Overview of Interstitial Cystitis Investigation
This interstitial cystitis investigation explored the etiology, pathology, diagnosis, and treatment of interstitial cystitis (IC) from the perspective of traditional Chinese medicine (TCM). In addition, it evaluated the benefits of acupuncture in the treatment of IC through a survey of 52 patients who received both Chinese and Western medical treatment. The study’s findings conclude that acupuncture effectively treated IC, reducing pain symptoms, frequency, urgency, and nocturia by around 50 percent. In addition, 75 percent of the patients reported that acupuncture helped their emotional state.
Interestingly, the study also showed that respondents had a much higher incidence of immune-related functional conditions than occurred in the general population. This observation suggests that IC is not isolated to the Bladder but is part of a broader problem affecting the entire body.
What is Interstitial Cystitis?
Interstitial cystitis (IC) is a chronic inflammation of the bladder wall. This debilitating condition affects many areas of a person’s life, both physically and emotionally. In 2010 there were approximately 400,000 people in the UK with IC, 90 percent female. All age groups are susceptible, from children to the elderly, but it most commonly affects women between 20 and 50.
There is no universally recognized clinical definition of interstitial cystitis. Therefore, no laboratory tests or biopsy results can measure the condition. Instead, providers make the diagnosis by exclusion. If one does not have (a) a urinary tract infection or (b) kidney stones, one likely has interstitial cystitis. Typical symptoms include urinary frequency, urgency, and pain.
Western Treatment For Interstitial Cystitis
None of the current Western medical treatments for IC are particularly effective. For example, a drug that reduces one patient’s symptoms may not affect another. Furthermore, there is no known cure for IC. Alternatively, several studies have shown the effectiveness of acupuncture in treating IC. For example, Tucker (2004) documented patients with severe symptoms that doctors had scheduled to remove their bladders. Despite the severity of their condition, they found complete IC relief with acupuncture.
This interstitial cystitis investigation reviewed the causative factors involved in IC and looked for commonalities between patients’ symptoms. In addition, it investigated the effects of IC on a patient’s life and the effectiveness of acupuncture in its treatment. Investigators hope this research will help practitioners develop a deeper understanding of IC to experience tremendous clinical success with this challenging condition.
Diagnosing Interstitial Cystitis
One must first rule out a bacterial urinary tract infection (UTI) to diagnose IC. Repeated episodes of symptoms without the presence of bacteria indicate the need for a cystoscopy to rule out bladder stones or tumors. If there are no stones, the condition is likely interstitial cystitis.
The main theories in Western medicine regarding the etiology involved in IC include the following:
- The bladder lining, which protects the underlying membranes from urine, becomes damaged from infection, radiation therapy, surgery, or another unknown agent.
- A low level of bacteria, undetectable by urine tests, causes inflammation of the Bladder’s lining. As a result, doctors often give patients prolonged courses of antibiotics, which rarely improve their condition. This fact suggests that there are no bacteria, that the bacteria are resistant to antibiotics, or that the bacteria have embedded into the bladder wall where the antibiotics cannot reach them.
- A viral infection attacks and causes damage to the Bladder.
- The body attacks itself in an autoimmune response. Many patients with IC have allergies (to food, chemicals, and pollen) and generally have oversensitive immune systems. Some urologists and immunologists support this view.
Western Treatment for Interstitial Cystitis
There are several Western medical treatments for IC, including:
- Analgesics (pain medications), such as paracetamol, tramadol, and gabapentin.
- Muscle relaxants.
- Long-term antibiotics.
- Antihistamines.
- Drugs that repair the bladder lining, such as Elmiron and Cystistat.
- In rare cases where the patient is in extreme pain, doctors surgically remove the Bladder, although this is considered a last resort.
- Doctors sometimes prescribe antidepressants. For example, amitriptyline has analgesic and sedative benefits that some patients find helpful.
Western medical treatments for IC have had limited success and only work in a small percentage of patients. For example, Elmiron (the only drug developed explicitly for IC) reduces urgency and pain by 50 percent, but only in 32 percent of patients (Nickel, 2005). Other drugs have similar or lower success rates.
Adverse Effects of Medications
Unfortunately, many of these medications have serious side effects. For example, Elmiron can cause liver problems, nausea, dizziness, and hair loss. Additionally, long-term antibiotic use damages the Stomach and intestines.
Interstitial Cystitis and Chinese Medicine
From an acupuncture perspective, practitioners often categorize IC as a mixed pattern involving either full or empty heat or dampness and an underlying deficiency of the Spleen and Kidneys. However, other cases are purely deficient. Maciocia (2008) lists the main patterns associated with IC as follows:
- Spleen qi and Kidney yang deficiency with yin fire
- Spleen qi and Kidney yang deficiency with dampness
- Spleen qi and Kidney yang deficiency with qi stagnation
- Spleen qi and Kidney yang deficiency with blood stasis
- Kidney yin deficiency with empty heat
Tucker (2004) adds more patterns to this list:
- Deficiency of zheng qi/Spleen – Lung vacuity
- Stagnation of Liver qi and Liver stagnant fire
- Spleen qi sinking/Spleen vacuity
- Stomach and Spleen vacuity cold
- Bi syndrome, blockage, and interference with circulation of qi and blood in the channels and collaterals, caused by injury to the lower spine and structures of the pelvic floor
- General disharmony amongst the zang-fu
Digestive System and Interstitial Cystitis
TCM practitioners recognize the importance of the digestive system when treating IC. While Western medicine identifies the Stomach as key to regulating digestion, Chinese medicine points to the Spleen function as essential. Li Dong Yuan’s Treatise on the Spleen and Stomach discusses how the pathology of the Spleen and Stomach is responsible for many diseases. He explains that weak Spleen qi can lead to dampness and heat in the lower abdomen:
“One function of the Spleen is to moving and transforming water liquids in the body. When the Spleen Qi becomes empty and weak, it cannot regulate water, leading to accumulation of dampness. Dampness hinders the free flow of yang Qi, resulting in depressive heat, which percolates downward to the lower burner.”
Spleen Qi and Immune Function
Furthermore, deficient Spleen qi leads to weakened Wei qi (immune function), making the patient vulnerable to pathogenic attack. One function of the Spleen is to raise qi. If the Spleen is weak, this raising function can be impaired, causing urinary urgency and frequency symptoms. TCM has long recognized the Small Intestine’s effect on the Bladder, noting that negative emotions can cause Heart fire, which can spread to the Bladder via its paired organ, the Small Intestine (Tucker, 2004).
Brizman (2007) suggests that pathology in the small intestine is responsible for many chronic diseases. Damage to the walls of the small intestine causes microbes, including bacteria and fungi, to travel systemically into the bloodstream and to other organs, causing disease. This condition is known as leaky gut syndrome and is associated with chronic fatigue, fibromyalgia, sinusitis, allergies, and ulcerative colitis (Meddings, 2008). Interestingly these conditions share similar symptoms with interstitial cystitis.
Investigation Methodology
Investigators posted fifty-two anonymous questionnaires to IC patients asking them to evaluate their treatment by Western medicine and acupuncture. In addition, they inquired about the patients’ IC and general health. The questionnaire format consisted of closed‑type questions that were quick and easy for patients to answer. The questions had a list of possible answers and an ‘other’ section at the bottom, where respondents could add anything they felt had not been covered.
The questionnaire used established criteria and pain scales to quantify the patients’ responses and determine their perception of acupuncture’s effectiveness in treating IC.
Interstitial Cystitis Investigation Results
The questionnaire was completed by 28 of the 52 patients, providing a 52 percent response rate. The study showed that many IC patients viewed acupuncture treatment as beneficial. Sixty percent of respondents rated acupuncture as bringing them a 75 to 100 percent recovery. This fact contrasts sharply with their rating of Western medicine, which 45 percent of respondents reported as bringing no recovery at all.
Although this interstitial cystitis investigation had a limited scale and scope, it reflected a very positive indication of acupuncture’s effectiveness in treating this condition. IC is a debilitating condition that dominates many aspects of a patient’s life, especially their emotional state. Many of the patients in the study had taken time off work because of their condition. Others had to give up work altogether. IC also significantly affected their relationships and social lives.
All of the IC symptoms manifested by the participants were reduced by at least 50 percent or higher following acupuncture treatment (higher if they received at least 12 treatments). Urgency and pain responded slightly more than frequency and nocturia. Investigators were shocked to discover how ill some patients had been before their acupuncture treatment.
The Severity of Interstitial Cystitis
One patient had been waiting for her bladder removal and came to acupuncture as a last resort. Through a combination of dietary changes and acupuncture, she managed to rid herself of all symptoms of IC. Unfortunately, this case was not isolated; many respondents felt abandoned by Western medicine. Most of the patients that came for acupuncture treatment were at their wits’ end, having undergone invasive and painful procedures and drug treatment with little ‑ if any ‑ success.
Consequently, these respondents are at the IC spectrum’s more severe and chronic end. Sixty-four percent of patients reported a bacterial infection before the onset of their IC. Most received repeated prescriptions for antibiotics, which from a TCM perspective, can suppress symptoms and drive the pathogen more profound into the body, simultaneously creating dampness. The properties of antibiotics are both cold and damp and can therefore suppress yang and injure the Spleen, further perpetuating a cycle of poor health. It is also possible that physicians misdiagnosed these patients as having a UTI when it was the onset of the IC.
Interstitial Cystitis and Stress
Researchers found that almost half (43 percent) of the patients reported extreme stress or shock before the onset of IC. Stress or shock causes a shift in the immune system, creating a propensity toward inflammation. In TCM terms, stress may weaken the Spleen, Kidneys, and Lungs, disrupting Wei qi and allowing an external pathogen (i.e., microbe) to take hold.
Many of the respondents had experienced several trigger factors before IC. For example, extreme stress and infection (from a virus or bacteria) can cause a shift in the immune system, predisposing a person to inflammation and mast cell production. Foods can also exacerbate IC symptoms. The worst foods appear to be citrus fruits, wine, and tomatoes.
IC Rarely Strikes Alone
In addition, IBS, food allergies, sinusitis, and colitis seem significantly higher in people with IC than in the general population. Back pain is also particularly associated with IC. However, it is unclear whether the pain originates from an injury ‑ and is therefore related to nerve damage ‑ or from a form of fibromyalgia ‑ which would indicate immune dysfunction. Interestingly, in TCM terms, the Bladder channel runs down the back.
The researchers concluded that IC patients had more immunological conditions than people in the general population. Three-quarters of IC patients in this interstitial cystitis investigation had at least four immune‑related conditions, and a third had six. This result supports the author’s theory that IC is part of a wider immunological imbalance rather than merely a condition affecting the Bladder in isolation.
Discussion
The authors concluded that a combination of infection and stress triggers a cascade of physiological changes in the Bladder resulting in damage to the Bladder’s lining and the production of mast cells. The damaged lining reduces protection from acids, increasing inflammation from food a drink, leading to further inflammation and immune reaction. IC is not just a bladder condition but a disease involving the digestive system – amongst other systems in the body.
This interstitial cystitis investigation concluded that acupuncture treated the physical symptoms of IC and the patient’s emotional state. Three-quarters of respondents reported that acupuncture helped them emotionally. It may be the case that the physiological changes that occur in IC also have their roots in emotional stress or trauma and that treating the emotional side begins to undo physiological damage.
Whichever comes first – the stress or the physical symptoms ‑ it is clear that patients with IC are often emotionally upset and anything to ease their burden is of value to them.
Implications for Clinical Practice
This study raises points that are important for clinical practice. Stress harms the immune and digestive systems. Clinical studies by Lutgendorf (2001) and Rothrock (2001) found that psychological stress caused symptoms of IC in humans and animals. Immunological research by Stojanovich and Marisavljevich (2008) links autoimmune diseases to stress. This study suggests that stress or shock triggered IC in many respondents.
Diet is another crucial factor in the treatment of IC. Shorter et al. (2007) conducted a study involving 104 patients that showed that diet affected IC symptoms in 90 percent of patients. This study suggests that diet is a significant factor in IC. Sixty‑one percent of patients reported that food or drink alone triggered attacks. The most implicated substances were citrus fruits, wine, coffee, carbonated drinks, and tomatoes. In addition, tea, yeast, and cheese are also problem foods.
Researchers were uncertain whether a person’s diet caused IC or exacerbated inflammation. The fact that 18 percent of patients reported that their diet had changed just before the onset of IC suggests that it may have been a critical factor in its onset. The authors recommended that acupuncturists include dietary modification in their treatment strategy for patients with IC. Whatever treatment a patient has, whether Western or TCM, a highly acidic diet makes it less likely to be successful.
A Broader Perspective on Interstitial Cystitis
The authors proposed that IC was merely a symptom of a more significant problem involving an imbalance of the patient’s immune system and that the patient’s mental‑emotional state strongly influenced its presence. For some, this imbalance may manifest as colitis, IBS, or other conditions, but in people with a weakness in the Bladder, it manifests as IC. Therefore, acupuncturists need to check whether patients with IC are also experiencing immune‑related conditions such as hay fever, chronic fatigue, asthma, eczema, chemical allergies, joint pain, and fungal or viral infections.
Many patients find that acupuncture simultaneously relieves symptoms from their other autoimmune conditions, suggesting that acupuncture calms the immune system. The authors in this interstitial cystitis investigation suggest that such immunological conditions are symptomatic of a shift in the immune system that predisposes a patient to inflammation and a generally allergic state.
Wei Qi and the Immune System
In TCM terms, this might be considered a dysfunction of the Wei qi caused by weak Spleen, Lung, and Kidney qi. According to Western medicine, the etiology of Spleen and Kidney pathologies are similar to those known to weaken the immune system – stress and shock, bacterial or viral attack, overwork, and improper diet. A weakened immune system (weak Wei qi) enables pathogens to enter and take hold. These pathogens destroy the bladder lining. So even if we can subsequently remove the pathogens, the damage to the Bladder is done. An acidic diet then exacerbates the problem.
Conclusion
This study indicates that acupuncture is superior to Western medicine in treating IC. Acupuncture addresses the physical symptoms of IC and improves the patient’s emotional state. IC does not necessarily correspond with a pattern of damp heat in the Bladder. Alternatively, a dysfunction of the zang-fu involving multiple patterns is responsible. Therefore, we must realize that understanding and treating this disorder will always involve complexity.
Next Steps
We have successfully treated interstitial cystitis at Raleigh Acupuncture for nearly 20 years. As noted in this interstitial cystitis investigation, we treat IC as an autoimmune condition, focusing on reducing inflammation by restoring balance to the body.
Reference
An Investigation into the Treatment of Interstitial Cystitis with Acupuncture Journal of Chinese Medicine • Number 94 • October 2010. By: Esther Holford and Toni Tucker http://www.tonituckeracupuncture.co.uk/downloads/ic_article.pdf
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First Interstitial Cystitic Research Study.
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Focus Keyphrase: Interstitial Cystitis Investigation
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What our Clients are Saying
I highly recommend Raleigh Acupuncture. I was getting urinary tract infections every three months since my son was born and it was driving me crazy. After six treatments I was cured and no longer got them. I was treated so well and am very happy.
Went to Raleigh Acupuncture for frequent UTIs. They took care of the problem and I don’t get them anymore. Thank you!
I have suffered from IC for over 10 years, with terrible cramping and burning urination, having to go to the bathroom every 5 minutes. I tried acupuncture out of desperation because I wasn’t getting relief anywhere else. It worked incredibly and took away most of my IC symptoms. Why didn’t I know about this sooner. Raleigh Acupuncture is a really good practice. They have kept me healthy for over three years now. I highly recommend them for treating IC.