Interstitial Cystitis and Calculi

Question 1

Interstitial cystitis (IC)

Answer 1

A chronic inflammatory condition of the bladder characterised by pain and a sense of pressure.
* It is not associated with infection and does not respond to antibiotic treatment.
* Significantly higher in women than men, though it is thought that many men previously diagnosed with non bacterial prostatitis may actually have IC.

Question 2

Interstitial Cystitis: Signs and symptoms

Answer 2

Mild to intense pressure / pain in bladder and pelvic area (intermittent or constant), urinary urgency and frequency, dyspareunia. Petechial (pinpoint) haemorrhages are often visible on cystoscopy.

Question 3

Interstitial Cystitis: Causes and risk factors

Answer 3

• Injury to the protective glycosaminoglycan layer of the bladder wall. Increases permeability, allowing potassium and chemical irritants in urine to damage underlying tissues.
• Allergic - IgE. Activation of mast cells histamine and cytokine release.
• Nerve pain - Mast cell activation
• Alterations to the urinary microbiome

Question 4

Interstitial Cystitis: Natural approach

Answer 4

• Follow guidelines for UTIs
• Assess for food allergy / intolerance. Elimination diet or IgG / IgE antibody testing. Environmental allergy
  (mould, pollen, mites etc.) IgE antibody testing.
• Follow the CNM Naturopathic Diet emphasising antioxidant rich vegetables alongside anti inflammatory foods and herbs e.g., oily fish (EPA); turmeric, fresh ginger.
• Include aloe vera juice (inner leaf gel) inhibits COX and hence PG2; appears to increase production of glycosaminoglycans

Question 5

Interstitial Cystitis: Supplements

Answer 5

Quercetin - 500mg 2x/d
* Anti-allergic, anti-inflammatory
N-acetyl glucosamine 1500-2000mg 3x/day
Condroitin 200-400mg 3x/day
* Increases glycosaminoglycan synthesis
* Reduces inflammation

Question 6

Interstitial Cystitis: Other

Answer 6

• Lactobacillus
• Corn silk and marshmallow root - soothe urinary tract
• Gotu kola - improves integrity of connective tissue and heals bladder ulcerations.
• Castor oil packs

Question 7

Urinary calculi

Answer 7

Formation of crystalline salts and organic matter in the kidney and bladder (gravel).
* May be asymptomatic or cause debilitating pain (renal colic) if a stone lodges in a ureter.
Other symptoms: Nausea, vomiting, fever.

• Calcium oxalate (the most common)
• Calcium phosphate.
• Uric acid.
• Struvite stones

Question 8

Urinary calculi: Causes and risk factors

Answer 8

• Dehydration
• Altered urinary pH
• Dietary acid load
  ‒↑ secretion of calcium
  ‒↓ secretion of citrate
  ‒↑ excretion of uric acid
• High table salt intake
• Low in fibre, high in refined carbohydrates and alcohol.
• ↑ Calcium supplementation
• High intake of oxalate rich foods
• High protein intake
• Purine rich foods

Question 9

Urinary calculi: Natural approach

Answer 9

• Hydration
• Alkalise
• Reduce all animal proteins and high purine foods.
• Reduce salt intake
• Increase potassium rich foods (fruit and vegetables) to reduce urinary calcium.
• Avoid oxalate rich foods such as spinach, rhubarb, strawberries, beetroot, almonds and cashews.

Question 10

Urinary calculi: Supplements

Answer 10

• Magnesium Citrate 600 mg / day) reduce calcium
• B6 (25 mg / day) - excretion of oxalates
• Folate (5 mg / day) - lowers uric acid
• Nettle leaf - diuretic
  Red juices (blackcurrant, cranberry, beetroot)