Interstitial Cystitis (IC) is a chronic pain syndrome affecting the bladder and pelvic area. It is also sometimes referred to as Bladder Pain Syndrome. It is a condition that is still poorly understood and hard to pinpoint and diagnose. Estimates state that approximately 3.3 to 7.9 million women ages 18 and older may experience IC, and those estimates may be underreported, meaning that even more women might be affected than are documented.
While many more women are affected than men (a ratio of women to men with this condition is estimated to be 5:1), men can also be diagnosed with this condition. It's hard to distinguish the symptoms of IC in men, and many are misdiagnosed with prostate inflammation, so it is possible that more men have IC but have not been properly diagnosed.
Severity can range from mild to very severe and even debilitating. A functional medicine approach to Interstitial Cystitis includes looking into potential contributing factors and addressing them through a holistic approach and lifestyle management.
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What Causes Interstitial Cystitis
The causes of Interstitial Cystitis are not fully understood or well defined. Much research has been done to understand this condition better. Below is an overview of a few research areas practitioners focus on.
Bladder Infections
According to some research, undiagnosed bladder infections may be an underlying factor. Similarly to how chronic gastritis is linked to an H. Pylori infection, there may be an infectious agent within the bladder epithelium that has not yet been discovered. There is also a possibility that a known bladder infection lingers after treatment and causes post-infection inflammation, which could lead to uncomfortable symptoms.
Urinary Microbiome
Many know of the gut microbiome, but fewer have heard that there is also a urinary microbiome living within our bladder. A dysbiosis, or disruption of this microbiome, may be a contributing factor for IC. However, research about this is still minimal, yet more is being done.
Histamine
Histamine is a chemical found in cells that are released during an allergic reaction. While more research is needed to determine an actual cause-and-effect phenomenon between allergies, histamine, and IC, a correlation has been suggested.
Food Sensitivities
Food Sensitivities are currently a known correlation with IC but have not yet been concluded to be a definite cause. Research shows that 90% of those with IC report food sensitivities. So, it is an avenue that more researchers should explore to gain more concrete evidence.
Lupus
Patients who experience Systemic Lupus Erythematosus (SLE) also have a 2-5x higher incidence of IC. Sometimes a rare form of IC, known as Lupus Cystitis, can precede the diagnosis of Lupus (SLE).
Interstitial Cystitis Signs & Symptoms
Signs and symptoms of IC can resemble those of a Urinary Tract Infection. However, in IC, there is typically no active infection involved. Severity can vary for each individual. Symptoms include:
- Urgent feeling to urinate throughout the day
- Frequent urination during the day and night, although only small amounts of urine come out.
- Pain in the pelvic and perineum area, often chronic
- Pain or discomfort when the bladder is filling with urine followed by relief after urination
- Pain during sex
- Pressure or tenderness over the bladder area
- Increased symptoms during stress
How is Interstitial Cystitis Diagnosed?
Interstitial Cystitis is challenging to diagnose, and even conventional medicine struggles to find definitive diagnostic tests. Often, IC is the result of a diagnosis based on exclusion, meaning other diagnoses are typically ruled out first.
A Urinalysis is usually the first tool to rule out urinary infections. If a urinalysis constantly returns negative for pathogens after weeks or months of symptoms, then IC may be diagnosed.
More invasive procedures may also be used. For example, a biopsy of the bladder or urethra may be performed to rule out bladder cancer. Another procedure is called a cystoscopy, where a small scope is placed inside the bladder for better visualization.
Functional Medicine Labs to Test For Root Cause of Interstitial Cystitis
Functional Medicine may be able to offer other avenues to testing and diagnosing that conventional medicine currently doesn't explore.
Bladder Infections
A Urinary Tract Infection (UTI) can have the same symptoms as IC, so it should be ruled out via a Urinalysis. Although unconfirmed, because there is a suspicion that chronic unresolved infections could be associated with IC, this is another reason why a Urinalysis would be helpful. Access Medical Laboratories offers a Urinalysis with Reflex to Culture, which could be a useful option.
Urinary Microbiome
Testing the urinary microbiome is not something that is easily done at this point. However, there are many great tests for analyzing the gut microbiome. And research shows that there is a connection between the gut microbiome and the urinary microbiome. The GI360 Microbiome Stool Test from Doctor's Data is an option for assessing the health and microbial makeup of the gut and urinary tract.
Histamine
Histamine is released during allergic responses and may be associated with IC. Measuring histamine in the blood, available through Access Medical Laboratories, can help determine whether there is an overabundance of histamine in the body.
Food Sensitivities
Food Sensitivities were noted in the large majority of those with IC. While research is currently only able to prove a correlation and not a causation, it might still be beneficial to test specific food sensitivities in these individuals for a more personalized management plan. KBMO Diagnostics' FIT 132 panel is an option.
Lupus
Because of the correlation to autoimmunity, specifically SLE, a thorough workup for SLE might be helpful. BioReference Laboratories offers a Lupus Antibody Panel (SLE) measuring 11 markers associated with SLE and could be beneficial to rule out the diagnosis.
Functional Medicine Approaches for Interstitial Cystitis
While the exact cause of interstitial Cystitis still isn't known, many factors likely contribute. Functional Medicine practitioners focus on supporting overall bladder health and well-being with nutrition and herbs.
Nutrition
For those with SLE and IC, a diet rich in whole grains, fruits, vegetables, fish, cold-pressed oil, sea salt (instead of table salt), and maple syrup (instead of refined sugar) may be beneficial.
The gut microbiome, as well as the urinary microbiome, can be supported by the inclusion of both a probiotic as well as a prebiotic supplement. Probiotics of the following strains may support a healthy microbiome: lactic acid bacteria, bifidobacteria, enterococci, Bacillus spp., and the beneficial yeast Saccharomyces boulardii. Prebiotics are the fuel that feeds beneficial bacteria and yeast and includes fructooligosaccharides (FOS), galactooligosaccharides, lactulose, and inulin.
Low histamine diets may also be worth considering since there is a correlation between histamine and IC symptoms. There are several versions of a low histamine diet. However, a few foods were noted across the board as histamine aggravators, including fermented foods and other high histamine foods such as processed or smoked meats, shellfish, alcohol, and dried fruit - these might be avoided or at least significantly reduced in the diet.
Because food sensitivities are so common in those with IC, addressing one's food sensitivities is important. However, if testing is not feasible, research has shown that the following foods are commonly associated with sensitivity in those with IC and are a great start when looking towards doing an elimination diet: citrus fruits, tomatoes, coffee, tea, carbonated and alcoholic beverages, spicy foods, artificial sweeteners, and vitamin C.
Herbs & Supplements
Bladder infections may be related to IC, and herbs might be a choice in managing the infections and the discomfort associated with them. A blend of Chinese herbs may be beneficial, specifically since many herbs contain natural antimicrobial properties. Research has tested the herbs Cornus, gardenia, curculigo, rhubarb, Psoralea, and Rehmannia in a tea. 83% of patients trying this tea for IC symptoms reported a reduction in discomfort.
Pharmacological studies (in vitro and in vivo) have shown corn silk to have notable bioactivities as an antioxidant and as an effective diuretic agent. These may make it helpful in managing symptoms of IC.
Other therapies that might help symptomatically are aloe vera (by supporting the mucus layer in the bladder wall that may have been irritated by sensitivities) and quercetin (which may help manage inflammation and discomfort).
Summary
Interstitial Cystitis (IC) is a chronic pain disorder that is unfortunately not fully understood. Diagnosis is difficult, even in a conventional setting, and management options are minimal. A condition like this is a candidate for functional medicine because when utilizing a more comprehensive approach through thorough testing, we can often explore some contributing factors that may go undetected in the conventional model.
Functional Medicine also provides more tools for supporting health. Diet and lifestyle changes can make a significant difference in managing symptoms and possibly addressing some contributing factors of IC.
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