When people have severe pain every time their bladders fill and no cause can be found, doctors often diagnose interstitial cystitis. Two recent reports offer hope for people with this previously hopeless incurable disease (1,2,3). If you have terrible discomfort when your bladder is full, and your doctor cannot find a vaginal, prostate or urinary tract infection, he usually refers you to a urologist who will examine the bladder directly. If he finds no cause, he usually diagnoses interstitial cystitis (4).
The bladder is a balloon lined by muscles that contract when it is full. The severe pain of interstitial cystitis may be caused by contractions of bladder muscles. The body produces a chemical called nitric oxide that relaxes muscles and blocks spasms. For example, hemorrhoids are felt to be caused by lack of nitric oxide with resultant spasms of the anal sphincter that cause blood vessels at the end of the intestines to enlarge. Several studies in the last year show that chemicals that raise nitric oxide levels relax the anal sphincter muscles and get rid of hemorrhoids (5,6,7,8,9,10). The study in the Journal of Urology shows that people with interstitial cystitis have low tissue levels of nitric oxide also, and that L-arginine, a protein building block, raises tissue levels of nitric oxide and relaxes bladder muscle spasms to help control the pain of interstitial cystitis (1,16).
Many doctors feel that interstitial cystitis is an infectious disease, although no particular organism is associated with this condition. When urine cultures are negative, I prescribe for the patient and his(her) sexual partner Doxycycline 100 mg plus Cipro 500 mg both twice a day for several months. An exciting new approach is to instil BCG, an attenuated bacteria that causes tuberculosis into the bladder. It causes horrible swelling and irritation that causes a strong immune reaction that has cured interstitial cystitis in some patients (2,3). Doctors used to think that a biopsy of the bladder could be used to diagnose interstitial cystitis, but now we know that they are wrong (11). Some studies show that at least some cases of interstitial cystitis are caused by infections that are not easy to find (12). Others show that it may be caused by your own immunity attacking your bladder lining (13). Elmyron is used to treat interstitial cystitis, but the Medical Letter states that: "Pentosan offers some relief of pelvic pain to a minority of patients with chronic interstitial cystitis." (14). It coats the bladder and reduces the discomfort of urine touching the bladder (15). DMSO is a medicine that reduces pain, but will not help heal your bladder. One report claims that long-term treatment with antibiotics may help some sufferers (16).
1) SD Smith, MA Wheeler, HE Foster, RM Weiss. Improvement in interstitial cystitis symptom scores during treatment with oral L-arginine. Journal of Urology 158: 3 Part 1 (SEP 1997):703-708. 1.5 gm. L-arginine orally daily for 6 months. Address SD Smith, Yale Univ, Sch Med, Dept Surg, Urol Sect, New Haven, CT 06510 USA.
2) KM Peters, AC Diokno, BW Steinert, JA Gonzalez. The efficacy of intravesical bacillus Calmette-Guerin in the treatment of interstitial cystitis: Long-term followup. Journal of Urology 159: 5 (MAY 1998):1483-1486. Address KM Peters, William Beaumont Hosp, Dept Urol, Royal Oak, MI 48072 USA.
3) R Ramoner, C Rieser, M Herold, H Klocker, G Bartsch, A Stenzl, M Thurnher. Activation of human dendritic cells by bacillus Calmette-Guerin. Journal of Urology 159: 5 (MAY 1998):1488-1492.
4) M Haarala, J Jalava, M Laato, P Kiilholma, M Nurmi, A Alanen. Absence of bacterial DNA in the bladder of patients with interstitial cystitis. Journal of Urology 156: 5 (NOV 1996):1843-1845.
5) SR Gorfine. Treatment of benign anal disease with topical nitroglycerin. Diseases of the Colon & Rectum 38:5 (MAY 1995):453-457.
6) NI Alstrup, OO Rasmussen, J Christiansen. Effect of rectal dilation in fecal incontinence with low rectal compliance: Report of a case. Diseases of the Colon & Rectum 38: 9 (SEP 1995);988-989.
7) WR Schouten, JW Briel, MO Boerma, JJA Awuerda, EB Wilms, BH Graatsma. Pathophysiological aspects and clinical outcome of intra-anal application of isosorbide dinitrate in patients with chronic anal fissure. Gut 39: 3 (SEP 1996):465-469. fissure healing rate of 88% at 12 weeks.
8) Lund JN et al. A randomized prospective double blind placebo-controlled trial of glycerol trinitrate ointment in treatment of anal fissure. Lancet 1977(January 4);349(9044):11-13.
9) Lund C, Scholefield JN, Glyceryl trinitrate is an effective treatment for anal fissure. Diseases of the Colon & Rectum. 1997 (aPRIL);40(4):468-470.
10) H Bacher, HJ Mischinger, G Werkgartner, H Cerwenka, Elshabrawi, J Pfeifer, W Schweiger. Local nitroglycerin for treatment of anal fissures: An alternative to lateral sphincterotomy? Diseases of the Colon & Rectum 40: 7 (JUL 1997):840-845.
11) PA Dundore, AM Schwartz, H Semerjian. Mast cell counts not useful in the diagnosis of nonulcerative interstitial cystitis. Journal of Urology 155: 3 (MAR 1996):885-887.
12) GJ Domingue, GM Ghoniem, KL Bost, C Fermin, LG Human. Dormant microbes in interstitial cystitis. Journal of Urology 153: 4 (APR 1995):1321-1326.
13) S Keay, CO Zhang, AL Trifillis, JR Hebel, SC Jacobs, JW Warren. Urine autoantibodies in interstitial cystitis. Journal of Urology 157: 3 (MAR 1997):1083-1087. 14) The Medical Letter June 6, 1997
14) Sparfloxacin: Dan Henry Family Foothill Clinic, Salt Lake City, Utah and Andrew DeAbate. Medical research Center New Orleans.
15) PM Hanno. Analysis of long-term Elmiron therapy for interstitial cystitis. Urology 49: 5A Suppl. (MAY 1997):93-99.
16) GE Korting, SD Smith, MA Wheeler, RM Weiss, HE Foster. A randomized double-blind trial of oral L-arginine for treatment of interstitial cystitis. Journal of Urology 161: 2 (FEB 1999):558-565.1,500 mg daily).
17) 67/100,000 INCIDENCE GC Curhan, FE Speizer, DJ Hunter, SG Curhan, MJ Stampfer. Epidemiology of interstitial cystitis: A population Based study. Journal of Urology 161: 2 (FEB 1999):549-552.
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