What is Interstitial Cystitis?

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• Interstitial cystitis (IC) is characterized by chronic bladder pain and is usually accompanied by urinary frequency and urgency without the presence of bacteria in the urine.

• While there are many potential causative factors and diagnosis may be made based on symptoms alone, it seems that the condition is primarily the result of increased urothelial permeability due to the breakdown of the glycosaminoglycan layer that normally protects the deeper layers of the bladder wall.

• At this point, there is no definitive test to diagnose IC and it is diagnosed based on clinical symptoms.

• Cystoscopy may be performed and determine whether the condition is ulcerative or non-ulcerative. 5-10% of IC patients will be categorized as ulcerative and will present with Hunner’s ulcers, which are red, bleeding areas on the bladder wall. 90% of IC patients will be categorized as non-ulcerative and will present with pinpoint hemorrhages on the bladder wall called glomerulations. Glomerulations are not necessarily specific to IC and can show with any inflammation to the bladder.

 

Signs of Interstitial Cystitis

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• Often the signs that one has IC are identical to the signs that one has when they have a  urinary tract infection. This can lead to misdiagnosis and sometimes treatment with antibiotics when there is no bacterial infection.

• The signs of IC can be

  • bladder pressure or pain

  • burning sensation when urinating

  • increased frequency of urination

  • increased urgency

  • urethral pain

  • vaginal pain, or for men - pain in the scrotum, testicles, or penis

  • pain during sexual intercourse

  • pain or discomfort can be constant or it can come and go

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What causes Interstitial Cystitis?

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There are several theories of what causes IC. Individuals may have more than one underlying factor contributing to their condition.

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Increased urothelial permeability

• This theory is based on the idea that the integrity of the bladder wall has been compromised.

• There has been a breakdown of the protective glycosaminoglycan layer that makes up the mucosal membrane of the bladder.

• With the loss of this layer, urine comes in contact with the deeper layers of bladder causing irritation, inflammation, and stimulation of nerves.

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Pelvic Floor Hypertonicity

• Pelvic floor hypertonicity (increased tone) may cause referred bladder pain without any actual problem in the bladder itself.

• This appears to be the cause of IC in some people and should be considered especially when the bladder lining is normal in appearance.

• This should also be considered when therapies aimed at restoring the mucosal membrane layer of the bladder are not making a difference.

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Mast Cell Activation

• Activation of mast cells and subsequent release of histamine are known to contribute to bladder hypersensitivity and inflammation.

• Food sensitivities that increase gut permeability may cause immune reactivity in the bladder, including mast cell degranulation, release of histamine, and resulting inflammation.

• Foods that are high in histamine, or produce histamine, can also be contributing factors.

• This theory should be considered for people who have IC and also suffer from allergies, hives, urticaria, or other histamine-related conditions.

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Over-expression and Activity of Nerves

• It has been shown that some people with IC have a higher density of sympathetic nerves supplying the bladder. This can create hypersensitivity to stress signals.

• Substance P is a neuropeptide released from neurons that is involved with pain perception. Elevated levels have been associated with urinary frequency and urgency in IC.

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Infection Theory

• This theory is based on the idea that past urinary tract infections have led to chronic inflammation in the bladder wall that continues even after the infection has been cleared from the urine.

• This theory is also based on the idea that bacteria and other pathogenic microorganisms have become embedded in the bladder wall.

• These microorganisms may be causing symptoms without showing up in traditional urinalysis because they are embedded in the bladder wall.

• Newer types of genetic testing that are much more sensitive may be useful in some situations.

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Food Sensitivities and Autoimmunity

• There is a high correlation of people who have IC who also have food sensitivities and increased gut permeability.

• Increased gut permeability leads to an upregulation of the immune system and is an underlying factor in many autoimmune conditions.

• While IC has not been officially categorized as an autoimmune condition, people who have IC often have other autoimmune conditions and this should be considered as a possible underlying factor.

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Stress and IC

• It is frequently reported that IC symptoms worsen for people when under stress. This has been studied and demonstrated, especially for moderate to severe cases.

• Stress activates the sympathetic nervous system and this can worsen bladder pain and symptoms in a number of ways:

  • Some people with IC have a higher density of sympathetic nerves supplying the bladder, which can result in hypersensitivity to stress signals.

  • Sympathetic activity has also been shown to increase mast cell release of histamine, which leads to direct inflammation.

  • Sympathetic activation is associated with increases in the release of substance P from nerve cells. Substance P is involved in pain perception and elevated levels have been associated with urinary frequency and urgency in IC.

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How can herbs help?

• IC is not a one-size fits all condition. There are multiple underlying factors that may contribute to the symptoms of bladder pain, urinary frequency, and urgency. With that in mind, herbal support can look very different from one person to the next. There are a few herbs that may be helpful for most people with IC, but it is important to target your root cause when choosing herbs to support IC.

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• Some herbal actions that may be helpful are:

  • Demulcent

  • Mucosal membrane tonic

  • Antiallergic

  • Inflammation modulator

  • Immunomodulator

  • Adaptogen

  • Anodyne

  • Nervine

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• To learn more about several herbs that may be particularly useful for IC, see my blog post Top 5 Herbs for Interstitial Cystitis (that you might not have tried).

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