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 suffer from IC, and those estimates may be under diagnosed, meaning that even more women are suffering than are reported.

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 the root causes and treating those roots via 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 would 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 causative 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 suffer from 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 would be a great 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 excellent 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 would still be beneficial to test specific food sensitivities in these individuals for a more personalized treatment plan. KBMO Diagnostics' FIT 132 panel is a great option.

Lupus

Because of the correlation to autoimmunity, specifically SLE, a thorough workup for SLE would be helpful. BioReference Laboratories offers a Lupus Antibody Panel (SLE) measuring 11 markers associated with SLE and would be beneficial to rule out the diagnosis.

Functional Medicine Treatment for Interstitial Cystitis

While the exact cause of interstitial Cystitis still isn't known, many factors likely contribute. Functional Medicine practitioners focus on lowering systemic inflammation and supporting bladder health with nutrition and herbs.

Nutrition

Reducing autoimmune manifestation in 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) has been shown to be quite beneficial.

The gut microbiome, as well as the urinary microbiome, can be improved by the inclusion of both a probiotic as well as a prebiotic supplement. Probiotics of the following strains are beneficial to 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 a good idea 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 should all be avoided or at least significantly reduced in the diet.  

Because food sensitivities are so common in those with IC, reducing one's food sensitivities is essential. 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 may be a great choice in combating the infections and the pain associated with them. A blend of Chinese herbs may be beneficial, specifically since many herbs contain natural antimicrobial functions. Research has tested the herbs Cornus, gardenia, curculigo, rhubarb, Psoralea, and Rehmannia in a tea. 83% of patients trying this tea for IC symptoms saw a reduction in pain.

Pharmacological studies (in vitro and in vivo) have shown corn silk to have remarkable bioactivities as an antioxidant and as an effective diuretic agent. These make it helpful in treating symptoms of IC.

Other therapies that may help symptomatically are aloe vera (by replenishing the mucus layer in the bladder wall that may have been irritated by sensitivities) and quercetin (which decreases inflammation and pain).

Summary

Interstitial Cystitis (IC) is a chronic pain disorder that is unfortunately not fully understood. Diagnosis is difficult, even in a conventional setting, and treatment options are minimal. A condition like this is a perfect candidate for functional medicine because when utilizing a more comprehensive approach through thorough testing, we can often discover some root causes that may go undetected in the conventional model.

Functional Medicine also gives us more treatment tools. Diet and lifestyle changes can make a massive difference in significantly decreasing symptoms and possibly reversing some root causes of IC in the first place.