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The condition known as interstitial cystitis has traditionally been believed to affect women significantly more than men, but that line of thought has been changing. In fact, recent research has suggested that instead of the painful condition affecting women tenfold over men, it may be closer to fivefold or less and that some men who get interstitial cystitis are being misdiagnosed with chronic prostatitis.
Diagnosing interstitial cystitis
Symptoms of interstitial cystitis are similar to those of chronic pain/chronic pelvic pain syndrome (CP/CPPS), which makes it challenging for clinicians to arrive at an accurate diagnosis. Some of those symptoms include pain in the pelvic area, urgent need to urinate, frequent need to urinate, and dribbling, among others. An accurate diagnosis is problematic because there’s a lack of accurate testing techniques to help confirm the possibilities. In addition, diagnosing interstitial cystitis typically involves using cystoscopy, which is invasive, expensive, may cause disease flare-up, and is not always available to patients. To muddy the waters even further, the diagnostic techniques to identify prostatitis, such as post-digital rectal exam, urinalysis and biopsy, are not always helpful either.
A promising thing about failing to differentiate between interstitial cystitis and chronic prostatitis, however, is that both conditions can be treated in basically the same way, at least when it comes to naturopathic medicine, as long as men don’t present with any type of bacterial infection.
That said, two major causes of interstitial cystitis and chronic prostatitis are pelvic floor hypertonicity and increased urothelial permeability. In naturopathic medicine, identifying the cause of the symptoms is much more important than naming the condition, as the cause will dictate the treatment.
What is pelvic floor hypertonicity?
In some men with chronic pelvic pain, pelvic floor hypertonicity is identified as the source of the symptoms. The pelvic floor is composed of muscles and fascia, and hypertonicity (abnormally high tension in the muscles) and trigger points in this area are believed to be involved in the development of interstitial cystitis. To make this identification, clinicians perform a modified digital rectal exam and apply finger pressure to several different areas of the pelvic floor. Men with pelvic floor hypertonicity usually feel pain or a burning sensation when this modified DRE is performed.
How to treat pelvic floor hypertonicity
If you have been identified as having pelvic floor hypertonicity, some natural ways to treat it include:
- Hot sitz baths, 15 to 20 minutes each night before retiring
- Magnesium supplements, 200 mg twice daily (shop Amazon magnesium supplements)
- Kava kava supplements (1,000 mg three times daily)
- Avoidance of prolonged sitting and Kegel exercises
- Work with a pelvic floor physical therapist if improvement is not experienced within 1 to 2 weeks
What is leaky urothelium?
The inner lining of the bladder (urothelium) is composed of several layers. If the urothelium gets damaged, it can leak molecules out of the bladder into the space (interstitium, which can lead to interstitial cystitis) between the tissue layers and into the bloodstream. One way doctors can test for this problem is the use of a potassium sensitivity test, which is performed during cystoscopy. This procedure will result in severe pain in men with interstitial cystitis but be painless in men without the condition. Because this test is invasive and can trigger a flare-up of the disease, it is not a routine practice.
An alternative approach, which has not been studied extensively, involves instilling lidocaine or lignocaine solution into the bladder. If men experience an improvement in symptoms, this helps confirm interstitial cystitis, but the test’s accuracy is questionable.
Treatment of leaky urothelium
Treatment of leaky urothelium is challenging because the condition is often accompanied by specific food intolerances. Therefore, patients should follow an elimination diet to identify the triggering foods, which is necessary for complete healing to occur. Once the triggering foods are noted and eliminated, natural treatment options include N-acetylglucosamine (NAG; 700 mg twice daily), aloe vera leaf gel (2 oz twice daily – shop here), and glutamine (5 g three times daily – shop here).
Men with interstitial cystitis are often misdiagnosed as having chronic prostatitis. However, because treatment for both of these conditions is often similar, arriving at a firm diagnosis is not always necessary. It is important, however, to identify whether patients have pelvic floor hypertonicity or leaky urothelium as the underlying cause of the symptoms.
Bassaly R et al. Myofascial pain and pelvic floor dysfunction in patients with interstitial cystitis. International Urogynecology Journal 2011; 22(4):413-18.
Forrest JB et al. Chronic prostatitis/chronic pelvic pain syndrome and male interstitial cystitis: enigmas and opportunities. Urology 2007; 69(4 Suppl):60-63.
Friedlander JI et al. Diet and its role in interstitial cystitis/bladder pain syndrome (IC/BPS) and comorbid conditions. BJU International 2012; 109(11):1584-91.
Metts JF. Interstitial cystitis: urgency and frequency syndrome. American Family Physician 2001; 64(7):1199-1206.
Taneja R. Intravesical lignocaine in the diagnosis of bladder pain syndrome. International Urogynecology Journal 2010; 21(3):321-24.
Yarnell E. Natural Approach to Gastroenterology. 2nd ed. Wenatchee, WA: Healing Mountain Publishing; 2010.