Urinary Tract Infections and Fibromyalgia Part II Interstitial Cystitis

Recurrent UTI symptoms may point at a problem known as interstitial cystitis (IC).

Interstitial cystitis is a chronic inflammatory condition of the bladder that causes frequent, urgent, and painful urination and pelvic discomfort. The lining of the bladder breaks down, allowing toxins to irritate the bladder wall, and the bladder becomes inflamed and tender and does not store urine well. The condition does not respond to antibiotics, since it is not associated with a bacterial infection like is UTI. Like UTI, IC is much more common among women than among men. Although the disease previously was believed to be a condition of menopausal women, growing numbers of men and women are being diagnosed in their 20s and younger. Data released just this year suggests that up to 12% of women may have early symptoms of IC.

Symptoms: The symptoms of IC are basically the symptoms of UTI, only more stubborn. IC is often misdiagnosed as UTI, until it refuses to respond to antibiotics. IC symptoms may also initially be attributed to prostatitis or epididymitis (in men) and endometriosis or uterine fibroids (in women).

Causes: The cause of interstitial cystitis is unknown, though several theories are being investigated, including autoimmune, neurological, allergic, and genetic. Regardless of the disease’s origin, IC patients clearly struggle with a damaged bladder lining. When this protective coating is compromised, urinary chemicals can leak into surrounding tissues, causing pain, inflammation, and urinary symptoms.

Diagnosis: IC diagnosis has been greatly simplified in recent years with the development of two new methodologies. The “Pelvic Pain Urgency/Frequency (PUF) Patient Survey,” created by C. Lowell Parsons, is a short questionnaire that helps doctors identify if pelvic pain could be coming from the bladder. The KCL test, also called the potassium sensitivity test, uses a mild potassium solution to test the integrity of the bladder wall. Though the latter is not specific for IC, it has been determined helpful in predicting the use of compounds designed to help repair the bladder lining.

Previously, IC was diagnosed by visual examination of the bladder wall after stretching it. This test, however, can contribute to the development of small hemorrhages, making IC worse. Thus, a diagnosis of IC is made by excluding other illnesses and reviewing a patient’s clinical symptoms.

Treatment of the bladder lining: Traditional medications work to repair and hopefully rebuild the wounded bladder lining, allowing for a reduction in symptoms. But FDA-approved therapies for IC have had recent setbacks in various research studies. Elmiron (pentosan polysulfate) is supposed to provide a protective coating in the bladder. But data released in late 2005 by Alza Pharmaceuticals suggests that 84% of Elmiron is eliminated—intact—in the feces. Another 6% is excreted in the urine. DMSO, a wood-pulp extract, can be instilled directly into the bladder via a catheter, yet it is much less frequently used in urology clinics. Research studies presented at recent conferences of the American Urological Association have demonstrated that at the FDA-approved dosage of a 50% solution of DMSO, irreversible muscle contractions and damage may occur. DMSO therapy has yielded mixed results, and long-term benefits appear fleeting.

Recently, the use of a new therapeutic instillation—implemented like DMSO—has generated considerable excitement in the IC community. And rightly so. Published studies report a 90% effectiveness in reducing symptoms. This treatment is called a “rescue instillation” and can be conducted with any number of “cocktails” to treat specific symptoms.

Another bladder-coating treatment, Cystistat, is believed to replace the deficient layer on the bladder wall. The primary component of Cystistat is sodium hyaluronate, a derivative of hyaluronic acid, which occurs naturally in the fluids of the eye, in the joints, and in the bladder-lining layer that is deficient in many patients with interstitial cystitis. This layer is believed to provide the bladder wall with a protective coating. Cystistat, however, is still in the process of approval and not yet available to the public.

Treatment of the pelvic floor: Pelvic-floor dysfunction may also be a contributing factor to IC symptoms. Thus most major IC clinics now evaluate the pelvic floor and/or refer patients directly to a physical therapist for a prompt treatment of pelvic floor muscle tension or weakness. The tension is often described as a burning sensation, particularly in the vagina.

Muscle tension is the primary cause of pain and discomfort in IC patients who experience pain during intercourse. Tender trigger points (small tight bundles of muscle) may also be found in the pelvic floor.

Exercises such as Kegels can be helpful as they strengthen the muscles, but they can provoke pain and additional muscle tension. A specially trained physical therapist can provide direct, specific evaluation of the muscles, both externally and internally.

Bladder distention (a procedure done under general anesthesia that stretches the bladder capacity) has shown some success in reducing urinary frequency and giving pain relief to patients. Unfortunately, the relief achieved by bladder distentions is only temporary (weeks or months) and consequently is not really viable as a long-term treatment for IC. It is generally only used in extreme cases.

Pain control is important in the treatment of IC, as the pain of this condition has been rated equivalent to cancer pain. A variety of traditional pain medications, including opiates, can be used to treat the varying degrees of pain. Electronic pain-killing options include TENS (a machine that sends electrical impulses to the skin through sticky pads) and PTNS (similar to a TENS treatment, except a needle is used).

Natural Remedies For IC

Alkalinizing the urine through diet seems to help reduce the burning pain and urinary urgency of IC in some patients. See the facing page for a list of common foods that seem to make IC worse. I know that the list can be intimidating, but I encourage my cystitis patients to conduct a modified elimination diet for 2–3 weeks, avoiding all the foods above. Then they challenge one of these foods at a time. If you do this, be sure to keep a food diary to keep up with what you learn about your body.

For more information about IC and your diet, visit www.ic-network.com/handbook and click under “Living with IC—Diet.”

Prelief by AkPharma, Inc. is calcium glycerophosphate, a food-grade mineral classified as a dietary supplement. It’s a natural
treatment for IC and also a good source of calcium. In a retrospective study conducted by AkPharma, over 200 patients consumed acidic foods and beverages with and without Prelief. Seventy percent of the patients had a reduction in IC pain and discomfort with the use of Prelief when consuming acidic foods. Sixty-one percent of them reported a reduction in urinary urgency after using Prelief. For more information or to order Prelief, visit www.prelief.com or call 1-800-994-4711.

Bioflavonoids are naturally occurring substances that act as mast-cell inhibitors (similar to an antihistamine), anti-inflammatories, and antioxidants. Since IC is associated with an increased number and activation of mast cells and inflammation in some patients, it has been suggested that bioflavonoids—quercetin in particular—have potential in the treatment of IC.

Cysta-Q, distributed by Farr Labs, is a quercetin-based dietary supplement that was specifically developed to target the symptoms of IC. Cysta-Q also contains bromelain, papain, nonacidic cranberry powder, nonacidic black cohosh, skull cap, wood betony, passionflower, and valerian in order to enhance the effectiveness of the quercetin. The quercetin used in Cysta-Q is derived from grape skin, onion skin, grapefruit rind and green algae. Initial studies have shown promise, but additional research is needed to access the long-term benefits of this natural formula. To find out more about Cysta-Q, visit www.CystaQ.com or call 1-877-284-3976.

Polysaccharides are long chains of sugar molecules. These naturally occurring substances may work by replacing the defective lining in the bladder, and they are thought to have a protective effect on the bladder. Elmiron is a synthetic polysaccharide. Examples of natural polysaccharides include glucosamine, chondroitin, marshmallow root, spirulina, and aloe vera. Desert Harvest, Inc., manufacturers a special IC-specific formula of aloe vera available in capsule form. It contains freeze-dried, whole-leaf aloe vera with no additives or fillers. Desert Harvest designed a double-blind, placebo-controlled study in which patients ingested three capsules twice a day with eight oz. of liquid for three months. Of the eight patients who completed the study, seven received relief from at least some of their symptoms. Of those seven, four experienced significant relief from all or most of their symptoms. Only one patient had no response after completing all six months of the study. For more information about Desert Harvest Aloe Vera products, visit www.desertharvest.com or call 1-800-222-3901.

Algonot-Plus combines polysaccharides (glucosamine and chondroitin) with quercetin and also adds an organic, unrefined olive seed oil from the island of Crete which increases absorption and adds its own antioxidants.

No formal research on this combined type of treatment for IC has yet been published, but several studies indicate that these supplements may be helpful, on their own, in the treatment of IC.
Glucosamine and chondroitin have previously been given to many IC patients in an open-label study with very good results when taken for a few months.

TC Theoharides, MD, and Grannum Sant, MD, have been involved in IC research and patient care for over 10 years. Their recent studies are encouraging for the benefits of combined therapies such as Algonot-Plus. For more information on Algonot-Plus, visit www.algonot.com, or call 1-800-254-6668.

 This information is taken from my book Treating and Beating Fibromyalgia and Chronic Fatigue Syndrome.

Learn more at www.getfibrobooks.com

Urinary Tract Infections and Fibromyalgia

Urinary tract disorders are another “layer of the onion” that might need to be peeled away to make you better. Of my FMS patients, 25% have chronic UTIs or interstitial cystitis. Individuals with fibromyalgia and CFS often have problems with their urinary system. They may experience chronic urinary tract infections (UTIs), interstitial cystitis, incontinence (involuntary loss of urine), and urinary retention (inability to pass urine).

Urinary Tract Infections

UTIs are more common in women who are sexually active, people with diabetes, and people with sickle-cell disease or anatomical malformations of the urinary tract. Also, women are more prone to UTIs than males, since a women’s urethra is much shorter and closer to the anus than a man’s. This is why proper hygiene is so important in females. UTI can be especially dangerous for infants and can cause permanent renal damage.

Symptoms and signs include painful, hesitant, frequent urination and high temperature lasting for more than three days. Nausea and vomiting along with pain and temperature may indicate a more complicated UTI, in which a kidney is infected.

Some urinary tract infections are asymptomatic. Others may have quite dramatic symptoms including confusion and associated falls, which are common for elderly patients with UTI who show up at the emergency room.

Diagnosis

The diagnosis of UTI is confirmed by a urine culture. A negative urine culture suggests the presence of other illness, such as chlamydia or gonorrhea.

Causes

Common organisms that cause UTIs include E. coli and S. saprophyticus. Less common organisms include P. mirabilis, K. pneumoniae, and Enterococcus spp.

Over 90% of UTIs are caused by E. coli. This bacteria is normally found in everyone’s gut and, with the exception of a few rare dangerous forms, it is a healthy part of our normal bowel bacteria. The problems begins when E. coli escapes the bowel and enters the bladder. The bladder is able to remove most infections through the process of urination, but E. coli are quite resilient and able to use projections to help them stick to the bladder wall.

Prevention of UTIs

• Drink 70 ounces of water a day.

• Avoid excess alcohol and caffeinated beverages.

• Don’t resist the urge to urinate; visit the bathroom as soon as you feel compelled.

• If you have frequent UTIs, avoid taking baths; take showers instead.

• Practice good hygiene by wiping from the front to the back to avoid contamination of the urinary tract.

• Sexually active women—and to a lesser extent, men—should urinate within 15 minutes after sexual intercourse to allow the flow of urine to expel the bacteria before specialized extensions anchor the bacteria to the walls of the urethra.

• Clean the urethral meatus (the opening of the urethra) after intercourse.

• Clean genital areas prior to and after sexual intercourse.

Conventional Medical Treatment

Most uncomplicated UTIs can be easily treated with oral antibiotics such as trimethoprim, cephalosporins, Macrodantin, or a fluoroquinolone (such as ciprofloxacin or levofloxacin).

Symptoms consistent with pyelonephritis, a serious kidney infection, may call for intravenous antibiotics.

Patients with recurrent UTIs may need further investigation such as ultrasound scans of the kidneys and bladder or intravenous urography (X-rays of the urinary system following injection of contrast material).

Often, long courses of low-dose antibiotics are prescribed to help prevent otherwise unexplained cases of recurring UTI.

Natural Treatment

Taking antibiotics will usually kill the bacteria that is causing a bladder infection, but will also kill the healthy “good bacteria” in your body. Always combat this side effect of antibiotics by taking probiotics along with them, 12 hours apart from each other.

Another option, which I prefer, is to try natural remedies before resorting to antibiotic therapy. If the symptoms don’t clear up within a couple days, then you can always start antibiotic therapy then. Natural therapies can also be used while you’re waiting for your tests results to confirm a UTI.

• Cranberry juice can end a UTI. In addition to acidifying urine, cranberries contain substances that inhibit bacteria from attaching to the bladder lining and, as such, promote the flushing out of bacteria with the urine stream. Dosage is one to two cups of pure cranberry juice (no sugar added) or 2–4 cranberry capsules (standardized to 11%–12% quinic acid) a day for 1–2 weeks. This may well be all you need to eliminate a UTI.

• D-mannose is a naturally occurring sugar similar in structure to glucose but metabolized differently. (Because the body metabolizes only small amounts of D-mannose and excretes the rest in the urine, it doesn’t interfere with blood-sugar regulation, even in diabetics.) Though D-mannose doesn’t kill bacteria, it prevents bacteria from attaching to the bladder wall. D-mannose is safe, even for long-term use, although most people will only need it for a few days. Those who have frequent recurrent bladder infections may choose to take it on a daily basis. I’ve found it to be the best option for stubborn, chronic UTIs.