ICN Guest Lecture Series Transcript Draft
Title: Interstitial Cystitis and Yoga: Can it help?
Date: February 25, 2002
Speakers: Dr. Emmy Ripoll & Dawn Mahowald, CYI

(Jill O.) Welcome to the ICN Guest Lecture Series. My name is Jill Osborne and it is my pleasure to be your host and moderator tonight. I am the founder of the IC Network. One of our goals for this lecture series is to bring the nations best resources directly into the homes and offices of IC patients in need. We have welcomed many of the brightest researchers and physicians in the IC world. Tonight is no exception. We are delighted to welcome Dr. Emmy Ripoll & Dawn Mahowald, CYI to our lecture this evening. They are the authors of "CYSTITIS A Time to Heal with Yoga & Acupressure: An Eight Week Exercise Program with Special Information on Interstitial Cystitis & Urethral Syndrome" and the popular “The Hatha Yoga Video for People with IC.”

Dr. Emmy Ripoll is board certified in Urology and Holistic Medicine. She has been practicing Medical Acupuncture for 8 years and is certified in Structural Hatha Yoga. Her constant search for a better understanding of urological conditions has now led her to the study of Osteopathic manipulation and rehabilitation. She has authored over 25 scientific publications and is constantly trying to breech traditional medicine and complementary modalities in hopes to improve the quality of care to her patients. She currently practices Urology with the Fergus Falls Medical Group in Fergus Falls, MN.

Dawn Mahowald has over 40 years of experience with yoga and has been teaching for over 10. She is certified in Structural Hatha Yoga. Her personal experience with IC has led her to research yoga for the most effective and soothing exercise available in that field. At present Dawn teaches private classes in Boulder, Colorado for people with urological disorders including prostate disorders, incontinence, and interstitial cystitis.  In addition to her other works, Dawn is a co-author with Shar Lee, CYI of Yoga, A Manual for Two or More, Double’s Yoga, covering doubles yoga, published in 1998 by Kriya Yoga Publications.

Together Dawn and Emmey have created three other yoga exercise tapes for people with diabetes and simple stress urinary incontinence as well as one for prostate health.  They also have a book “Incontinence: A Time to Heal with Yoga and Acupressure” for people with simple stress urinary incontinence.

Tonight, they are here to discuss their innovative approach to rehabilitating IC patients.  Welcome ladies!

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(Jill O.) Its quite rare (and refreshing) to see a urologist who takes such a whole body approach to IC. Dr. Ripoll, could you describe your approach to treating IC?

[DRRIPOLL] My approach to IC is based in the understanding and the honoring of people’s individuality. The same way we all have different personalities we also have different biochemistries.  Another aspect to take into account is the fact that IC is also not a single disorder and the causes of it and its manifestations vary from person to person. Without looking at those differences, we are just using cookbook medicine, which can be beneficial in many patients but not all.

Also, I had a willingness to acknowledge my own limitations which led me to find other professionals who could provide help for my patients.  I feel that a strong partnership between patient and health care providers is of utmost importance and the realization that the patient is the only one who can truly heal themselves is critical; the rest of us are just coaches.

I realize I am being a bit vague about specific treatments but they do vary a lot from person to person. I will tell you that I always like to make sure that we rule out other bladder conditions and if the patient has not had a proper traditional evaluation, I will encourage the patient to do so. Then I will evaluate the patient and take a good history and try to find what has worked in the past and what hasn’t.

Then I will evaluate the patient and try to determine whether allergies, infectious agents, musculoskeletal conditions (such as SI joint dysfunction), pelvic floor dysfunction, etc. are present. We like to also check for bladder lining problems, environmental exposures, etc.

As you can see, people may have one or more of these conditions (usually most patients’ conditions are multifactorial) and unless we have a clear understanding of the components of the disease, it is hard to successfully help the patient.

(Jill O.) How did you begin working together???  Please share with us how you first became interested in developing a yoga program specifically for interstitial cystitis patients? Can you tell us about the classes that you taught? What hospital?? What were your goals and the results?

[DRRIPOLL] It was my frustration with the lack of success of traditional urology in the treatment of IC that made me look elsewhere. I am thankful to all the people who came to me looking for answers.  It was they  who gave me the motivation to expand my practice at every level.  Facing my own limitations and the ones of my profession, gave me the gift and the opportunity to learn from other traditions and to realize how much knowledge was out there, not all of it under the auspices of Urology.

As I became more conscious of the importance of the musculoskeletal system as primary or secondary source of IC, it forced me to look at modalities, which would help, heal and maintain the health of musculoskeletal system. Yoga seemed like the perfect candidate. I liked the gentleness of it, the lack of competition in it, and also the psycho emotional benefits from it.

It felt all encompassing as it addressed the physical and the emotional. It also was a good complement to physical therapy, osteopathy, chiropractic, acupuncture, and other structural modalities. I loved the fact that it could be done at home, giving patients control of their own healing and making them more self sufficient.

I was fortunate to find Dawn, a very experienced Yoga teacher with a special interest in IC. We taught our classes in Boulder Community Hospital over the course of several years giving us an opportunity to find out what worked and what didn’t. Also, we kept careful tract of the urinary symptoms in order to document objective improvements.  By the way, most patients reported both objective and subjective improvements.

(Jill O.) For newbies, can you share what the guiding principles of yoga are? Is it a relaxation method? Is it an exercise method? Is it both?

[DAWN MAHOWALD] Hatha Yoga (often referred to as “yoga”) is a 7000-year-old fitness science developed in India.  Hatha Yoga is a complete fitness art and is often used in India as medical tool to prevent illness, aid healing, induce relaxation, and reduce stress and its effects. Students of it gain physical strength, muscle tone, flexibility, stamina and endurance, plus relaxation and inner calm.

Yoga aims for balance in the mind, body and spirit.  The word yoga is Sanskrit for union or joining (like our word “yoke”).  The word ha means sun; tha means moon.  Thus Hatha Yoga joins and balances different emotional, mental and physical elements in a human being as symbolized by sun and moon

There’s nothing magical, mystical or religious about Hatha Yoga.  You don’t have to believe a thing to experience its benefits.  All you have to do is use your mind, body, and breathing to bring you into a state of balance and peacefulness coupled with physical strength and vitality.

The exercises in Hatha Yoga are called asanas – sometimes they are called poses, or postures.  There are about 84 basic poses and over 800,000 variations and combinations.  Asanas are believed by the people who have worked with them to affect the muscles, nerves and glands in the body; bathing them with fresh blood, massaging them, stretching them, and toning them.

Hatha Yoga differs from other exercise systems in these ways:

(1) It’s noncompetitive.

(2) It’s non-judging. You observe yourself in asanas, without criticism.

(3) It’s nonviolent. You never bounce, force, or allow pain.

(4) It’s mentally stimulating and fascinating as you explore stretching and your mind-body response to it.

(5) It’s FUN.

(6) You can start it at any age, and

(7) You can do it for the rest of your life.

The essence of doing Hatha Yoga is for you to be aware of how your body feels and responds as you are doing the asana.  The degree of physical flexibility achieved doesn’t determine your success in yoga, nor does the number of times you do an exercise or how long you hold a pose.  Success is measured by your inward attention to the body and mind in the poses.  ** Only by not straining or forcing does true progress in physical flexibility and strength come.**

Not straining or forcing is good advice for anyone who wants to do Hatha Yoga, but it is especially good advice for people who have Cystitis, Interstitial Cystitis, or Urethral Syndrome.  Many of us who have dealt with these disorders know that jumping into a new type of exercise program and pursuing it vigorously at the start can bring on an attack of the disorder. 

We may exercise strenuously and enthusiastically one day only to wake up the next day in severe pain.  The best way, with any new program, including yoga, is to start gently and build up gradually, take it easy.  And, never, ever, exercise beyond your means.

(Jill O.) How does Hatha Yoga specifically work as an exercise?

[DR RIPOLL] Hatha Yoga works by using the static stretch.  This means that you enter a pose with a slow, steady motion and then you hold it for as long as you are comfortable and breathing comfortably.  This doesn’t mean you can be lazy. You learn to “play your edge” between comfort and discomfort, always reaching as far as you can within our own comfort zone and never allowing pain.  Always, you are responsible for deciding how much you can or should do in yoga.

Hatha Yoga has recently come to the attention of western medical practitioners because of the vast array and range of exercises and its ability to help reduce feelings and effects of stress.  It also appears to be very helpful for people with IC, Urethral Syndrome, and Cystitis.  Hatha Yoga can help you to learn how to relax tense muscles, both pelvic floor and other muscles.  Feelings of stress, which often accompany chronic disorders, can greatly be reduced with regular Hatha Yoga practice.  Muscles can be toned and strengthened without sweating, bouncing, or running [1] .

(Jill O.) Briefly, what are the different types of yoga?

[DAWN MAHOWALD] There are many different types of yoga. Briefly, here are few of the more popular types of yoga available today:

ASHTANGA YOGA is a very aerobic type of yoga where one moves relatively quickly through a full range of asanas.   This is yoga where you can really work up a sweat as well as get and keep your heart rate up. It is a good type of yoga for a person who is relatively young and already in good health.  One of the better known teachers of this type of yoga is Richard Freeman.

BIKRAM YOGA was popularized by Bikram Choudry (India). This yoga is done in very warm rooms, 85-90 degrees.  Bikram states that since yoga was developed in hot climate, students will get more out of it by doing it in similar environment.  He further states that the heat of the room warms the muscles up (so there no need for warm-up exercises) and reduces the number of injuries (this has not been proven by any studies yet). It’s a good form of yoga for people who are already in good health.

CLASSICAL YOGA  was the first type of yoga brought to the US and Europe.  Popularized by Indra Devi (Eugiene Peterson), classical yoga concentrates on the main asanas used in India and uses very few “pre-yoga” or “warm-up” exercises.  This makes it a rather difficult form of yoga for the average American because of our physical lifestyle, bad backs, and general lack of flexibility.  It is good for people who already have some degree of flexibility and are in relatively good physical shape.  There are lots and lots of books and teachers of classical yoga.

IYENGAR YOGA concentrates on the alignment of the body and posture in the asanas (to help reduce injuries) while building flexibility and strength.  Iyengar was one the first teachers to present an organized outline of how Indian medicine used each of the yoga asanas for particular physical ailments.  While most Iyengar style classes would be too strenuous for someone with IC, some Iyengar trained teachers do work with people who have special issues (like IC) and do run special yoga therapy classes.  Lyengar trained yoga teachers for your area can be located by going to their association’s website at www.iyoga.com/ and searching on your area.

STRUCTURAL YOGA is an off-shoot of Iyengar and other forms of Yoga and was developed by an American physical therapist and yoga instructor, Tom Styles, PT.  He and other teachers like him have done a lot of work to help adapt the structural and alignment qualities of Iyengar yoga with many pre-yoga and Physical Therapy movements.  Their work has made it easier for the average westerner to work gradually and safely into the other types of yoga.  This is an excellent style for someone who is injured or is sick and is highly adaptable for people with IC (Dr. Ripoll and Dawn Mahowald are both certified to teach this type of yoga).

ACU-YOGA is a form of yoga which helps stimulate the Acupuncture Meridians and points from Chinese Medicine without using acupuncture needles (Dr. Ripoll and Dawn Mahowald are both well versed in Acu-Yoga).  This is an excellent style of yoga for people who are dealing with special issues (like IC).  A well known teacher in this area of yoga is Dr. Michael Reed Gach Ph.D.  You can find out more about him and his books and classes on the internet.

RESTORATIVE YOGA is an almost completely passive style of yoga.  Students are placed on various bolsters, pads, folded blankets, etc. and are completely supported in a pose.  This gives them the benefits of the pose without the effort of performing it.  This type of yoga is used very successfully with very ill people (HIV positive, MS, etc.).  It does have one drawback for people with IC and other forms of cystitis. Some of the postures can over-stretch pelvic or abdominal muscles and cause muscle spasms.  If someone with IC wants to try this type of yoga, we suggest you find a yoga teacher who is well trained in this type of yoga.  An excellent teacher in this area of yoga is Dr. Judith Lasiter, Ph.D.  You can find out more about her and her books and classes on the internet.

VINYASA YOGA or VINIYOGA is similar in some ways to Ashtanga in that the student moves from one posture to another fairly quickly.  However, the Vinyasa style is usually gentler and less strenuous than Ashtanga Yoga.  Some of the simpler, flowing sequences of Vinyasa Yoga can be tailored to people with IC.  One very well established teacher in this field of yoga is Gary Kraftsow.  You can find out more about him and his books and classes on the internet.

The above is just a sampling; there are many other types of yoga and many types of teachers.  If you want to do yoga, it is important you find one that works for you.

(Jill O.)  What approach do you specifically use with IC patients?

[DRRIPOLL] We use a combination of Acu- and Structural Yoga for our programs.  In our book, “Cystitis, A Time to Heal with Yoga and Acupressure” we present an eight Week set of classes for people with IC and other forms of cystitis.  The classes start out with very simple pre-yoga movements and asansas and as the weeks progress the exercises do too.  We encourage you to work at your own pace and often make suggestions on alternate poses if a new one might be too difficult for you.

We also have taken great care to use poses which are particularly good for people with the different forms of cystitis and the side effects of those different forms.  Many of the poses included are designed, according to Hatha Yoga theory, to improve the health and overall functioning of the bladder.  Others are for helping with low back pain, pelvic floor spasticity, and even some for helping to start and stop the flow urine more easily.

(Jill O.) How much has yoga helped your patients and students with IC and other forms of cystitis?

[DAWNMAHOWALD] In the classes we taught at Boulder Community Hospital, over 90% of our students felt that yoga helped with some or all or their symptoms and that it helped most when done consistently over a period of time.

Before we go any further, keep in mind the information we are presenting here is a combination of our opinions and observations as doctor and as yoga teachers as well as feedback (in the form of filled-out questionnaires) from our yoga students.  It is not based on formal, long-term, double blind studies backed up by secondary and tertiary research and therefore cannot yet be considered scientific or medical fact.

First, yoga will likely not cure either Cystitis or IC. However, over 90% of the students who answered our questions at the end of the eight week class said that yoga was helpful in reducing their symptoms, including: pelvic and abdominal pain, burning, pelvic floor spasticity, frequency, urgency, difficulty starting the flow of urine, and feelings of physical exhaustion and mental or emotional stress.  Many also said they had an easier time sleeping when they did yoga regularly.

The degree to which students thought yoga helped, varied from “some what” to “very much”.  And, when looking at specific symptoms, most students felt they were helped more in certain areas than in others.  For example, some had a large reduction in frequency, and a moderate decrease in urgency, and so on. 

Another question we get is, “If yoga is going to help me, how quickly will I see results?”  The answer seems to be, “It depends.”  A few students reported they saw some results after only a week’s worth of practice.  Most students, however, said that over a period of several weeks, they noticed a slow, gradual improvement or a “hills and valleys” pattern of improvement (some days better, some worse, but the general trend was towards better).

In informal follow-up conversations with those who have now done yoga for longer periods of time (1-5 years), many felt that it works even better over the longer term.

(Jill O.) What should people with IC look for when looking for a yoga class?

[DRRIPOLL] There are two things people with IC should always take into account when starting a new yoga program: finding the right class and the right teacher that work for them.

First, let’s talk about finding the right class.  It is important to match the class with your abilities.  For example, the best type of class for someone with serious IC is an extremely gentle, easy class like some of the ones taught for seniors or at senior centers.  If you have lower back difficulties in addition to IC, try a class specifically for people with low back disorders.  Do NOT do any exercise that put pressure on your bladder or which involve tightening pelvic floor muscles. 

Now, let’s talk about teachers.  Places to start looking for both teachers and classes can include, the yellow pages, local health clubs, schools, recreation centers, hospitals, doctor’s offices, HMO’s, bulletin boards at work, at church, or in health food stores, newspaper ads, the internet, yoga magazines, professional yoga teachers associations, and any other places you can think of.  You can also ask friends, health care providers, or local physical education teachers.

Once you find a teacher, try to contact them by phone or go to their class and arrange a time to talk with them. Remember, there are many types of yoga teachers: specialists, generalists, those with many years of experience, new ones, some with a religious approach, and some with a secular approach.  So, set your preferences and questions up beforehand and don’t feel discouraged if you don’t find a match right away.

A. When you do get a chance to talk with a teacher here are some questions you can ask them:

B. What kind of classes do they teach, beginning or more difficult?  Beginning, easy classes are usually better to start with.

C. What is their background in yoga?

D. Do they have training? 

E. How long have they been teaching?  For people with chronic disorders, it is usually better to pick a teacher who has over 5 years or more of direct teaching experience and some form of training.  There are even some teachers trained specifically in yoga therapy.

F. Do they know what your needs are, or, since many forms of chronic cystitis are not very well known, are they willing to learn what your needs are?  Some teachers may not be able to accommodate you.  They may have contractual obligations to the organization they work with, or the needs of the other students they teach may conflict with your needs.

G. How large are their classes or do they teach privately?  Smaller classes, 10 or less, are usually better for people with chronic disorders.  You may also want to consider a couple of private classes to get you started, then later join a group class.

H. Are they willing to give references or can you talk to some of their students?

I. Most teachers will gladly talk with you and, if they are not the right person, will give you leads to other teachers.  Again, don’t feel discouraged if you don’t find what you want on the first try.  Take your time and find a teacher and class that work for you.  It will pay off in the long run.

(Jill O.) Is there anything that an IC patient shouldn't do?

[DMAHOWALD] There are some poses and types of Hatha Yoga a person with chronic Cystitis or IC should avoid, either because they may irritate the bladder or because they stimulate the meridians incorrectly for a person with these disorders.  However, if the Cystitis or IC go into remission the poses are fine. These include:

- Headstand and Headstand variations which put the entire weight of the body on the top of the head or require the tightening of the pelvic floor muscles.

- Full Shoulder Stand and variations which cause tightening of the pelvic floor muscles.

- Breathing exercises where the stomach muscles are forcefully pulled in (i.e., Kapalabhati and Bhastrika).

- Breathing Exercises done lying on back with weights on the abdomen.

- Nauli or Stomach Churning.

- Lower body muscular contractions, locks, or bhandhas (i.e., Uddiyana, Asphenia, and Moola) if they cause pain.

- Sun Salutation Series (can sometimes be okay for people with IC, try carefully).

- Standing or Sitting Forward Bends that put pressure on the abdomen or parts of the abdomen (i.e., Forward Bends with legs or one leg in the lotus position, etc.).

- Twists that put pressure on the abdomen.

- Triangle Poses (some people find these helpful; try and see).

- Yoga done in very warm or hot rooms (Bikram style).

- Intense Ashtanga or Aerobic Yoga (if you like moving yoga, try a more gentle Vinyasa style Yoga).

- Water Yoga (if chlorine irritates your bladder).

- Any pose which you feel makes your symptoms worse.

(Jill O.) What common mistakes do IC patients make?

[DRRIPOLL] By far, the biggest mistake people make is diving, full tilt, into an exercise program and not allowing for their own specific needs.  If you have IC it is always better to start slowly and gently and always pay attention to how your body is responding to the exercise.  There is often much pressure to “work thru the pain” or follow the “no pain, no gain” exercise philosophy and this can be a disaster for anyone with chronic cystitis or IC.

The second most common mistake they make is not listening to their own instincts and body.  So many times we have had the feedback, “Even though I had done the exercise before and was fine with it, I just knew I shouldn’t have done it that day.  But, everyone else was doing it, so I did it, and I felt terrible the next day…..”

(Jill O.) We know that many IC patients struggle with muscle spasms and/or muscle pain, thus making exercise difficult.  What must IC patients be careful of when attempting a new yoga program?

[DMAHOWALD] There are two specific mistakes we see with IC patients is that they (like most people new to yoga) try too hard to stretch and often end up over-stretching themselves and they tend to hold the poses for too long.  Our advice is to always err on the side of caution.  If you know you can touch your shins, work gradually over a period of weeks or months to try to touch your toes, don’t try to get there right away. 

Or, if you know you can stay in a pose for five complete breaths and still be breathing lightly, don’t try for ten breaths, try 5 1/2.

(Jill O.) If a patient is in a flare and feeling uncomfortable, is yoga safe to do?

[DRRIPOLL] Yes, if they do the very, very gentle types of exercises, asanas and basic deep breathing.  It can even help to reduce the pain.  As always, however, it is critical to only work to capacity and never allow the exercise to exacerbate the pain.

(Jill O.) Can a patient use yoga to help reduce the effects of a flare?

[DMAHOWALD] Absolutely.  During a flare we often recommend the very gentle, beginning poses, the deep breathing exercises, and the resting poses included in our book, “Yoga, a Time to Heal with Yoga and Acupressure”. 

(Jill O.) Are there any daily tips that you can share that can help patients on a daily basis?

[DRRIPOLL] Yes! When you try any of the suggestions below, give them a fair try.  And, if you try any of the complementary therapies, remember that most people notice improvements after several treatments, not just one (up to several months).  Also, keep a bladder dairy and record your alternative sessions that can really help you track success.

- The first is to urinate in the natural position once a day (i.e. urinate while squatting over a bed pan – nighttime is usually best for this as your leg, back, and feet muscles are at their most flexible out at this time).

(Jill O.) Why do it this way?

[DAWNMAHOWALD] Urinating in the natural position is squatting down to urinate (like we do when we are on a hike in the woods and nature calls).  This position stretches the pelvic floor muscles and helps to support the muscles which push waste out of the body. Also, from a acupressure point of view it massages the bladder meridian and helps to restore proper function to the bladder.  From a Physical Therapy point of view, the squatting position helps to put the muscles of the pelvic floor back into proper alignment.

(Jill O.) More daily tips?

[DRRIPOLL]- Try making these changes to your diet:  Increase the amount of liquid you drink.  Eat fresh foods which are freshly prepared as much as possible instead of pre-packaged or preserved foods. Yoga feels that food is just as important in the treatment of cystitis as exercise, so it recommends that one avoid the following foods: alcoholic beverages, coffee and tea (even decaffeinated), medicines with caffeine, carbonated beverages and soft drinks of all kinds, aged cheeses (fresh are okay), sour cream, citrus juices and fruits, citric acid or products with citric acid in them, other highly acidic fruits and their juices vitamin C supplements (buffered may be okay), sourdough breads, meats which contain nitrates or nitrites, vinegar or products with vinegar in them, soy sauce, tomatoes and tomato products, spicy foods (i.e. hot like chili or cinnamon), white sugar, corn syrup, and artificial sweeteners, nuts, chocolate, MSG, onions, garlic, preserved foods (including frozen, canned, or pickled), food colorings and artificial ingredients, foods you are allergic to.

- Stop smoking! Void regularly; do not try to “hold it”. Void urine before and after sexual intercourse. Wear loose clothing & loose cotton or silk underwear or no underwear. Avoid recreational drugs. Try other complementary therapies, such as biofeedback, chiropractic treatments, homeopathy, pain clinics, Qi Gong, prayer, meditation, stress reduction techniques, and anything else that catches your interest.

- Consider working with a Physical Therapist familiar with pelvic floor trigger points.  These points can help release pelvic floor tension.

- Get checked for allergies. Foods, perfumes, chemicals, detergents, additives, or even your own urine can contribute to or cause problems.  Take showers or chemical-free warm water baths.  Avoid bubble baths and hot tubs.

[DAWNMAHOWALD]- Regular sleep is a critical factor in healing.  If you are having trouble with any part of the sleep cycle, or you no longer have a sleep cycle because of cystitis or IC, consider getting a set of the Gandharva Veda music CD’s ($108 US) or tapes ($70 US) from www.mapi.com .  They are worth every cent you will pay.  The Gandharva Veda music has been researched and used in India for, literally thousands of years, to help people regain and maintain normal body bio-rhythms. 

Our students and patients have had enormous success with this type of music both in improving the quality and duration of their sleep. There are eight volumes to a set and each volume is designed to be played at a specific time of day.   They will not cure cystitis, but almost every one we have ever recommended them to has felt that they are a marvelous complementary sleep aid.

- Consider gradually removing as many chemical pollutants from your life as you can.  A good book on this subject is Non-toxic, Natural, & Earthwise by D. L. Dadd.  If your body does not have to fight excess chemicals it will have more energy for healing.

(Jill O.) Can you recommend any web sites that would help patients learn more about yoga?

[DMAHOWALD] The following sites are quite good:

www.yogajournal.com

www.yimag.org

www.yogasite.com

www.will-harris.com/yoga

The first two are websites for two of the most popular yoga magazines in the US; they are loaded with information.  The third is good general information site.  And the last is good site for people working in an office who would like to take a quick stretch during the day; it is fun site with some great little stretches to try.   (If you have a bad back, go easy on the side stretches and forward bends.)

(Jill O.) What resources do you have to share?

 [DRRIPOLL] Our book, Cystitis, A Time to Heal with Yoga and Acupressure is now available from www.1stbooks.com (you can search by title or either of our names).  It contains the 8-week yoga course we taught so successfully at Boulder Community Hospital in Boulder, CO. 

There is even an inexpensive e-book (electronic book) version of it available for people with Cystitis or IC who are on disability.  It is an excellent resource because you can use it on your own, in a group, or even take it to a local yoga teacher and have them help you with a personalized plan.

The IC Network also sells our video tape “The Hatha Yoga Program for People with Interstitial Cystitis”.  This tape is a direct result of our classes also and works well for people who have light to moderately severe cases of IC.  It contains a three part program (very beginning, beginning, and intermediate exercises) for people with IC (the exercises also help with other forms of cystitis, but the tape is really targeted to IC).

We also just launched our website; cystitis-and-yoga.com.  It is still a small website, but has links to get our book and video.  We hope over the next year to build it up and add more features.

Also, Dawn Mahowald and Dr. Ripoll will be offering week long “IC Lifestyle” retreats this summer in beautiful Breckenridge, Colorado.  These retreats will feature analysis and treatments by professionals in the fields of Acupuncture and Chinese Medicine, Ayurveda, Physical Therapy, Lifestyle Counseling, Therapeutic Massage, Western Medicine and more for each participant. 

There will also be classes in yoga, diet, and more. All meals and lodging will be provided. There will be a Urologist in attendance every day and plenty of time to enjoy the beautiful Rocky Mountain scenery and outdoor activities.  Each retreat will be limited to no more than six participants, so that each participant has ample access to the best our team has to offer. 

The dates of the sessions for 2003 are:  July 20-26, August 17-23, and September 21-27.

The cost for a week long retreat is $2,799 ($2,499 if you register 8 weeks before the session starts).

For more information contact us at info@yogamed.net or watch our website over the next 2-3 weeks.

(Jill O.) Dawn, you're currently working on a new book for cystitis patients.  Can you tell us about that?

[DAWN MAHOWALD] Actually, both Dr. Ripoll and I are working on it together.  It is called, “Interstitial Cystitis, A Time to Heal with Ayurveda”.  My personal path to management and healing of IC was through Ayurveda (the classical medicine of India).   I was so impressed by its ability to tie in so many different aspects of life and apply them towards healing, I decided to study it myself (I’m very close to getting my certification in Ayurvedic Education).  Last year we started the book and expect to have it to the publisher in late summer of this year.

------------- Audience Questions -------------------

[audience member] Dr. Ripoll! Do you feel that yoga and a gentle movement program would be beneficial for her and do you have any other suggestions for Hunner’s ulcers patients.

[DRRIPOLL] Although patients with Hunner’s ulcers seem to have more severe symptoms, gentle yoga can still be of great help for them. Other treatments that can be very helpful can be addressing the lining of the bladder with a bladder coating, alkalinizing their urine, treating against allergies by doing N.A.E.T treatments for foods and for the urine itself. Also the relaxation of the pelvic floor which is often experienced with yoga will facilitate bladder emptying and therefore cut down on bladder irritability and exposure of the ulcers to noxious urine
 
[audience member] You mention what foods we should avoid but what food that are tasty are beneficial to our IC  health and well being?

[DAWNM] That is great question! However, it is too long to answer here.  We are going to address that subject extensively in our new book on IC and Ayurveda, due out in the fall or winter of this year
 
[audience member] You recommend a combination of Acu-Structural Yoga for people with IC. But, how about Restorative Yoga for people with illnesses such as MS? What if the patient has both MS and IC? What would you suggest then?

[DAWNM] That is an excellent question.  We would recommend the restorative yoga over any others. The most important thing is to get a really well trained yoga therapist to work with.  Don’t forget to educate your therapist on IC; most therapists are aware of the constraints of patients with MS, but not necessarily those for patients with IC.

[audience member] What about foot message?

[DRRIPOLL] Foot massages can be a form of acupressure and reflexology. Both can be very powerful treatments.  Additionally, for the foot massage, Ayurveda would recommend that the massage be done with sesame oil to help calm and soothe the nervous system.

[audience member] What about acupressure in comparison with yoga... any comments???

[DAWNM] Both are excellent.  Our exercises are actually a combination of both. Yoga has the benefit of providing exercise. Acupressure treatments, in addition to helping with both symptoms and causes, can also give the patients the feeling of well-being.  Acupressure is extremely powerful technique which is not exclusive with yoga. As a matter of fact many yoga postures work because they massage or stimulate certain meridians and acupressure points.  And, many of the meridian exercises prescribed by acupuncturists are identical to yoga exercises.

[audience member] I know the food question was to broad but why is sugar such a no no?  That’s the hardest thing for me to give up.

[DAWNM] Ayurveda views sucrose or plain table sugar as a non-natural product and non-natural products  are not considered to be as good for us as more natural ones such as fruit sugars, honey, etc.  Ayurveda also does not really recommend corn based sugars, like corn syrup, either.  If you really feel you need something sweet try a little date sugar or maple syrup/sugar.

[DRRIPOLL] Sugar will inhibit proper function of the acupuncture meridian called the Spleen Meridian. The Spleen Meridian is responsible for helping people hold the urine and decrease frequency and nocturia. That is one of the reasons why in Chinese medicine refined sugar products will be discouraged.

[audience member] Dr. Ripoll, Do western meds, such as elmiron, ditropan, pyridium, and pain meds, with all their side effects get in the way of natural healing?

[DRRIPOLL] Both western medicine and complementary medicine are very helpful and not mutually exclusive. I believe you can do both and can benefit from both. It is often helpful to find somebody who can help you with both. That’s one of the reasons why I like the term complementary rather than alternative medicine.

[audience member] Can those of us who can't physically do the Yoga moves still benefit from its breathing techniques alone?

[DAWNM] Yes, yes, and yes!  A very good book on the subject is Light on Pranayama by BKS Iyengar.  Also, get a teacher trained in pranayama (breathing exercises) to help you - breathing exercises, beyond the basic deep breathing and alternate nostril breath can also be harmful if not done properly.

[audience member] Being a male diagnosed with IC, do you feel your techniques work well for us to?

[DRRIPOLL] Many men who suffer from IC often have a strong component of pelvic floor dysfunction and can benefit very nicely from yoga.  In my experience, men who undergo pelvic floor rehab with both yoga and PT are able to void better with better streams and less pain associated with intercourse

[audience member] Can we just learn the yoga from your video or must we take a class?

[DAWNM] You can always learn by yourself from books (I did it for years).  However, a teacher can open doors a book could never do because they are there with you and see everything you are doing and can help you with their insights.

[audience member] Speaking of intercourse are their yoga exercises that help with the pain associated with sex and IC?

[DAWNM] We have never addressed that in our classes or surveys, however in theory anything that helps to relax both the pelvic floor and the mental state of the person with IC is supposed to help with intercourse also.
 
[audience member] I have been wondering why when I urinate, it burns and I get chill bumps just after I’m done

[DRRIPOLL] A burning sensation can often be related to pelvic floor spasms, which can also then generate a more systemic reaction including goose bumps. Other people experience sweats and other systemic reactions
 
[audience member] What about the use of hot tubs - any negatives to that?  I also have many inflammatory issues that would be served well by the use of a hot tub.

[DRRIPOLL] Hot tubs are usually not a great idea for people with serious IC; the chemicals can be very irritating.  We recommend instead a warm to hot bath with no chemicals in it (get a chlorine filter for the tub, they are often available at health food stores).  You also could use 1/3 cup baking soda in the bath.

[audience member] How much time a day or week is needed to get benefits from the Yoga for our IC?
 
[DAWNM] It would be really helpful if you could do yoga exercises three to six times a week (you need at least one day a week off).  The amount of time you spend in each session depends how much time you have and, most importantly, how you are feeling.  In my experience, even 15 minutes of yoga a day can help anyone who does it.
 
[audience member] Is smoking really bad for IC?

[DAWNM] From the Ayurvedic point of view, smoking can be a root cause of IC in some people and a strong irritant for others.  Ayurveda recomends that anyone with IC quit smoking as soon as possible.

[DRRIPOLL] From the Western point of view smoking is the number one cause of bladder cancer. It is a powerful irritant and can aggravate IC.  I also recommend that anyone with IC quit immediately.

[audience member] I have heard so many great things about the effects on acupuncture for people with IC.....How would you rate Yoga against acupuncture?
 
[DRRIPOLL] Yoga and acupuncture are complementary and synergistic. They both address different issues. In my opinion they should be done concurrently.

----------- Questions End --------------

Contact Information –

Dr. Emmey A. Ripoll, MD,
Fergus Falls, MN Medical Group
615 S. Mill St.
Fergus Falls, MN 56537
1-800-247-1066

Dawn R. Mahowald, CYI,
1890 Lehigh St.
Boulder, CO 80305
1-303-499-7350

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