Cystitis (Interstitial)

a bowl of cranberries

Cystitis (also known as bladder infections or irritated urinary bladder) is a syndrome that expresses itself as urinary frequency and urgency, pelvic pain or pressure, and burning upon urination. Conventional treatment is with antibiotics (sulfa drugs or floxin drugs), but results and side effects may be undesirable or inadequate for many reasons. Cystitis can be acute or chronic in nature and severity. Acute attacks can be handled, especially if early treatment begins. Many botanicals have been successfully used for millennia, to treat cystitis. 

Interstitial cystitis (IC) is the more chronic, debilitating form characterized by painful bladder syndrome, leaky bladder syndrome, and irritated bladder syndrome. It does not even involve bacteria (as normal bladder infections might), so antibiotics are simply irrelevant. Chronic interstitial cystitis will take a concerted effort on the individual’s part and a program of natural agents. 

CAUSES

There are probably a number of possible reasons for symptoms that are acute or chronic cystitis. Several pathophysiological factors have been proposed for IC, involving autoimmune, infectious, neurological, and psychological factors. Symptoms include: nonbacterial inflammation of the bladder, small bladder, urethral inflammation, a yeast infection, and undiagnosed infection. Bladder infections are almost always caused by bacteria that have migrated from the intestinal tract to the bladder via the urethra. Drink plenty of water to keep the bladder flushed out and the bacteria from gaining a foothold.

There is considerable evidence suggesting that mast cells (allergic cascade) play a role in the pathology of IC. Evidence of mast cell involvement comes from increased levels of histamine in the walls of the bladder epithelium in patients with IC. Many IC sufferers have a history of allergies. In many cases utilizing the Elimination Diet was found to be helpful in identifying and eliminating allergic foods.

Estrogen may play a role in IC. First, IC occurs only in women and often worsens premenstrually during ovulation. Estrogen will augment mast cell activation and proliferation. Estrogen exacerbates many autoimmune conditions. IC has a classic picture of an autoimmune disease: symptom chronicity with exacerbations and remissions, the lack of a clearly defined pathogen, and occasional response to steroids or immunosuppressants.

DIET

For many individuals with IC, dietary modifications are a good first-line therapy. Nearly 60% of IC patients can identify acidic foods (cola, alcohol, sugar, spicy foods, vinegar, caffeine, red meat) may cause a flare-up of symptoms. Eating a more alkaline diet may be helpful. 

If food allergies exist, then try to relieve symptoms by natural means. Perform an Elimination Diet for at least two weeks. Try to eliminate or decrease the ingestion of processed foods, wheat (gluten) and dairy products, and refined carbohydrates. Other recommendations include:

  • Drink plenty of pure water (up to 8 glasses per day), but restrict intake in the evening or at night. 
  • Eat plenty of fresh vegetables, fruits, legumes, and whole grains only. 
  • Eliminate bladder irritants such as coffee, cola, alcohol, black tea, and chocolate. 
  • Don’t eat chicken liver, brewers yeast, raisins, soy sauce, grapes, fava beans, corned beef, nuts, hard cheese, apples, peaches, pineapple, cantaloupe. Citrus, pickled herring, bananas, beer, wine, mayonnaise, and sour cream, if you have symptoms. 
  • Eat only lean, organic meats and fish (tuna, mackerel, salmon, and herring are best). 

SUPPLEMENTAL PROTOCOL

  1. UVA URSI (Bearberry) – is an herb most useful for urinary inflammation. It should only be used for 2-4 weeks, and is not recommended for long-term use. Dosage: 2-4 capsules daily for a few weeks. Also available as Uva Ursi tea or tincture with recommended doses of 2-3 times a day. Do not combine with cranberry (may make the urine too alkaline). 
  2. METHYLSULFONYLMETHANE (MSM) – a sulfur-like supplement that is structurally related to DMSO. It has an ability to deplete inhibiting substances from the bladder wall and stimulate mast cell degranulation. It is estimated that 80 percent of patients show improvement with MSM treatment. Dosage: start with 1 gram a day and gradually increase under a qualified practitioner’s supervision. 
  3. OMEGA 3, 6 FATTY ACIDS (Fish oil and Evening Primrose Oil) – these essential fatty acids have an anti-inflammatory effect and promote healing. Dosage: 3-6 capsules daily or as directed. 
  4. CRANBERRY – keeps the walls of the bladder slippery and makes the environment inhospitable to bacteria. Cranberry may be effective because it acidifies the urine, which may be antimicrobial. Dosage: 3-4 cranberry capsules (400mg) daily or 1,500 ml of organic cranberry juice. 
  5. QUERCETIN (Bioflavonoids) – these natural substances derived from colorful fruits are highly effective in decreasing inflammation by mast cell inhibition. Mast cell inhibition is considered a reasonable goal in the treatment of IC. Quercetin will improve the absorption of vitamin C, and blocking histamines that may worsen condition. Dosage: 200mg 2-3 times a day. 
  6. PLANT STEROLS – also known as phytosterols, these substances are the fats present in all plants, including fruits and vegetables. Although chemically similar to animal fat cholesterol, they act different in the body as immune modulators. They can decrease the inflammatory process and maintain cortisol and elevation of DHEA levels. Dosage: as directed on package. 
  7. VITAMIN E and VITAMIN C – potent antioxidants that destroy free radicals. Vitamin C may help to slightly acidify the urine, thus killing bacteria. Dosages: Vitamin E 400IU daily; Vitamin C at doses of 500 mg every 3-4 hours for 10-14 days, then maintain 1,000 mg daily.. 
  8. L-ARGININE – an amino acid that is the natural precursor to nitric oxide (plays a fundamental role in reducing inflammation). In one study, patients taking 1.5 grams of arginine orally for six months resulted in a significant decrease in urinary voiding discomfort, lower abdominal pain, and urinary frequency over the night. Dosage: 1.5-2.4 gm daily. 
  9. CHONDROITIN SULFATE – has been shown to cause an inhibition of histamine release. Although no research has been preformed to date, oral chondroitin sulfate has been used clinically, with no side effects, with moderate success. Dosage: 500-1200mg daily. 
  10. MELATONIN – is the chief secretory product of the pineal gland, is a direct free radical scavenger and an indirect antioxidant that acts to stabilize cell membranes and decreasing inflammation. Dosage: 3-20mg daily. See a qualified health practitioner before taking mega-doses. 
  11. LICORICE (Glycyrrhiza glabra) – should be considered as an anti-inflammatory component in formulas as well, acting by sparing cortisol with relieves adrenal stress. Licorice exerts an effect that might benefit with IC. Dosage: see instructions. 
  12. SELENIUM – an antioxidant mineral that may decrease free radicals. Dosage: 50 mcg per day.  
  13. KEGEL EXERCISE – to strengthen pelvic floor muscles. 
  14. OREGON GRAPE and GOLDENSEAL – these natural antioxidants destroy free radicals and boost the immune system. Dosage: 250-500 mg 3 times a day, unless pregnant. 

Appleton, J. Arginine: Clinical Potential of a Semi-essential Amino Acid. Alternative Medicine Review, December 2002;7(6):512-517.

Blumenthal, M. (ed). Review of Botanicals Useful in the Treatment of Cystitis. Herbclip, Nov. 24, 1997.

Interstitial Cystitis: A Most Challenging Diagnosis. Bioniche Inc, London, Ontario. www.bioniche.com

LaValle, JB. Tips for Counseling on Cystitis. Nature Medicine Course, Level 1. 1997.

Leyton, E. Herbs and Exercise Ease Cystitis. Alive #223, May 2001. P 16.

Marshall, K. Interstitial Cystitis: Understanding the Syndrome. Alternative Medicine Review, 2003. 8(4): 426-434.

Yarnell, E. Botanical medicine for Cystitis. Alternative & Complementary Therapies, Aug. 1997, 269-275.

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