Complementary and Alternative Treatments
for Interstitial Cystitis (IC)

Article by Michael J. Altamura, M.D., F.A.C.S.

Interstitial cystitis (IC) is thought to be a chronic multifactorial disease of the bladder characterized by severe urgency to urinate, urinary frequency day and night, and chronic pelvic pain which improves after voiding.

Several explanations have been advanced to explain the underlying cause of this disease but some have not been substantiated. An explanation which has been widely accepted in recent years involves a defect in the glycosaminoglycan (GAG) layer on the inner lining of the bladder wall. This defect in the GAG layer is thought to cause abnormal permeability in the inner lining of the bladder thus allowing urinary substances to infiltrate the bladder wall. This infiltration of the bladder wall by urinary substances is thought to be responsible for the irritative lower urinary tract symptoms of patients with interstitial cystitis.

More recently, another explanation was put forth when it was discovered that patients with interstitial cystitis have diminished nitric oxide synthase activity in the urine. Nitric oxide synthase is necessary for the production of nitric oxide which is required for bladder muscle relaxation. Furthermore, inhibition of nitric oxide synthase has been shown to increase bladder wall permeability.

Yet another proposal is based on electron microscopy findings of focal inflammation involving the nerves in and around the urinary bladder wall. This could explain the pain experienced by patients with interstitial cystitis. This then provides the basis for the use of anti-inflammatory agents in this condition.

Because IC is probably a multifactorial disease and the precise mechanism causing this disease has not been elucidated, standard treatments including bladder distension under anesthesia, dimethyl sulfoxide (DMSO), pentosan polysulfate (Elmiron), amitriptyline (Elavil), hydroxyzine (Vistaril, Atarax), intravesical heparin, intravesical BCG and cimetidine, used to treat this disease to date have been only partially effective at best. No placebo controlled studies have been done for some of these agents and some others have not been found to be superior to placebo.

More recently, some researchers have focused their attention on a class of medications called immunomodulators which have either immunsuppressive effect or have antiallergic or anti-inflammatory action. The medications studied include cyclosporine (Neoral), methotrexate (Trexall), montelukast (Singulair), and suplatast (IDP) marketed in Japan. The number of women studied was small ranging from 9-14 and the results variable with some showing more promise than others.

Keeping in mind the factors that have been implicated in the causation of this disease, Dr. Altamura is now offering a complementary approach using a regimen of phytonutrients (plant-derived medicines), glyconutrients (essentially important sugars) and antioxidants, each working in a different capacity to alleviate the symptoms of this debilitating disease until the precise mechanism for it is discovered.