Researchers in San Diego are conducting the second formal study in the United States to determine if hyperbaric oxygen therapy (HOT) is helpful in the treatment of interstitial cystitis. Several studies completed in Europe have shown promise in this new and unusual treatment approach.

Hyperbaric oxygen therapy (aka decompression therapy) is most well known for saving the lives of scuba divers. The patient is placed in a pressurized chamber where they breathe 100% oxygen for a period of time. The increased pressure allows the lungs to absorb more oxygen than they would at normal pressure. The blood stream then delivers the oxygen throughout the body where it can help fight infection, stimulate growth factors and stem cells and enhance healing.

Hyperbaric therapy is currently used for the treatment of: anemia, brain abscess, burns, carbon monoxide poisoning, traumatic injury, gangrene, sudden deafness, diabetic foot ulcers, radiation injury, skin grafts, sudden vision loss and radiation cystitis.

Hyperbaric Oxygen Shows Success

Researchers in Germany were the first to explore HOT as a possible treatment for interstitial cystitis.(1) Their 2004 study showed that increasing oxygen levels could help the bladder heal and improved IC symptoms of frequency, urgency, pain and, most significantly, a dramatic increase in bladder capacity. That same research team released a larger double blind study in 2006 that involved 21 patients, 14 of whom received hyperbaric therapy.(2) This study, too, found a decrease in pain and urgency. The researchers concluded that 30 treatments of hyperbaric oxygenation was a “safe, effective and feasible therapeutic approach to interstitial cystitis” which resulted in a sustained, long term results.

Researchers in Japan shared their first experience in a case series of two patients who were treated with 20 sessions of hyperbaric oxygen therapy. They reported that Hunner’s lesions disappeared and that pain and frequency were improved.(3)

Hunner’s Lesions Respond Well To HOT Therapy

The same Japanese team released a study which demonstrated that HOT therapy was particularly successful for patients struggling with Hunner’s lesions.(4) They followed eleven IC patients (eight with lesions, 3 without) who had not responded to previous therapy. They received 2.0 ATA for 60 minutes/day × 5 days/ week for 2 or 4 weeks. After ten sessions, patients were evaluated. Seven patients had a significant improvement in their pelvic and and urinary symptoms. At one year post treatment, pelvic pain, urinary frequency and bladder capacity were still improved.

Two of the patients received a second round of treatment and remained stable for more than two years, leading the authors to suggest “it is likely that a repeated course of HOT could accelerate the healing phase of ulcerative PBS/IC disease.” Cystoscopic examination demonstrated marked granulation (healing) of the ulcerative lesion at the end of HOT treatment in all responders.

The dynamic research team at Beaumont Health conducted the first formal study in the USA. Based upon previous studies, they sought to determine if HOT therapy would be more successful with lesion patients and less effective with patients without lesions. Eight patients com- pleted the study, six with lesions and two without. 83% of patients with lesions improved, with 66% showing long term success at six months. Two patients had their lesions heal at the six month check in. Only one non lesion patient improved. Because this study is small, they suggested that additional studies be conducted.(5)

The final published study comes from Japan. Researchers at the Osaka City University School of Medicine conducted an animal study which found that HOT suppressed inflammation, edema, and fibrosis in bladder wall, with a significant decrease of inflammatory biomarkers.

How It’s Done

Hyperbaric oxygen therapy is usually performed as an outpatient procedure. There are two types of units that it can be done in. A small tube like structure can hold one person. You will be asked to lie on a table and then it will be slid inside the tube. Fair warning. This could be very difficult for claustrophobics.

Larger facilities usually have a large room that is designed to accommodate several people. It looks like a large hospital room where you can sit or lie down. You may receive oxygen through a mask over your face or a lightweight, clear hood placed over your head.

During hyperbaric oxygen therapy, the air pressure in the room is about two to three times normal air pressure. The increased air pressure will create a temporary feeling of fullness in your ears, similar to what you might feel in an airplane or at a high elevation. You can relieve it by yawning or swallowing.

For most conditions, therapy lasts approximately two hours. You will be closely monitored throughout the treatment. Afterwards, you may feel tired and/or hungry.

Potential Risks

As with any therapy, it is very important to understand the poten- tial side effects. Oxygen is extremely flammable thus fire is a serious risk. You will be asked to remove all metal products that could spark. Ear injuries were reported in the IC studies, including a temporary loss of hearing. Eardrum rupture is also possible. High oxygen can also cause the lens of your eyes to change causing temporary near sightedness. Lung collapse (barotrauma) is also possible.

Conclusion

HOT therapy has been slow to arrive in the USA but is now available at specialty centers across the USA. The challenge, of course, is determining if your urologist is familiar with the technology and willing to try it. As we continue to see across the country, most urologists are unable to attend national conferences and are often unaware of new resources and developments. Many are still unaware of the AUA’s Guidelines for the Diagnosis and Treatment of IC despite the fact that it was released in 2011. Bring this article with you as you broach the subject. The research studies cited below present a solid case for the consideration of HOT therapy, especially for patients with Hunner’s lesions.

The other challenge is insurance coverage. Many HMO’s and health insurance companies may be unwilling to pay for it, explaining that it is still an experimental therapy.

Don’t blame the clinician, educate them. Bring this article. Ask them to do their own research. Search the web for HOT centers near you so that you can provide a list of available centers. Try to catch their interest. Again, for the Hunner’s lesion patient not responding to other therapies, this is a worthwhile option to explore.

At this time, there are more than 192 clinical trials around the world testing hyperbaric oxygen therapy as a therapy for a variety of conditions. 37 studies are actively recruiting patients who struggle with radiation injury, inflammatory bowel disease in children, ulcerative colitis, post concussion syndrome, stroke, dementia, amputation, UTI, IC and others.

References

  1. van Ophoven A, et al. Hyperbaric oxygen for the treatment of interstitial cystitis: long-term results of a prospective pilot study. Eur Urol. 2004 Jul;46(1):108-13.
  2. van Ophoven A, et al. Safety and efficacy of hyperbaric oxygen therapy for the treatment of interstitial cystitis: a randomized, sham controlled, double-blind trial. J Urol. 2006 Oct;176(4 Pt 1):1442-6.
  3. Tanaka T, et al. Hyperbaric oxygen therapy for interstitial cystitis resistant to conventional treatments. Int J Urol. 2007 Jun;14(6):563-5.
  4. Tanaka T, et al. Hyperbaric oxygen therapy for painful bladder syndrome/interstitial cystitis resistant to conventional treatments: long-term results of a case series in Japan. BMC Urol. 2011 May 24;11:11.
  5. Gallego-Vilar D, et al. Maintenance of the response to dimethyl sulfoxide treatment using hyperbaric oxygen in interstitial cysti- tis/painful bladder syndrome: a prospective, randomized, comparative study. Urol Int. 2013;90(4):411-6.
  6. Wenzler DL, et al. Treatment of ulcerative compared to non-ulcerative interstitial cystitis with hyperbaric oxygen: a pilot study.