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Cystitis The Traditional Osteopathic Perspective

a brief synopsis of the condition

Howard Beardmore, August 2007

From a traditional osteopathic perspective irritation of the bladder is not 'caused' by infection with a microorganism but primarily by mechanical pressure upon the bladder, commonly from disposition of the uterus.

The urge to urinate is reflex from pressure sensors in the bladder, if this was caused by increased urine production the volume of urine would be great and it very often is not. The symptoms of frequent urges to urinate commonly associated with scant, cloudy urine therefore point to a more reflex, external factor. The continual desire to urinate sets up a secondary irritation in the ureters and this, if left unaddressed, starts a cascade of events that can lead to the irritation tracking back up to the kidneys. This of course can interfer with the function of the kidney and lead to serious constitutional consequences.

The suspensory ligaments of the uterus render the uterus potentially unstable in the upright or sitting posture, that is top heavy with regard to its centre of gravity making it vulnerable to anti flexion (falling forwards) or the counter movement of anti version (falling backwards). This may be why many patients report relief of symptoms by lying down because this would cause the uterus to fall backwards, off the bladder.

If the spine of the patient in the optimum position has three arches at rest the tendency for the uterus to malposition is less likely. Most of the cases that I have seen of long-term chronic cystitis have either flat lumbar spines or hyper flexed or torsional lesion patterns to the pelvis.

Osteopathic etiology

So when the patient presents with this distressing condition and a history of regular suppressive medication it is important to explain there is a real reason why this condition occurs and that it is not down to 'bad luck' or uncleanliness. If the patient is used to certain triggers like drinking alcohol, intercourse, or attacks during menstruation etc then it is natural for the patient to be potentially fearful of these activities.

It is a huge relief for many to understand that not only can they do something about it but also that it is also possible to break the cycle without recourse to regular suppressive, symptomatic interventions. Intervention early enough can completely abort the pathway to kidney involvement.

Traditional osteopathic practice is concerned with the resting state of the spine and pelvis and treatment is directed to correlate and improve the arch mechanics. The patient is instructed that should an attack occur whilst in a treatment program that there are positions that she can get into to relieve the pressure on the bladder and therefore gain confidence that the maintaining factors can be addressed.

Other maintaining factors

Other factors that seem to be common are use of the contraceptive pill and this may be because the continual unrelieved congestion often present adds 'weight' to the already vulnerable uterus. I have always found that it is nigh on impossible to resolve a case of cystitis when the patient continues to take the pill whilst undergoing treatment.

One way to prove this is for the patient to take a break from the pill whilst undergoing treatment and once the case has resolved and not reoccurred for a period of 3 months if they wish to start again it is their choice. Then if the cystitis returns, usually at the next menstrual event the patient can make an informed choice to stop using this method of contraception.

Hydrotherapy applications

Kellogg gives various hydrotherapy applications that can assist the acute phases and mentions the avoidance of cold immersions of the trunk, legs and feet, as they tend to produce tonic contractions of the bladder and increase the visceral circulation.

Again I would add that a prescriptive list of palliative methods is not appropriate without treatment to correct maintaining factors and no different in effect to the orthodox approach to treatment.

Identifying maintaining factors

The key to a successful result relies on identifying the maintaining factors that are leading to the irritation and correcting those rather than attempting to moderate the effect. Areas to assess include:

  1. Perversions in spinal mechanics that may lead to the uterus tipping forwards and pressing on the bladder. This may be an extended lumbar arch that not only upsets the position of the uterus it also drops the diaphragm leading to a general ptosis (prolapse) of the abdominal contents.
  2. Hormonal contraceptive medications that may cause a twisting reaction in the pelvis due to prolonged artificial stagnation of the uterus. This effectively increases the density of the uterus because waste (venous) blood is heavier than arterial blood. As the uterus is generally on the right hand side the centre of gravity of the body follows suit and the common pattern is to find that the pelvis has side shifted to the right, effectively underneath the uterus to support it.
  3. Excesses of diet, alcohol, late nights and generally enervating activity will always amplify the likelihood of an acute phase and should largely be avoided at these times.
  4. Increasing the amount of unprocessed food particularly the juicing of salvesterol rich leafy greens will always help build a reserve of alkali that increases the ability of the body to neutralise the build up of acidity as part of a general health programme.
  5. Avoid snacking on starchy processed food as this increases the likelihood of visceral ptosis (prolapse) and drains the nutrient reserve. Excess refined sugar also congests the liver and the consequent increase in density produces reactive torsions in the pelvis. This destabilises the support of the uterus. An excellent book by Dian Shepperton Mills called 'curing endometriosis through diet' is an excellent uterine health book and is recommended reading for a wider explaination of why processed food is non nutrient for a wide variety of gynilogical conditions.

Integration, not isolation with regard to treatment

Correcting the spinal mechanical disturbances requires a practitioner who understands the principles of traditional osteopathic technique and not an approach that seeks to manipulate areas both viscerally and mechanically in isolation. The key is to integrate the mechanics, not palliate segmental perversions by just gapping the stiff joints, or mobilising contractured soft tissue with short levers and high velocity thrusting.

As an empirical observation, at rest the spine and sacrum should present with four distinct arches, only then are the mechanics said to be in the neutral position. If we take this as an optimum against which to gauge the presentation of the patient, the 'lesion' pattern relevant to that patient can be clearly seen. The maintaining factors that have led to the condition will be different in every case, there may be more common patterns in some cases but success does not come by being 'prescriptive' about treating conditions.

The 'perversions' from the neutral position must be judged in context as a complete lesion and not a set of isolated, segmental malpositions that require 'correcting'. Unwinding the pattern as a whole is the key to understanding the curative approach.

All too commonly these days there are more practitioners learning to think in a reductionist way, using the 'tissues causing symptoms' approach. You cannot use the thinking process of one discipline and the technique of another and call it wholeism. A good analogy is to imagine a builder of wooden ships being asked to make a metal boat using the tools of his trade.

Treat the context not the condition

In cystitis the 'bit that hurts' does not require treatment, but the environmental context that has led to the symptoms, encompassing a symbiosis of at least mechanics, physiology and proximate principles; that is usually asymptomatic, often does. In short I have never treated anyone for cystitis by attempting to treat the bladder!