No cure for interstitial cystitis, but treatments help
DEAR DOCTOR K:
I have interstitial cystitis. Medication hasn't helped much. Could dietary changes help?
In patients with interstitial cystitis (IC), the bladder wall becomes irritated or inflamed, causing pain and painful or frequent urination. Some patients need to urinate as often as 60 times a day.
The cause of IC remains a mystery. The symptoms of IC are often similar to those of a bacterial urinary tract infection. However, in IC, there is no bacterial infection and the symptoms do not respond to antibiotics.
Diagnosing IC can be tricky. Some women with painful and frequent urination, and no bacteria found on a urine culture, can actually have an infection of their urethra, the tube that carries urine out of the bladder. Two sexually transmitted bacterial infections, chlamydia and gonorrhea, can cause a urethral infection. Unfortunately, the usual urine culture does not detect them; special testing is necessary.
When a person clearly has IC, there are several treatment options. Unfortunately, no single therapy has been particularly successful. You may need to try several before finding the right one or combination of therapies. Because there is no cure for IC, the goal of treatment is to reduce symptoms.
Dietary modifications can indeed help to control your symptoms. You should avoid smoking, alcohol, caffeinated beverages, artificial sweeteners, spices and hot peppers, citrus fruits or juices, other high-acid foods such as tomatoes, and (unfortunately) chocolate. If other foods trigger your symptoms, avoid those as well.
Other treatment options include:
-- Bladder training: Learn to reduce frequent urination by letting longer periods of time pass before urinating. This does not reduce pain.
-- Oral medications: Pentosan polysulfate sodium (Elmiron) is the only medication approved for the treatment of IC, but it is effective in only about one-third of patients. Other oral medications are not approved specifically for IC but may offer relief. One such medicine is amitriptyline, a medicine first used for depression. It also reduces pain caused by irritated nerve endings.
-- Bladder distention: Sterile water is used to stretch the bladder. Most patients feel worse for a couple weeks after the procedure. After that, up to half of patients feel better. This procedure may work by increasing bladder capacity or interfering with pain signals. It is done under general anesthesia.
-- Bladder instillation (bladder wash): The bladder is temporarily filled with a sterile solution containing one of a number of ingredients that help relax the bladder and alleviate pain.
-- Electrical nerve stimulation: Mild electrical impulses are passed into the body through wires placed below the navel, on the lower back, or inside the rectum or vagina.
These treatments may sound a little harebrained and several of them are definitely uncomfortable, but they often work. My patients with IC generally have had no doubt that the disease was worse than the treatment. I'm hopeful that one day research will lead us to a treatment that is simple, painless and effective.
(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)
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