INTERSTITIAL CYSTITIS CBD AND POSSIBLY THC-A??
I have had a number of patients come in with complaints related to Interstitial Cystitis. IC is a fairly common problem in both men and women and is essentially an inflammatory condition of the bladder and at times the urethra. Treatment is not great and there are many patients out there suffering with urinary frequency and urgency. Often catheters or diapers are required. Clearly it is a serious issue without great therapy.
Here is a link to a few dozen articles showing the presence of both CB1 and CB2 receptors in the bladder. So, it would seem that cannabinoid therapy would be worth a try.
So, far, I have had some good responses with modest doses of CBD. I want to now try adding THC-A to their regimens.
So, if any of you out there want a trial of CBD and THC-A, give me a ring.
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Marijuana as medicine is now legal in 16 states and the District of Columbia. Patients in these locations need to be certified to use it based on a doctor’s recommendation and a qualifying condition. Interstitial Cystitis (IC) is not listed as a qualifying condition in any of the states, but most list chronic pain or muscle spasticity, which would qualify most IC patients. If you are in one of these states and are interested in trying marijuana as a medicine for your IC, here are some of the things you need to know and consider:
- IC patients’ comments to the ICA about medical marijuana are mostly positive, but some are negative. The effects may depend on the strain and method of delivery.
- Studies on medical marijuana and IC are lacking. It is nearly impossible to study in the United States because of federal restrictions. We may learn more soon from other countries.
- Current approved marijuana-like drugs contain the most psychoactive marijuana component (THC) or a variation of it. Other marijuana compounds, however, may be more helpful for pain and inflammation. Some marijuana strains and drugs under development reduce or eliminate THC and emphasize these other compounds.
- If you live in a state where medical marijuana is not legal, you cannot go to a state where it is legal and use it.
- Safe use depends on consulting a knowledgeable physician in a reputable medical marijuana clinic and on dispensaries and knowledgeable caregivers who understand IC and the marijuana strains that might be appropriate for it.
- State and federal marijuana laws conflict, and recent federal and local actions may make safe access difficult. Understand what the restrictions are where you live so you won’t risk legal problems and can use carefully recommended and safely dispensed medical marijuana.
- Even in states where medical marijuana is legal, some pain care contracts or medical practices may require that you not use medical marijuana. Learn your doctor’s requirements for care before making your making your decision.
You can learn much more about medical marijuana and IC in our ICA Update feature “Running Ahead of Research on Medical Marijuana,” in the Fall 2011 issue.
Revised Tuesday, May 26th, 2015
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CBD for interstitial cystitis
Interstitial Cystitis (or IC for short) is a chronic bladder health issue affecting millions of people (largely women). IC causes bladder pressure, bladder pain and sometimes pelvic pain. The pain ranges from mild discomfort to severe.
Interstitial cystitis signs and symptoms include:
- Pain in your pelvis or between the vagina and anus in women.
- Pain between the scrotum and anus in men.
- Chronic pelvic pain.
- A persistent, urgent need to urinate.
- Frequent urination, often of small amounts, throughout the day and night (up to 60 times a day)
Treatment options often consist of:
- Physical therapy
- Prescription medications such as antihistamines and antidepressants
- Lifestyle and diet changes such as reducing stress, quitting smoking, exercising and cutting out common bladder irritants such as the “4 Cs”: carbonated beverages, caffeine in all forms (including chocolate), citrus products and food containing high concentrations of vitamin C.
- Medical procedures such as bladder distention
- Alternative medicines such as acupuncture
My own experience with IC began in 2004 during a very busy tax season where I was at the office day and night (I am a CPA). I was having constant pain in my bladder and had to go to the bathroom 30-40 times a day. I have struggled over the years with this condition although I believe now I am one of the lucky ones. When I joined a support group on Facebook I quickly realized my case was probably a “medium” case. The pain and suffering of the individuals affected by IC are beyond my comprehension. It has been said that the pain of IC is equivalent to that of chronic cancer pain! Quality of life is diminished greatly in many cases.
During periods of active IC the urge to urinate is constant. No matter how many times you urinate, your bladder still feels full. You get up multiple times per night for a trip to the bathroom, you start avoiding liquids at all cost because the pain of an empty bladder is bad enough, imagine the pain when your bladder is actually full! I still to this day refrain from ordering the “free beverage” on a plane flight or drinking coffee or any liquids before I have to drive somewhere or be somewhere without a bathroom. My kids’ school is a 12 minute drive. I would have to use the restroom in the nurse’s office prior to returning home and this was when I was not flaring!
IC patients are seen by urologists and are typically subject to constant appointments, tests, medications, and procedures. My arsenal of bottles alone for just a medium case of IC consisted of CystaQ, Prelief, marshmallow root, prebiotics, probiotics, D Mannose and of course the ICN (IC Network) food app for your phone that tells you what foods are approved for IC to avoid triggers!
How I met CBD and hatching the relationship
Coming full circle, I made the decision to start taking CBD products in response to a genetic predisposition for an unrelated disease. CBD is relatively new to most of us so I didn’t know to research it for my IC. After a few weeks of taking the CBD products it occurred to me that my bladder was feeling better than it had in a long time. I started doing some research on the relationship to find out why CBD was making my IC symptoms feel better.
How does CBD affect the bladder?
CBD isn’t going to cure IC, but the most profound implications of having IC are bladder inflammation, pain and urinary frequency. Research to date on CBD related to its effects on the body’s endocannabinoid system show that CBD could minimize these discomforts. Furthermore, a hallmark feature of having IC is the flares that occur. Controlling flares is really the action item always at hand for an IC sufferer and perhaps if CBD can assist with inflammation, pain and urinary frequency, it may be able to help control flares.
The body’s endocannabinoid system houses its cannabinoid receptors. Cannabinoid receptors are found throughout the body and are implicated/activated in a multitude of bodily processes from pain perception to immune system to nervous system and many many more. The two primary (or at least most studied) cannabinoid receptors are referred to as CB1 and CB2. These cannabinoid receptors are influenced by internally produced endocannabinoids as well as externally introduced cannabinoids such as CBD, which is short for Cannabidiol.
Both cannabinoid receptors, CB1 and CB2, have been found to be located in human bladders and studies (albeit limited at this juncture) have shown that CBD impacts pain, inflammation and urge incontinence in the bladder. Based on the positive findings to date, additional studies continue to be conducted to research the effects of CBD on bladder health.
CBD and inflammation/swelling
Many studies have concluded that CBD is a powerful anti-inflammatory. Cannabinoids have been tested in several experimental models of autoimmune disorders such as multiple sclerosis, rheumatoid arthritis, colitis and hepatitis and have been shown to protect the host from the further development of the disease through induction of multiple anti-inflammatory pathways.
Furthermore, specific to bladder inflammation, in one animal study researchers inflamed the bladders of certain rats and then treated their CB2 receptors with cannabinoids. The result was that bladder swelling was reduced and urinary frequency was inhibited in the group that received the cannabinoid treatment. While we are not rats, the study concluded that due to these findings the cannabinoid receptor 2 is a potential therapeutic target for treatment of painful inflammatory bladder diseases such as IC.
CBD and pain
In addition to aiding in an anti-inflammatory effect, CBD has been shown in many studies to reduce pain in connection with inflammation.
One study specifically looked to invoke the endocannabinoid system as an alternative to opioids for severe bladder pain and notes the pain reduction comes with minimal side effects, and I quote “Manipulation of the endocannabinoid system has emerged as an appealing alternative to opioids for management of severe bladder pain providing an intriguing alternative that has the potential to provide effective analgesia with minimal systemic side effects.”
CBD and urge incontinence
Studies related to CBD and bladder health have been conducted in connection with multiple sclerosis, a condition that often includes lower urinary tract dysfunctions, predominantly overactive bladder. One study concluded that cannabis could be beneficial for managing bladder dysfunction and suggested further studies after urge incontinence episodes were significantly reduced in the multiple sclerosis patients participating in the study.
Finding my balance with CBD (was it love at first sight?)
When I was originally researching / trying different brands of CBD oils and products, my first realization was that I didn’t care for the “original” flavor of the CBD oil. Thankfully, there are many different flavors available. I later discovered soft gels and then I discovered soft gels with curcumin! CBD with curcumin? This has to be the greatest supplement combination ever invented! Curcumin, the principle substance in turmeric, is widely believed to have anti-inflammatory and antioxidant properties. So many of the conditions we find ourselves struggling with are directly related to inflammation and oxidative stress, including IC. So, when it comes to love at first sight, I think yes to CBD with curcumin!
My recommendation if you are trying CBD for the first time is to try the oils first, that way you can adjust the dosage much easier to find your sweet spot. Edible gummies also offer lower end dosage such as 5 mg if you want to start there. Then, if you are comfortable with the dosage you can start using gel caps which often come in 25 mg capsules. I personally don’t vape, but several vaping options are available to integrate the benefits of CBD into your life. In addition, vaping CBD provides the fastest onset of all the delivery methods. As far as dosage, I do believe that experimentation is key as not only do CBD effects vary from person to person, but IC as a general matter affects everyone a little differently and has different root causes. Some patients may need more, some less to feel the benefits. In addition to the softgels with curcumin, my favorite CBD oil is this mint chocolate flavored CBD oil from Charlotte’s Web. So good!