Mr K.R., a 42-year-old financier originally from Kenya, was troubled by recurrent dull pelvic pain accompanied by blood in his urine. The pain intensified as his bladder filled with urine, then decreased after being emptied. Such episodes lasted for a few days to three weeks or longer. Physical exertion, he believed, triggered the attacks. He also complained of a permanent urgency to urinate, a greater frequency of urination, and a continuous vague but unpleasant sense of pressure in the bladder and the surrounding pelvic region.
On investigation, his prostate was not enlarged, and his rate of urinary flow was normal. He had no urinary tract infection or bladder cancer, neurological disorder or sexually transmitted disease. A cystoscopy, performed during a period of remission, revealed bladder-wall inflammation, but no glomerulations - pinpoint bleeding caused by recurrent irritation. A biopsy of the bladder wall revealed the presence of mast cells, suggestive of allergic or allergy-like reactions.
When Mr K.R. came to see me, there was blood in his urine, so I tested him for schistosomiasis (a parasitic infection endemic in Africa), which was negative. He reluctantly agreed to a second cystoscopy, carried out while he was not in remission and with a full bladder. This time, glomerulations were indeed observed, explaining the blood in his urine.
Given the absence of other diseases to account for his symptoms, and the cystoscopic evidence of bladder-wall inflammation and glomerulations, I diagnosed interstitial cystitis (IC).
The patient went back to his urologist, who agreed with this diagnosis and presented him with three choices of treatment:
* Bladder distention, or stretching the bladder. Symptoms may worsen for 24-48 hours after the procedure, but should either return to predistention levels or improve (in about 35 per cent of cases, it's believed) after three or four weeks;
* Bladder instillation in which, every two weeks, 50 mL of dimethyl sulphoxide (50 per cent solution) is instilled into the bladder, retained for 15 minutes and voided by the patient. Hypersensitivity reactions and bladder spasms may occur, and longer-term use requires eye (for possible cataracts), kidney and liver assessments at six-month intervals;
* The oral drug pentosan polysulphate sodium (PPS; Elmiron), 100 mg three times a day. Clinical trials have shown improved symptoms in 38 per cent of PPS-treated patients, although the changes may take up to six months to become evident. In addition, the drug is known to adversely affect liver function and, therefore, needs to be monitored.
Mr K.R. declined all three options and came back to me for alternatives. I prescribed the homoeopathic combination remedy Cephyl (by Boiron of Lyon, France), which helped. But what was even more beneficial was transcutaneous electrical nerve stimulation (TENS). Gentle stretching exercises further relieved his IC symptoms - the unpleasant pressure pain was under control and the episodes of blood in the urine seemed to be fewer and farther between.
He later came to tell me that while taking antihistamines for his hayfever, the whole IC problem improved considerably. This suggested that there was an allergic component to his condition.
While there is no scientific evidence linking IC and diet, anecdotal reports do suggest links between bladder irritation/inflammation and certain foods such as alcohol, tomatoes and other nightshades (e.g. potatoes and aubergines), spices, chocolate, citrus, caffeinated drinks, high-acid foods and artificial sweeteners.
By eliminating these items from his diet and reintroducing them one at a time, he was able to determine which, if any, affected his symptoms. Mr K.R. also quit smoking (tobacco is a nightshade) as the habit is known to be a major cause of bladder cancer. When he excluded chocolate, coffee, tea, red wine and cola drinks from his diet, his urination urgency and frequency problems totally disappeared; blood in his urine has also not recurred in four years so far.
Harald Gaier is a registered naturopath, osteopath, homoeopath and herbalist. He can be contacted at The Diagnostic Clinic, London, tel: 020 7009 4650