Interstitial Cystitis Part Two: Treating the Root Cause
by Lara Spector, ND
Natura Wellness Clinic
3885 Duke of York Blvd. Suite 211
Mississauga, ON L5B 0E4
As described in my first article, interstitial cystitis (IC), also known as painful
bladder syndrome, is a chronic inflammatory condition associated with usually a long
history of discomfort and/or pain in the bladder. Other symptoms may include increased
urinary frequency, urgency, and pressure in the pelvic region. The purpose of this article
is to review the key factors contributing to IC as well as evidence-based therapies that
address each of these contributing factors.
The etiology of IC is multifactorial and the following are key physical factors when
addressing the condition:
- Inflammation and dysfunction of the bladder epithelium (associated with mast-cell
activation and glycosaminoglycan (GAG) insufficiency) 
- Urine acidity 
- Arylalkylamine sensitivity 
- Infection 
It is also very important to address the psychological factors of IC, for example stress.
Stress is a key contributing factor to IC, which was addressed in the first article.
It is important to note that no single pathological process is universally present in
patients with IC. When treating a patient with IC, it is helpful to remember two guiding
principles of naturopathic medicine: identify and treat the causes, and treat the whole
Key Therapies for Each Key Factor
- Inflammation and Dysfunction of the Bladder Epithelium
Inflammation plays a key role in interstitial cystitis, and bladder-wall permeability is a
hallmark of approximately 80% of cases of IC. Bladder epithelium thinning, erosion,
and increased infiltration of mast cells are characteristics of IC-bladder biopsy samples.
The first layer of the bladder destroyed by these inflammatory processes is the
glycosaminoglycan (GAG) layer, which acts as the barrier between the bladder wall
tissues and the urine.
Diet.Dietary modification is standard IC therapy and is geared towards an antiinflammatory
nature. Often a food/symptom/voiding diary is essential in discovering
potential triggers and eliminating them. For some, avoiding inflammatory foods such as
gluten, dairy, and sugar can be a great start, in addition to avoiding irritating IC foods
as described below in the Acidity section. Another option is an IgG test to determine
immune-mediated food sensitivities.
Glucosamine Sulfate and Quercetin.Glucosamine sulfate is a precursor for the
GAG layer, and thus may provide usable substrates to aid in the healing of the bladder
wall. One study demonstrated beneficial effects using Pentosan polysulfate, which
contained quercetin and glycosaminoglycan precursors. Quercetin was discussed in
the previous article as a powerful flavonoid that inhibits activation of mast cells and has
- Urine Acidity
Diet.Studies have shown a relationship between acidic, urine-producing foods or liquids
with an increase in IC symptoms. The most common trigger foods and beverages are
alcohol, carbonated drinks, citrus fruits, tomato-based products, coffee, and chocolate.
In addition, a steady intake of water will help to dilute urine and reduce irritation of the
Potassium Citrate or Baking Soda.In addition to dietary modifications, consuming
alkalinizing agents such as potassium citrate or baking soda may be useful at increasing
the urinary pH and alleviating symptoms.
- Arylalkylamine Sensitivity
Diet.Arylalkylamine-containing foods (tryptophan, tyramine, and phenylalaline) have
been shown to exacerbate IC symptoms and include the following foods and beverages:
bananas, beer, cheese, mayonnaise, aspartame, nuts, onions, raisins, sour cream,
wine, and yogurt. Avoiding these foods, in addition to acidic and inflammatory foods,
can be therapeutic in alleviating symptoms of IC and allowing for healing of the bladder
Uva Ursi.Some cases of IC are associated with recurring bacterial infections, a
condition known as chronic bacterial cystitis. Uva ursi is one of the most-commonly
used antimicrobial herbs for urinary tract infections. It has been shown to significantly
reduce urinary symptoms associated with infection. It is important to note that for
optimal results, this herb should be taken when the urinary pH is at least 8, as its
antimicrobial effects require an alkaline pH in the urine.
Bushu.This herb has a long history of use in urinary tract infections. It has antimicrobial
effects and has a specific affinity for the urinary tract, where it can soothe inflamed
Interstitial cystitis is a multifactorial condition and, as mentioned in the article, no single
pathological process is present universally in patients with IC. It is thus important to
determine the root causes of the individual’s symptoms, which commonly include
bladder-wall dysfunction and permeability, urine acidity, and infection. Addressing
the root causes with specific, evidence-based naturopathic modalities—such as diet
modifications, herbs, supplementation of key nutrients, and lifestyle counselling—can
bring relief to the IC patient.