Interstitial Cystitis
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Overview
Interstial cystitis is a chronic inflammation of the urinary bladder with no known infectious cause. Cause is unknown, probably multifactorial.Diagnosis
Associated Signs/Symptoms:
- Frequent urination (8 or more times/day) and urinary urgency (90%).
- Pain relieved by voiding.
- Nonspecific pelvic pain.
- Small mucosal disruptions, mild cellular infiltrates, and sub-urothelial infiltrates (90%).
- Concomitant food or respiratory allergies (40%).
- Concomitant irritable bowel syndrome (20%).
- Petechiea or Hunner’s ulcers visible upon cytoscopic examination of the distended bladder. Bleeding when distended (20%).
- Worse during estrogen-dominant portion of menstrual cycle.
- Autoimmune component suggested by frequent presence of anti-bladder and anti-Tamm-Horsfall (bladder mucus) autoantibodies. Also associated with Sjogren’s syndrome.
- Mast cell and lymphocyte infiltration of the muscularis.
- Elevated levels of substance P, possible neuropathy.
- Possible association with vaginal flora such as Corynebacterium spp, Lactobacillis spp, and the yeast Torulopsis glabrata.
- Deficient levels of nitric oxide in bladder walls may be associated with bladder spasms.
- Increased incidence after surgery that used silk sutures.
Differential Diagnosis
- Hypothyroid [Barnes; Starr2005, pg 142].
Treatment
- Reduce muscle spasm (arginine 1.5g/day for 6 months, kava, calcium channel blocker, acupuncture, hydrotherapy).
- Identify and remove allergens or dietary irritants (IgG food-allergy test, IgE scratch test for silk allergy, food elimination diet).
- Heal the mucosa (glycosaminoglycans: oral chondroitin sulfate, glucosamine sulfate, heparin, N-acetyl-D-glucosamine 300-500 mg TID)
- Stabilize mast cells
- Reduce inflammation (fish oil, bromelane, quercetin)
- Soothe tissues (demulcents: Zea mays stigmata (cornsilk) tea.
- Balance immune system (Eleutherococcus senticocsus)
- Antimicrobials (just in case)
- Homeopathy (mercurius)
Pathophysiology
Hypothyroidism is associated with a thinning of the endothelial lining of the urinary bladder, resulting in irritation of the bladder by its contents [Hertoghe1914; Starr2005, pg 142].ICD-9 Codes
| ICD9-Code | Description | Comments |
|---|---|---|
References
Unless specifically noted above, references used in the construction of this web page include the following:[FDM] Lecture notes from Functional Medicine University.
[SCNM] Lecture notes from Southwest College of Naturopathic Medicine.
[UT] Lecture notes from the University of Tennessee graduate programs in Chemistry and Biochemistry.
[Hertoghe1914] E. Hertoghe. Thyroid Deficiency. Lecture presented to the International Surgical Congress at the New York Polyclinic School and Hospital (April 1914). Copy availaible from Broda O. Barnes M.D. Research Foundation at http://www.brodaobarnes.org [Cited by Starr2005].
[Starr2005] Mark Starr. Hypothyroidism Type 2: The Epidemic. Columbia, MO: Mark Starr Trust (2005).
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