Why is interstitial cystitis (IC)/bladder pain syndrome (BPS) so difficult to treat?The underlying cause of interstitial cystitis/bladder pain syndrome is not clear and may be different depending on the individual. Multiple factors may be involved including:
- Chronic bacterial infections
- Autoimmune conditions
- Allergic reactions and excess mast-cell activation (which causes histamine release)
- Exposure to irritating elements or toxins
- Food reactions
- Psychosomatic (mind-body) factors
- Chronic inflammation
- Bladder trauma
- Disruption of the bladder’s GAG (glycosaminoglycans)/proteoglycan layer
- Pelvic floor dysfunction
What are the symptoms of interstitial cystitis (IC)/bladder pain syndrome (BPS)?
- Discomfort, increased bladder pressure and pain that often gets worse as the bladder fills
- Pain can be in the bladder, urethra, vulva, vagina, male genitalia, rectum or lower back
- Increased urgency and/or frequency with urination (up to 30 times per day in some cases!)
- Worsening of symptoms associated with sexual intercourse or vaginal penetration
- For many women, pain is worse during menstruation
- About 5-10% of interstitial cystitis (IC)/bladder pain syndrome (BPS) cases present with ulcers (called Hunner’s ulcers) and bleeding in the bladder
How is interstitial cystitis (IC)/bladder pain syndrome (BPS) diagnosed?Interstitial cystitis (IC)/bladder pain syndrome (BPS) tends to be a diagnosis of exclusion. It’s critical to differentiate chronic UTI (urinary tract infection) from interstitial cystitis (IC)/bladder pain syndrome (BPS). Your doctor should take a comprehensive patient history and order testing to rule out infections, neurological disorders, kidney stones, cancer, endometriosis, pelvic masses, prostate enlargement and other structural abnormalities.
Interstitial cystitis (IC)/bladder pain syndrome (BPS) is often associated with other conditions.The majority of the patients I’ve seen with IC/BPS had other chronic health concerns. Studies have shown that autoimmune and other conditions such as Sjögren’s, systemic lupus erythematosus (SLE), inflammatory bowel disease (Crohn’s and ulcerative colitis), allergies, irritable bowel syndrome (IBS), chronic fatigue, sleep disorders, chronic migraine and fibromyalgia are more common among people with interstitial cystitis/bladder pain syndrome than in the general population. The presence of allergies in IC/BPS patients has been estimated at 40-80% of those with the condition. It’s likely that interstitial cystitis (IC)/bladder pain syndrome (BPS) shares many of the same underlying inflammatory and immune challenges seen in these other disorders.
How do you treat interstitial cystitis (IC)/bladder pain syndrome (BPS)?Because there are multiple factors to consider in the underlying cause of IC/BPS, there is no “one size fits all approach.” The American Urological Association (AUA) has recommended a step-wise approach to treating interstitial cystitis (IC)/bladder pain syndrome (BPS).
- First-line treatment includes education, self-care, behavior modifications and stress management.
- Second-line treatment may include physical therapy, pain management and medications. These medications may be given orally or inserted directly into the bladder using a catheter (intravesical therapy).
- Third-line treatment may include cytoscopy with hydrodistention or treatment of Hunner’s lesions with laser, electrocautery (burning) and/or injections. Cytoscopy is the insertion of a small tube through your urethra so that the doctor can see the inside of your bladder. During hydrodistention, the doctor fills the bladder to a high pressure state with fluid in order to see any abnormalities associated with interstitial cystitis.
- Fourth-line treatment may include Botox injections or neurostimulation. Neurostimulation involves surgically inserting a small device into the body. The device sends out mild electrical signals that “compete” with the pain signals traveling between the spinal cord and the brain.
- Fifth-line treatment is Cyclosporine (an immune-suppressing drug).
- Sixth-line treatment includes major surgery.
- Mental and Emotional Health: There is a clear connection between the health of the mind and body. Relaxation techniques and stress management are recognized as an important component of managing IC/BPS symptoms.
- Sleep: Sleep quality and quantity are important for overall health and healing. Poor sleep patterns and lack of melatonin may play a role in interstitial cystitis (IC)/bladder pain syndrome (BPS).
- Diet: Many interstitial cystitis (IC)/bladder pain syndrome (BPS) sufferers find that certain foods and beverages, especially acidic foods, can be a trigger. Consuming a whole-foods diet while avoiding refined, sugary and processed foods is important for decreasing inflammation. Consuming collagen-rich foods such as bone broth or collagen powder can provide precursors to glycosaminoglycan (GAG) formation and may support reduced bladder permeability and healing. Some people may benefit from an Autoimmune Paleo (AIP) diet or low histamine diet. I’ve also found food sensitivity testing to be helpful in identifying trigger foods for my patients.
- Activity: Exercise and activity that is appropriate for your current level of health can reduce inflammation and support overall health.
- Nutritional Status: Vitamin D is the most common nutrient deficiency I find in practice. It plays a very important role in immune function and overall health. Vitamin D deficiency has also been linked with pelvic floor disorders. Other vitamin and mineral deficiencies can contribute to poor health and immune function. My favorite test to check for nutrient deficiencies is the micronutrient test by SpectraCell Laboratories.
- Gastrointestinal Health: It is estimated that humans have about 2.5-5 lbs of symbiotic bacteria, fungi, viruses and parasites in our digestive tract that play a crucial role in our immune function and overall health. Infections or imbalances in these microbes can be a chronic source of inflammation and immune stimulation that can contribute to autoimmunity. In practice, I use the DNA-based stool test from Diagnostic Solutions Lab to assess for infections, gastrointestinal immune function and digestion.
- Hydration: People with interstitial cystitis (IC)/bladder pain syndrome (BPS) may be tempted to limit their fluid intake to decrease their frequency of urination. However, adequate hydration is important for overall health and helps to dilute irritants and toxins in the urine. Adequate fluid intake is also important for preventing urinary tract infections and constipation which can make symptoms of interstitial cystitis (IC)/bladder pain syndrome (BPS) worse. I’ve also had patients report significant benefit from drinking alkaline water.
- Environmental Exposures: Compounds such as mold, pollen and chemical exposures can lead to allergies and an increase in mast cells and histamine. Several studies have shown a link with elevated mast cells and histamine in interstitial cystitis (IC)/bladder pain syndrome (BPS). Overall, there is agreement that mast cells play a role in pain syndromes including interstitial cystitis (IC)/bladder pain syndrome (BPS). Given the high number of IC/BPS patients with allergies and other immune challenges, addressing environmental factors is an important aspect of treatment.
- Structural Integrity: Tight pelvic floor muscles are often a component of IC/BPS. Physical therapies like myofascial therapy and acupuncture can be helpful for muscle relaxation and decreasing pain.
- Genetics: There are multiple genetic variants or SNPs (single nucleotide polymorphisms) including MTHFR, DAO, MAO, HNMT and PEMT that can lead to excess histamine and potential aggravation of interstitial cystitis (IC)/bladder pain syndrome (BPS). Optimizing your nutrients and managing stress can support better histamine balance. Dr. Ben Lynch has written a great article about histamine intolerance, methylation and MTHFR.
- Treating the Whole Person: As mentioned previously, interstitial cystitis (IC)/bladder pain syndrome (BPS) is often associated with other conditions or health challenges. Naturopathic doctors typically spend 90 minutes or more in their new patient visits to really understand and address all of the factors that contribute to a person’s state of health.
Additional natural strategies for interstitial cystitis (IC)/bladder pain syndrome (BPS) include:
- Mast cell stabilizers such as quercetin and buffered vitamin C (non-citrus source) can help decrease histamine release.
- Urtica dioica (stinging nettles) can be helpful due to anti-inflammatory and antihistamine properties.
- Calcium glycerophosphate is a mineral complex that can be used to buffer acidic foods. This is best for occasional use. Long-term use is not recommended because it can decrease stomach acid and compromise digestion.
- Demulcent herbs can help protect and soothe the bladder lining: Althaea officinalis (marshmallow…the root, NOT the candy! 🙂 ), Zea mays (corn silk), Avena sativa (oatstraw), Ulmus rubra (slippery elm) and Aloe vera.
- Essential fatty acids such as fish oil can support healthy cell membranes and decreased inflammation.
- Anti-spasmodic herbs can help with pain relief.
- Probiotics and immunoglobulins for improved GI health and immunity.
- DAO (diamine oxidase) enzymes to help break down histamine.
Final MessageIf you’re suffering from interstitial cystitis or bladder pain, please know that you can get better. Symptoms are your body’s way of telling you that something in your life is out of balance. There are multiple causes of this painful condition, and it will take some detective work to uncover the reasons why you’re having these symptoms.
Do you suffer from interstitial cystitis or bladder pain? What have you tried that has helped you? Comment below!
The naturopathic doctors (NDs) at Attune Functional Medicine proudly serve the Denver metro area including Broomfield, Boulder, Arvada, Louisville, Thornton, Lafayette, Westminster, and Erie. Telehealth is also available for long-distance care.