This chapter highlights the complementary approaches available to patients with Interstitial Cystitis.

Traditional treatments have been helpful in the relief of IC symptoms in many patients. But, patients rarely find relief with a single treatment option.

The discovery of alternative methods for IC, has brought hope in the management and treatment in the lives of patients suffering with IC. It has enabled patients to take better control of their physical health.

Acupuncture is one of the oldest treatments of medical therapy and dates back over 5,000 years. Today acupuncture is being used for the treatment of IC.

Quoted page 235:
'Acupuncture involves the placement of needles into specific acupoints in order to rebalance the individual's flow of energy and to block pain…Acupuncture is theorized to provide pain relief by stimulating large-diameter myelinated afferent nerves thereby inhibiting spinal transmission of pain…'

According to one study done in the treatment of IC with acupuncture, to achieve significant symptomatic relief, it has been suggested that acupuncture treatment is best if given for 6-8 weeks with two treatments per week, this (Rapkin and Kames)

Interstitial Cystitis pain has been compared to the intense pain that cancer patient experience and with chronic back pain Most patients, when in severe pain react by breathing faster (increasing the pace ) By breathing slowly it can interrupt the pain cycle.

Quoted page 236
'The sympathetic nervous system is dramatically influenced by the way in which individuals breath. During thoracic breathing, sympathetic activity increases, as does muscle tension. Slow diaphragmatic breathing, on the other hand, tends to decrease sympathetic tone, thereby encouraging a state of generalized relaxation.'

Diaphragmatic breathing has been beneficial for those who suffer with pelvic floor dysfunction and with IC. Pelvic floor dysfunction, is often associated with pelvic pain, urgency frequency, hesitancy and decreased flow rates. Pelvic floor dysfunction was present in 70% of IC patients that meet the criteria of the NIDDK. In this study, patients were treated for a period of three months, which included conservative treatment, sitz baths and relaxation therapy which consisted of diaphragmatic breathing and muscle relaxation techniques.

Quoted 236
'Diaphragmatic breathing is a quick and simple method to break the tension-pain-tension cycle. Continued practice of this technique has helped patients by enhancing muscle relaxation, relieving stress and pain while rehabilitating pelvic floor musculature.'

Progressive muscle relation is a stress reduction technique. it has been documented that stress plays a major role in pain perception. This technique is done by, voluntarily tightening and relaxing certain muscle groups. Because pain can induce muscle contractions and this can further lead to more pain, It is important that we reduce the muscle tension, so that the pain signals are disrupted.

Quoted page 237: '…It involves establishing an alliance with the patient, teaching her to relax through suggestion, and then shifting her focus away from the sensation of pain'

Hypnosis, can not totally alleviate pain and can however help the patients to modify their perception of pain. The studies on hypnosis, in the treatment of IC have many mixed results. IC patients however have found hypnosis to be helpful in the reduction of stress and reduction of muscle tension. It is recommended for a complimentary therapy because the pros are that is has no side effects and It helps the patient to have more control of his/her life.

The effectiveness of behavioral modification has been considered significant therapy in the treatment of IC. This is one therapy that is sometimes beneficial because it helps modify behavior of your bladder such as frequent voiding. With Bladder retraining programs/therapy, IC patients have been able to decrease the number of voids per day.

Quoted page 237
'Severe pain associated with bladder filling has been the only major impediment to successful implementation of such strategies. Behavior modification techniques using individualized bladder holding protocols have provided for a reduction in IC symptomatology and an increase in self-control among patients.'

Chaiken conducted a research study that concluded that out of 42 patients on a average of 12 weekly sessions the following results were documented:

1. average of 93 minutes between voids
2. 98% had a decrease of voids from 17 voids to 8 voids per day
3. Bladder capacity increased in 38 of 42 patients by an average of 73ml

1. decreased urinary frequency, urgency and nocturia in 15 patients
2. increased voiding volumes in all patients by a average of 92cc before treatment to 179cc after treatment

1. increase in voiding volume- 65 cc in one month
2. 11 patients had no changes in symptoms after therapy

Biofeedback assists patients to gain awareness and greater control over physiological process through bio-electrical instrumentation. An EMG facilitated biofeedback helps teach patients to relax muscles that are causing pain. Electromyographic biofeedback has been found to be useful adjunctive therapy in the treatment of IC and pelvic floor dysfunction; however, long term follow up studies and the role of the placebo effect should be considered for further research.

Our Acknowledgements