Interstitial Cystitis Part Two: Treating the Root Cause

Lara Spector
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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
905 276-6800
laraspector.nd@gmail.com


Interstitial Cystitis A Naturopathic Approach



Introduction

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:

  1. Inflammation and dysfunction of the bladder epithelium (associated with mast-cell activation and glycosaminoglycan (GAG) insufficiency) [1]
  2. Urine acidity [2]
  3. Arylalkylamine sensitivity [3]
  4. Infection [2]

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.


Treatment Considerations

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 person.


Key Therapies for Each Key Factor Interstitial Cystitis A Naturopathic Approach
  1. Inflammation and Dysfunction of the Bladder Epithelium
  2. Inflammation plays a key role in interstitial cystitis, and bladder-wall permeability is a hallmark of approximately 80% of cases of IC.[4] 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.[3]

    Diet.Dietary modification is standard IC therapy and is geared towards an antiinflammatory nature.[5] 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.[6] Quercetin was discussed in the previous article as a powerful flavonoid that inhibits activation of mast cells and has anti-inflammatory properties.[7]

  3. Urine Acidity
  4. Interstitial Cystitis A Naturopathic Approach

    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 bladder wall.[4]

    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.[8]

  5. Arylalkylamine Sensitivity
  6. 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.[9] 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 wall.

  7. Infection
  8. Interstitial Cystitis A Naturopathic Approach

    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.[10]

    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 bladder epithelium.[10]


Conclusion

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.