex.

The fourth possible cause of the body’s autoimmune reaction is a hyperimmune state (pathologically enhanced immunity) or an immunological imbalance with a violation of the “selector”, suppressing autoimmunity, thymic function or with a decrease in the activity of the T-suppressor subpopulation of cells and an increase in the activity of killer and helper subpopulations.

Autoimmune diseases are caused by dysfunction of the immune system as a whole or its individual components. In particular, it has been proven that suppressor T-lymphocytes are involved in the development of systemic lupus erythematosus, myasthenia gravis or diffuse toxic goiter. In these diseases, there is a decrease in the function of this group of lymphocytes, which normally inhibit the development of the immune response and prevent the aggression of the body’s own tissues. With scleroderma, an increase in the function of helper T-lymphocytes (T-helpers) is observed, which in turn leads to the development of an excessive immune response to the body’s own antigens.It is possible that both of these mechanisms are involved in the pathogenesis of some autoimmune diseases, as well as other types of dysfunctions of the immune system. Most autoimmune diseases are chronic. There are periods in their development: complete remission, exacerbations and remissions. As a rule, chronic autoimmune diseases lead to serious dysfunctions of internal organs and the patient’s disability. Autoimmune reactions accompanying various diseases or taking medications, on the contrary, are short-lived and disappear along with the disease that causes their development.

Known autoimmune diseases.

1. Addison’s disease
2. Agammaglobulinemia
3. Alopecia
4. Amyloidosis
5. Ankylosing spondylitis
6. Anti-GBM / Anti-TBM Jade
7. Antiphospholipid syndrome
8. Autoimmune angioedema
9. Autoimmune dysfunction
10. Autoimmune encephalomyelitis
11. Autoimmune hepatitis
12. Autoimmune disease of the inner ear (AIED)
13. Autoimmune myocarditis
14. Autoimmune pancreatitis
15. Autoimmune retinopathy
16. Autoimmune urticaria
17. Axonal and Neuronal Neuropathy (AMAN)
18. Balo’s disease
19. Behcet’s disease
20. Benign mucosal pemphigoid
21. Bullous pemphigoid
22. Castleman disease (CD)
23. Celiac disease
24. Chagas disease
25. Chronic inflammatory demyelinating polyneuropathy (CIDP)
26. Chronic recurrent multifocal osteomyelitis (CRMO)
27. Churg-Strauss Syndrome
28. Shramlitric Pemphigoid
29. Kogan’s syndrome
30. Cold agglutinin disease
31. Congenital Heart Blog
32. Coxsackie myocarditis
33. CREST Syndrome
34. Crohn’s disease
35. Dermatitis herpetiformis
36. Dermatomyositis
37. Devik’s disease (optic neuromyelitis -neuromyelitis optica)
38. Lupus disc
39. Dressler’s Syndrome
40. Endometriosis
41. Eosinophilic esophagitis (EO)
42. Eosinophilic fasciitis
43. Erythema nodosum
44. Essential mixed cryoglobulinemia
45. Fibromyalgia
46. Fibrous alveolitis
47. Giant cell arteritis (temporary arteritis)
48. Giant cellular myocarditis
49. Glomerulonephritis
50. Goodpasture Syndrome
51. Granulomatosis with polyangiitis
52. Graves’ disease
53. Guillain-Barré Syndrome
54. Hashimoto’s thyroiditis
55. Hemolytic anemia
56. Henok – Schonlein Purpura (HSP)
57. Herpetic gestation or pemphigoid gestation (PG)
58. Hypogammalglobulinemia
59. IgG – nephropathy
60. Sclerosing disease associated with IgG4
61. Immune thrombocytopenic purpura (ITP)
62. Myositis due to inclusion (IBM)
63. Interstitial cystitis (IC)
64. Juvenile arthritis
65. Juvenile diabetes (type 1 diabetes)
66. Juvenile myositis (JM)
67. Kawasaki disease
68. Lambert-Eaton syndrome
69. Leukocytoclastic vasculitis
70. Lichen
71. Larval sclerosis
72. Lunar conjunctivitis
73. Linear IgA disease (LAD)
74. Systemic lupus erythematosus
75. Chronic Lyme disease
76. Meniere’s disease
77. Microscopic polyangitis (MPA)
78. Mixed connective tissue disease (MCTD)
79. Moray’s ulcer
80. Fly Disease – Habermann
81. Multiple sclerosis
82. Myasthenia gravis
83. Myositis
84. Narcolepsy
85. Neutropenia
86. Ocular cicatricial pemphigoid
87. Optic neuritis
88. Palindromic rheumatism (RR)
89. PANDAS
90. Paraneoplastic cerebellar degeneration (PCD)
91. Parxysmal nocturnal hemoglobinuria (PNH)
92. Parry Romberg’s syndrome
93. Partism (peripheral uveitis)
94. Parsonnage-Turner Syndrome
95. Pemphigus
96. Peripheral neuropathy
97. Peripheral encephalomyelitis
98. Pernicious anemia (PA)
99. POEMS syndrome
100. Nomatode polyarteritis
101. Polypharyngeal syndromes type I, II, III
102. Polymyalgia rheumatic
103. Polymyositis
104. Postmyocardial infarction syndrome
105. Post-cardiotomy syndrome
106. Primary biliary cirrhosis
107. Primary sclerosing cholangitis
108. Progesterone dermatitis
109. Psoriasis
110. Psoriatic arthritis
111. Pure red cell aplasia (PRCA)
112. Pediatric gangrenosis
113. Raynaud’s Phenomenon
114. Reactive arthritis
115. Reflex sympathetic dystrophy
116. Recurrent polychondritis
117. Restless Legs Syndrome (RLS)
118. Retroperitoneal fibrosis
119. Rheumatic fever
120. Rheumatoid arthritis
121. Sarcoidosis
122. Schmidt’s Syndrome
123. Sclerite
124. Scleroderma
125. Sjogren’s Syndrome
126. Sperm and testicular autoimmunity
127. Severe Face Syndrome (SPS)
128. Subacute bacterial endocarditis (SBE)
129. Suzak’s Syndrome
130. Sympathetic ophthalmia (SO)
131. Takayasu’s arteries
132. Temporary arteritis / Giant cell arteritis
133. Thrombocytopenic purpura (TTP)
134. Tholos-Hunt Syndrome (THS)
135. Transverse myelitis
136. Type 1 diabetes
137. Ulcerative colitis (UC)
138. Undifferentiated connective tissue disease (UCTD)
139. Uveitis
140. Vasculitis
141. Vitiligo
142. Wegener’s granulomatosis (or granulomatosis with polyangiitis (GPA))

Supplement information on cystitis.About Nonbacterial

There is medical publication ,
according to which:
Infectious nonbacterial cystitis includes the following forms of the disease:

• viral – the cause may be BK virus, cytomegalovirus, adenovirus ( study )
• mycobacterial rare, 2 people per 100 thousand
• chlamydial
• fungal – candidal
• Schistosomal (Schistosomes are parasites that can be easily picked up when swimming in a not very good fresh water body, they penetrate the skin and live where they like)

Non-infectious cystitis can be:

• radiation – after radiation therapy and other radiation
• chemical – after chemotherapy and other exposures
• autoimmune – according to study , antibodies to the tissues of the bladder are found in the blood
• interstitial – the International Continence Society invented the term painful syndrome bladder rum “.The reasons are unclear. Despite years of intense research, there are currently no clinical or urinary markers; no absolutely specific radiographic, laboratory or serological results;
Possibly the most promising urine biomarker for IC / BPS is antiproliferative factor (APF).
This small 8-amino acid peptide has been associated with suppression of cell growth, increased transcellular permeability, and decreased levels of proteins that form intercellular junction complexes.APF is synthesized and secreted by bladder epithelial cells in patients with IC / BPS and may play a key role in pathophysiology. In vitro studies have shown that removal of APF from cell culture media restores cell proliferation and membrane integrity. ( Source )
—————-

I think that autoimmune and interstitial cystitis are for the most part the same thing. Where the reasons are unexplained, the activity of certain cytokines is suspected – this is it, there are a lot of such incomprehensible syndromes, in different areas.
If you have absolutely pure analyzes and a set of painful symptoms, you need to start from autoimmunity (although, it would be better if there was some kind of candida or trimatode, it might be worth re-testing in another laboratory, for greater confidence).