Interstitial Cystitis – Medical Marijuana Research Overview

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Interstitial cystitis is a chronic bladder condition that typically affects women in their 30’s and older. Studies have shown cannabis helps reduce bladder inflammation and manages urinary frequency and pain symptoms.

Overview of Interstitial Cystitis

Interstitial cystitis, or painful bladder syndrome is a condition that causes severe bladder pressure and pain and causes the need to urinate frequently. The chronic condition is more common in women than in men. Interstitial cystitis causes a person to feel the need to urinate more often and when the bladder is holding smaller volumes of urine.

The pain associated with interstitial cystitis is typically located in the pelvic region and in the area between the vagina and anus in women or between the scrotum and anus in men. The symptoms associated with interstitial cystitis typically fluctuate, flaring up in response to things like long periods of sitting, stress, exercise, sexual activity and menstruation. Interstitial cystitis can lead to the stiffening of the bladder wall, which reduces bladder capacity and makes a person have to urinate more frequently. Having to urinate frequently and experiencing pain commonly interferes with daily life.

The cause of interstitial cystitis is unknown, but a defect in the protective lining of the bladder, which allows toxic substances in urine to irritate the bladder wall, has been associated with the condition.

There is no cure for interstitial cystitis. However, medications and other therapies, like nerve stimulation, bladder training, and stretching of the bladder, can help in managing symptoms.

Findings: Effects of Cannabis on Interstitial Cystitis

Research suggests that cannabis can help reduce bladder inflammation and urinary frequency because of its impact on the body’s endocannabinoid system. Both cannabinoid receptors, CB1 and CB2, have been found to be located in human bladders (Wang, Wang & Bjorling, 2013). Tetrahydrocannabinol (THC) and cannabidiol (CBD), two major cannabinoids found in cannabis, activate the CB2 receptors of the endocannabinoid system. In an animal study, researchers discovered that the activation of CB2 receptors with cannabinoids were effective at inhibiting inflammation. Bladder swelling was reduced and urinary frequency was inhibited in the group that received cannabinoid treatment. These findings suggest that THC and CBD, which activate the CB2 receptors, could help in the treatment of chronic bladder diseases like interstitial cystitis (Wang, Wang & Bjorling, 2014). Another study confirmed that activating CB2 receptors with a cannabinoid inhibited the severity of bladder inflammation (Wang, Wang & Bjorling, 2013). In animal studies, THC and other cannabinoids were found to inhibit electrically-evoked bladder contractions, which suggests a relationship between CB1 receptors and bladder function (Pertwell & Fernando, 1996) (Fullhase, et al., 2014).

The administering of THC and CBD were found to significantly decreased urinary urgency and the number and volume of incontinence episodes in multiple sclerosis patients with bladder dysfunction. In addition, pain and quality of sleep significantly increased (Brady, et al., 2004). Another study also found that cannabis significantly reduced urge incontinence episodes in multiple sclerosis patients (Freeman, et al., 2006).

Cannabis has also proven effective for managing the pain associated with interstitial cystitis. A case study found that a 31-year-old woman diagnosed with chronic cystitis and who’s pain had proven intractable to other treatments for about 20 years experienced a significant reduction in pain when taking oral THC. Throughout treatment, the patient had to reduce dosage because of psychotic side effects, confusion and bad dreams. However, once the dosage was reduced, the patient continued to experience a reduction in pain, but with diminished side effects, and remained stable for six months until completion of the case study (Krenn, Daha, Oczenski & Fitzgerald, 2003). An animal study also showed that THC was effective at suppressing pain in hypersensitive bladder disorders like interstitial cystitis (University of Pittsburgh Medical Center, 2006).

States That Have Approved Medical Marijuana for Interstitial Cystitis

Currently, only the state of Illinois has approved medical marijuana specifically for the treatment of interstitial cystitis. However, in Washington D.C., any condition can be approved for medical marijuana as long as a DC-licensed physician recommends the treatment. In addition, a number of other states will consider allowing medical marijuana to be used for the treatment of interstitial cystitis with the recommendation from a physician. These states include: California (any debilitating illness where the medical use of marijuana has been recommended by a physician), Connecticut (other medical conditions may be approved by the Department of Consumer Protection), Massachusetts (other conditions as determined in writing by a qualifying patient’s physician), Nevada (other conditions subject to approval), Oregon (other conditions subject to approval), Rhode Island (other conditions subject to approval), and Washington (any “terminal or debilitating condition”).

Several states have approved medical marijuana for treating “chronic pain,” which is a common symptom associated with interstitial cystitis. These states include: Alaska, Arizona, California, Colorado, Delaware, Hawaii, Maine, Maryland, Michigan, Montana, New Mexico, Ohio, Oregon, Pennsylvania, Rhode Island and Vermont. The states of Nevada, New Hampshire, North Dakota, Montana, Ohio and Vermont allow medical marijuana to treat “severe pain.” The states of Arkansas, Minnesota, Ohio, Pennsylvania and Washington have approved cannabis for the treatment of “intractable pain.”

Recent Studies on Cannabis’ Effect on Interstitial Cystitis
  • Regular THC and CBD treatments reduced pain that had proven intractable to other treatments in a 31-year old chronic cystitis patient.
    A case of cannabinoid rotation in a young woman with chronic cystitis.
    (http://www.ncbi.nlm.nih.gov/pubmed/12565180)

References

Brady, C.M., DasGupta, R., Dalton, C., Wiseman, O.J., Berkley, K.J., and Fowler, C.J. (2004, August). An open-label pilot study of cannabis-based extracts for bladder dysfunction in advanced multiple sclerosis. Multiple Sclerosis, 10(4), 425-33.

Freeman, R.M., Adekanmi, O., Waterfield, M.R., Waterfield, A.E., Wright, D., and Zajicek, J. (2006, November). The effect of cannabis on urge incontinence in patients with multiple sclerosis: a multicentre, randomised placebo-controlled trial (CAMS-LUTS). International Urogynecology Journal and Pelvic Floor Dysfunction, 17(6), 636-41.

Fullhause, C., Campeau, L., Sibaev, A., Storr, M., Hennenberg, M., Gratzke, C., Stief, C., Hedlund, P., and Andersson, K.-E. (2014, January). Bladder function in a cannabinoid receptor type 1 knockout mouse. BJU International, 113(1), 144-151.

Krenn, H., Daha, L.K., Oczenski, W., and Fitzgerald, R.D. (2003, January). A case of cannabinoid rotation in a young woman with chronic cystitis. Journal of Pain and Symptom Management, 25(1), 3-4.

Pertwee, R.G., and Fernando, S.R. (1996, August). Evidence for the presence of cannabinoid CB1 receptors in mouse urinary bladder. British Journal of Pharmacology, 118(8), 2053-8.

University of Pittsburgh Medical Center. (2006, May 21). Marijuana-derived Drug Suppresses Bladder Pain In Animal Models. ScienceDaily. Retrieved November 9, 2015 from www.sciencedaily.com/releases/2006/05/060521103039.htm

Wang, Z.-Y., Wang, P., & Bjorling, D. E. (2013). Activation of cannabinoid receptor 2 inhibits experimental cystitis. American Journal of Physiology – Regulatory, Integrative and Comparative Physiology, 304(10), R846–R853.

Wang, Z.-Y., Wang, P., and Bjorling, D.E. (2014, April). Treatment with a cannabinoid receptor 2 agonist decreases severity of established cystitis. The Journal of Urology, 191(4), 1153-1158.

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