Dr. Jay Burstein: The standard dosage is 500 mg, 3x a day. L-Arginine is an amino acid, which is a building block of protein. Proteins are naturally found in the body. This is actually a food substance with no side effects. If you're going to use it, I think it should be used long term.

2. I was diagnosed with IC in 1982. I am now 16 weeks pregnant (age 37) and have had no problems until this week. I am having bladder discomfort and frequent urination. Since this did not occur until recently, can this be IC related? My Ob-Gyn's office has looked at the urine sample but they don't pay much attention when I tell them if it's related to IC the sample will not show a bacterial infection. Any suggestions??

Dr. Jay Burstein: Yes, it's possible that the IC made it worse. However, we have found that 75% of patients who become pregnant usually get better. A urinalysis is absolutely necessary here to rule out a possible UTI. At 16 weeks, it can be normal for the uterus to put some pressure on the bladder. This could be a source of your discomfort. Sometimes the uterus may also move, which could resolve your problem as well.

Dr. Jay Burstein: There are no clinical studies showing that MSM is effective for IC. I'm unfamiliar with the use of the supplement and heartily encourage you to contact the manufacturer for safety information.

Dr. Jay Burstein: I've referred to Gerald F. Combs "The Vitamins, 2nd ed." From Academic Press. It states that lipoic acid is an antioxidant. However, only trace amounts are needed in tissues to be effective. Available information indicates that animals are completely capable of manufacturing lipoic acid. No deficiency disorders have been reported linked to lipoic acid. Lipoic Acid supplementation has shown to be without effect in various research studies. This sounds like a waste of your money.

Dr. Jay Burstein: No, we're not at an impasse. One of the new treatments worth looking at is BCG. In research studies at William Beaumont Hospital, they've shown a 60% response rate & improvement in IC patients, compared with a 27% placebo response. This response was durable for up to thirty three months. To learn more about BCG, please review Ken Peters "Meet the Expert" transcript on the ICN.

Dr. Jay Burstein: The question of whether IC is the result of a fastidious agent has yet to be confirmed although some early research has been intriguing. It is possible that a small percentage urology patients may have some type of low grade infection but this may be one of many possible causes of urinary tract irritation.

Just because bacteria is present, doesn't mean that there is an infection. Consider your skin. At any one time, you will find bacteria on your skin, but that doesn't mean that you have an active infection. So, the presence of low count bacteria from a urine specimen may not represent a true infection. Infection is defined by inflammation. You have to have an inflammatory response. So when a microbiologist exams for an infection, he needs to see an infectious agent (a bacteria) and white blood or pus cells. If there is no pus, then it is defined as a colonization.

Is it normal for enterococcus to colonize the bladder? No.

Is a full urologic evaluation warranted if enterococcus is found? Absolutely.

If we have patient who has active symptoms, the presence of bacteria, but no pus cells, we'll still treat for infection.

A word of caution: Patients should never self administer antibiotics. This can result in severe resistant infections. If you feel that you have an infection, request a urinalysis and culture. You should never take antibiotics unless an infection is found by culture. Treatment for yeast may also be needed.

Talk over any concerns you have with antibiotics with your personal physician. Just understand that some physicians won't do this if they don't see the triad if symptoms, inflammation and bacteria.

Dr. Jay Burstein: No, actually Ditropan is a muscle soother. It's an anti-spasmodic that helps to reduce bladder sensation. It decreases the sensation of the urge to urinate. I have had no patients complaining of increased irritability from Ditropan. Valium is not bladder specific. We use it very sparingly in our practice.

For bladder irritation, I recommend bladder alkalization. Potassium Citrate or Sodium Bicarbonate can help. The use of a topical anesthetic, like pyridium, can be used short term. It's metabolism is a little rough on the kidneys, so we prefer short term use only. Urised is a combination of several medications that can reduce bladder sensitivity.

Prelief, for food sensitivities, can alkalinize the foods. That can, perhaps, reduce food induced irritation.

Dr. Jay Burstein: For many patients, IC can be controlled primarily through diet. There is no question about that. However, research suggests that the earlier that IC is diagnosed and treated, the easier it is for the condition to improve. With today's relatively easy treatments, like Hydroxyzine, there's no reason to rely on just one approach. It seems like you're looking for one specific easy thing to do. And, it might work. Usually it's a multi modal approach to treating IC is more effective. You shouldn't exclude other approaches.

Dr. Jay Burstein: I do not usually see back pain as a main symptom of IC. Yes, the pain can radiate to the back but it doesn't tend to be the main manifestation in my IC practice. My suggestion would be a thorough orthopedic examination and referral to a pain center. The trend for pain clinics now is to blend alternative and complementary pain strategies, including: botanical and herbal remedies, trigger point injections, acupuncture, massage therapy, physical therapy and deep tissue manipulations. There's no reason for you to suffer at home. Use the available resources in your community. Build your personal skills. Take a class in pain (and stress) management if needed! Take action and be proactive.

Dr. Jay Burstein: Several people have asked about the genetic role of IC but, at this point, we just don't know. Research is currently being conducted to see if there is a genetic connection.

Dr. Jay Burstein: In our state, Illinois, they have to provide this upon request. You can't have the originals, but they should make copies available of your file. Call your local medical association if you are unclear of the laws in your state.

Dr. Jay Burstein: No, that's NOT normal. That can signify some type of obstruction or poor coordination between the pelvic muscles and the bladder. It could also indicate a neurogenic bladder. It would be important to have a urodynamic evaluation and pelvic floor assessment.

In spinal cord injuries, we often see a condition called "dysinergy" where the muscles that should be relaxing during the process of urination actually contract instead. In other cases, such as incontinence or pain syndromes, poor coordination can be a learned response. Thus, bladder retraining may be an option here.

Repeated straining can increase damage and promote the negative pathology to the pelvic floor. If you're finding yourself straining to urinate, consult your doctor.

Dr. Jay Burstein: No. That is, most likely, just distraction as a result of your symptoms or pain.

Dr. Jay Burstein: (1) It's just a routine procedure. There's no reason to modify your diet before the procedure other than following the no food no drink rule after midnight.

(2) It's very individual. Some people do very well after a hydro, some are unchanged and some get worse. I tell my patients that you might get better, stay the same or get worse, which is why we prescribe pain medication and urised as needed. If you have a painful reaction to the procedure, you can anticipate needing to rest for a week or so. I've never had a patient get worse as a result of the procedure other than just post operative discomfort.

Dr. Jay Burstein: I was not aware that anyone was advocating the use of NAET until recently. Although I am usually receptive to alternative strategies for IC, I found NAET to be without merit.