• Nicole Cozean, PT, DPT, WCS

Holistic Treatment for Interstitial Cystitis: What does it mean, and why is it so important?

Holistic: Encompassing the whole of a thing, and not just the part.

Interstitial cystitis is a complex condition that entangles many different parts of the body - the pelvic floor, bladder, nerves, and even the brain are often affected. It negatively affects sleep and can make eating a healthy diet more difficult. All of the different components of the condition need to be addressed for true healing to take place.

'Holistic treatment' is a phrase that gets tossed around a lot, but sometimes seems to lose it's meaning. Some use it to mean whatever new (and often unproven) treatment they are offering, while others take it to automatically mean non-Western, alternative medicine like acupuncture or Chinese herbs.

Simply put, holistic simply means looking for treatments that address all

aspects or facets of interstitial cystitis.

Holistic treatment looks beyond the 'quick fix' mentality, realizing that true healing for complex diseases and conditions must treat the whole person. Medication, diet, lifestyle, stress, mental health - all play important roles in treating chronic conditions. This is a pragmatic approach. It is not anti-Western medicine (though many people use it that way), or advocating for a particular style of treatment. It takes what works, regardless of the source, and puts it to use for patients - the whole purpose of PelvicSanity.

All medical organizations and advocacy groups that have studied IC recommend a holistic approach with a combination of different therapies, including the Interstitial Cystitis Association (ICA), the American Urological Association (AUA), and American College of Obstetrics and Gynecology (ACOG). You'll also hear fancier synonyms like 'mutli-modal treatment' or 'combination therapy.'

For more detailed information on each of these categories, you can see The Interstitial Cystitis Solution.

"No single treatment has been found effective for the majority of patients, and the fact that acceptable symptom control may require trials of multiple therapeutic options (including combination therapy) before it is achieved"

-AUA IC Guidelines, 2014

Oral Medications

Oral medications for IC can play an important role in a holistic treatment plan. Common medications for IC include antidepressants to help calm the nervous system and reduce pain, antihistamines that can help prevent inflammation, pain medication ranging from aspirin to opioids to medical marijuana, Pentosan Polysulfate (PPS, Elmiron) to try and protect the bladder lining, and muscle relaxants to aid with pelvic floor physical therapy.

Bladder Treatments

There are some treatments for IC that target the bladder directly. Bladder instillations deliver medication directly to the bladder. In about 10% of IC patients there wounds in the bladder lining (known as Hunner's lesions) that can be cauterized and healed to reduce symptoms. Nerve stimulation targets the overactive nerves that are reporting the urgent need to use the bathroom to the brain, and BOTOX to the bladder can help relax the muscles of the bladder.

Pelvic Floor Physical Therapy

Pelvic floor physical therapy looks to address the component of pain and urinary symptoms that are due to tight, stressed, and knotted pelvic floor muscles. Pelvic floor dysfunction is almost ubiquitous with interstitial cystitis - measured in at least 85% of patients - and can mimic or create any of the symptoms of interstitial cystitis. Pelvic floor physical therapy works to release tension from these muscles, clear out inflammation, and restore normal function. It's the only treatment shown to sustainably help a majority of IC patients, and the only treatment given an 'A' evidence grade by the American Urological Association.

Stretching, Self-Care, and Massage

Stretching, self-care, and self-massage can be important aspects of a holistic IC treatment. They can help complement physical therapy, allowing you to keep the gains you see with PT. The IC Stretching Regimen takes only 20 minutes each day, but helps to relax the tight pelvic floor muscles and alleviate pain and bladder pressure. Self-care techniques like fascial release, trigger point release, and foam rolling can all help break up knots (or trigger points) in the muscles to restore normal length and function.

Diet and Lifestyle Changes

Approximately 85% of patients with IC report sensitivity to certain foods. While there seems to be a spectrum - some patients have no food sensitivity at all, while others are highly sensitive to many items - there are a handful of common trigger foods that are often culprits. Caffeine, alcohol, artificial sweeteners, citrus fruits and juices, and tomatoes are among the most prevalent. An elimination diet can help you understand what foods are triggers. There is no such thing as an 'IC Diet' - it's unique to each patient. Simply 1) avoid trigger foods and 2) eat healthy. That's it!

Many patients notice that prolonged sitting or driving exacerbates their symptoms - that's a common sign of underlying pelvic floor dysfunction. Avoiding prolonged sitting and other lifestyle changes can be important to a holistic treatment plan.

Mental Health

So many patients have had their pain trivialized or been told it's 'all in your head' that it's difficult to talk about mental health. Interstitial cystitis is absolutely a physical condition that causes real, physical pain and symptoms. With any chronic pain condition, it actually begins to re-wire the brain to expect pain. Stress has also been shown to have an impact on pain levels. Simple techniques like deep breathing, meditation, yoga, or therapy can have a major benefit on physical symptoms.

Complementary and Alternative Medicine

The line between 'complementary and alternative' medicine and the standard of care is fluid - pelvic floor physical therapy used to be considered an alternative treatment, and is now the most proven therapy for interstitial cystitis. One of the most common drugs in the world - aspirin - began as willow bark tea hundreds of years ago.

There are many supplements that have been shown to have benefit for some IC patients, including Calcium Glycerophosphate (Prelief), L-Arginine, Aloe Vera, Omega-3 Fish Oil, Vitamin D, and the combination of different ingredients in CystoProtek. Acupuncture has been shown in clinical trials to help with many chronic pain conditions - if you have had success in the past with acupuncture, it may be worthwhile to try again.

In Summary

The condition is complex, and entangles many different parts of the body - the pelvic floor, bladder, nerves, and even the brain are often affected. Holistic treatment is necessary to treat all these different areas for true healing.

Everyone is different; what works for others may not be effective for you, and vice-versa. A holistic treatment plan maximizes your chances for success.

Additional Resources

Dr. Nicole Cozean is the founder of PelvicSanity physical therapy, Orange County's premier pelvic floor physical therapy clinic. One of only 270 PTs to be board-certified in the pelvic floor, and the first PT to serve on the ICA Board of Directors, Nicole is the author of the acclaimed and best-selling book The Interstitial Cystitis Solution (2016). She is an adjunct professor at her alma mater, Chapman University. The PelvicSanity blog focuses on presenting practical, positive information to help patients beyond the walls of Nicole's clinic.

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