Top 5 Herbs for Interstitial Cystitis (that you might not have tried)

Interstitial Cystitis (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.


The following list is by no means comprehensive, but it highlights some herbs that are specific to different root causes of IC.


Baikal Skullcap (Scutellaria baicalensis) and Histamine Response


Is this herb for me?


You may want to consider Baikal skullcap if you are prone to seasonal allergies, suffer from multiple food sensitivities, and are sensitive to foods that are high in histamine. Baikal skullcap has been used in Chinese medicine for over 2000 years, including for inflammation and respiratory infections (Zhao Q, 2016).


How does it work?


Activation of mast cells and subsequent release of histamine are known to contribute to bladder hypersensitivity and inflammation (Shan H, 2019). In vitro and animal studies have shown that flavonoids found in Baikal skullcap, such as baicalin, inhibit the release of histamine by mast cells and demonstrate antiallergic activity (Bone, 2003). A study that screened over 2000 herbs looking for those that blockade histamine release found Baikal skullcap was one of the 2 most influential herbs (Kim D-S, 2010). In combination with a low-histamine diet, herbs and supplements that stabilize mast cells can modulate the allergic response to reduce mast cell degranulation and subsequent histamine release.


How to use it:


The part of Scutellaria baicalensis that is used is the root. The easiest way to ingest it is by liquid extract (tincture) or capsule.

  • Tincture: If using a liquid extract, the dosage can range from 1-9mls per day, depending on whether using for maintenance or an acute flare. Liquid extracts are usually made in an alcohol base, so for those who have bladders that react to alcohol, it may be better to use a capsule.

  • Capsules: There are many encapsulated products available on the market which can be taken as recommended on the label or as directed by an experienced herbalist. Products will vary in strength, so dosages will vary as well.


Kava (Piper methysticum) and Pain

Is this herb for me?


During an IC flare due to any cause, or for IC that is thought to be caused by nerve compression or abnormal neurological activity kava can be extremely useful. There is a long history of its use to reduce pain in the urinary tract, including by early 20th century Eclectic physicians specifically for this purpose (Yarnell, 2019).


How does it work?

  1. Anesthetic effect: Kava has an anesthetic (pain reducing) effect topically. If you have ever tried kava and then felt that your throat was numb, you experienced the direct anesthetic effects of this plant. I have witnessed that it can be very effective in reducing acute oral pain as well, such as when applied to an abscessed tooth in need of dental work. When the constituents of kava move through the urinary tract, they will have this same numbing effect on the bladder.

  2. GABA activity: In addition to a direct numbing activity, another way that kava may be helpful is by promoting GABA activity. Many people have heard about how GABA can help to reduce anxiety, but lesser known is that there are GABA receptors on mast cells. Mast cells contain histamine and play a major role in allergies. When GABA receptors on mast cells are activated, there is an inhibitory effect which stabilizes the mast cells, which in turn reduces histamine release. In this way, kava may be modulating both inflammation and the immune system.

  3. Cannabinoid receptor activity: Lastly, one of the kavalactones found in Kava has been shown to bind to cannabinoid receptors, and it is likely that other kavalactones do as well. There are cannabinoid receptors in the bladder that when activated may reduce urinary pain, reduce nerve impulses to urinary muscles, and exert a relaxing effect on the bladder (Stansbury, 2018). Kava relaxes the pelvic floor (Yarnell, 2019) making it a good choice for those who have pelvic floor hypertonicity as a root cause.

How to use it:

  • Tincture: If using liquid extract (tincture), take 1-3ml 3x/day.

  • Capsules: If using capsules, take 500-1000mg 3x/day.

  • Tea: If making kava tea, there are lots of ways to do it, but one known rule is that it should not be made with boiling water which will destroy the kavalactones. Here is one simple tea recipe: Add 3 Tbsp of powdered root per cup of cold or lukewarm liquid, steeped in a muslin bag for 10 minutes, then the muslin bag should be squeezed thoroughly. The liquid could be just water, but since kavalactones are fat-soluble it is best to have 1/3 of the liquid be something that contains fat, such as coconut milk.


Ashwagandha (Withania somnifera) and Stress


Is this herb for me?


If you are aware that stress influences the frequency and severity of your bladder symptoms, an adaptogen to modulate the stress response could be helpful. There are lots of herbs with adaptogenic activity, so finding the right one for you is important and can take time. Working with an experienced herbalist can help narrow down which adaptogen would be most helpful.


I chose to highlight ashwagandha because it is both an adaptogen and a nervous system relaxant. Many people who have IC exhibit anxiety. And having IC, itself, can contribute to both stress and anxiety. Ashwagandha is relaxing, anxiolytic, helps with sleep, and modulates the adrenal stress response.


How does it work?


It has frequently been reported that stress can exacerbate symptoms of IC, and this has been studied and demonstrated, especially for moderate to severe cases of IC (Rothrock N E, 2001). When we are under stress, our sympathetic nervous system gets activated. This can worsen bladder pain and symptoms in a number of ways.

  1. Nerve hypersensitivity: It has been shown that some people with IC have a higher density of sympathetic nerves supplying the bladder, which results in hypersensitivity to stress signals (Robbins M T, 2008).

  2. Histamine release: Sympathetic activity has been shown to increase mast cell release of histamine, which leads to direct inflammation (Robbins M T, 2008).

  3. Substance P: Sympathetic activation is associated with increases in the release of substance P from nerve cells (Robbins M T, 2008). Substance P is involved in pain perception and elevated levels have been associated with urinary frequency and urgency in IC (Houck C, 2010).

How to use it:


Ashwagandha can be taken in a variety of ways. The therapeutic dosage is generally 3-6 grams daily, and it is best taken for at least 1 month before assessing results.

  • Capules: If taking caps, I recommend pure ashwagandha powder in a veggie cap. There is no need to choose a standardized extract or a product with any extra ingredients. I usually recommend 1500mg twice daily, though some people need less, and some people need more.

  • Powder: If using as a powder, it can be mixed into liquid and drunk, or mixed into food and eaten. A traditional Ayurvedic preparation involves warming the powder in milk as a nighttime sleep aid. Try this with almond milk or coconut milk and add a bit of cinnamon for a yummy bedtime treat. Another yummy way to take ashwagandha is to mix it into homemade nut butter balls.

  • Tea: If using cut & sift ashwagandha, it can be made into a tea. Since it is a root, bring it to a boil and simmer for 20 minutes, then strain and drink. It blends well with cinnamon and licorice and is more palatable as part of a blend than all by itself.


Marshmallow (Althaea officinalis) and Mucosal Membrane Soothing

Is this herb for me?


Marshmallow is supportive for most people who have IC. It is a gentle herb and can be used daily to soothe and support the healing of the mucosal membrane of the bladder. If your bladder feels irritated and inflamed, there is a good chance that marshmallow will help. But If you are experiencing an acute flare, anything can be irritating, so it is best to start slowly.


How does it work?


Marshmallow is in the malvaceae plant family, and all the plants in this family have the distinction of being mucilaginous. Okra is in this family, for example, and is the original ingredient used to thicken gumbo soup.


So, why is mucilage good for an irritated bladder? In healthy bladders, the mucosal membrane that protects the bladder wall is covered in a mucous-like layer made of GAGs (glycoaminoglycans). A contributing factor in IC is the breakdown of this protective GAG layer which allows substances to penetrate deeper into the bladder wall and cause inflammation. The demulcent action of marshmallow is achieved by the expansion of mucilage polysaccharides as they absorb moisture, swell, and form a gel that is soothing and healing to mucosal membranes.


How to use it:


Marshmallow root is most effective when taken in the form of a tea made with cold water or a powder mixed into water.

  • Tea: If using cut & sift marshmallow root, create a thick cold infusion by steeping 6 heaping tablespoons in a quart of cold water overnight. Strain the tea in the morning and drink cold, or gently warm in a pot on a stove.

  • Powder: If using marshmallow root powder, add 1.5 tablespoons to 3 cups of water. Mix together and drink. I find the easiest way to mix the powder into water is to use a blender. It just takes a moment and then I have a pleasant frothy drink to sip on throughout the day.


Licorice (Glycyrrhiza glabra) (Glycyrrhiza uralensis) and Mucosal Membrane Healing

Is this herb for me?


Licorice can be found in many herbal formulations that are aimed to soothe and heal the mucosal membranes of the body, including the bladder. It is well known to have healing effects on both gastric and duodenal ulcers in the GI tract. While licorice will likely be soothing and healing for most cases of IC, it may be particularly useful in cases where bladder ulcerations have been detected, though there is no specific research on this to date.


How does it work?


Researchers believe that licorice enhances blood flow to the mucosal membrane and increases the mucus production, thereby allowing tissue to regenerate and heal. The ability of licorice to increase mucus production by epithelial cells appears to occur in a number of places that epithelial tissues are found, including the bladder (Braun, 2015). Additionally, licorice is considered an anti-inflammatory of the highest order, acting in numerous ways to modulate inflammation. This activity further contributes to the symptomatic relief it can provide, notwithstanding all the other myriad ways that licorice may be supportive to physiology.


Cautions:


A variety of side-effects, cautions, and interactions exist for licorice. Side effects of elevated blood pressure and fluid retention are possible when used in high doses for more than 2 weeks (Braun, 2015). Licorice is also contraindicated with a number of medications and medical conditions. The DGL form of licorice, where the glycyrrhizin has been removed, has fewer side effects and contraindications. Please consult with a trained herbalist or health care provider.


How to use it:


Licorice can be taken in a variety of ways; as tea, liquid extract (tincture), powder, or in the form of DGL (deglycyrrhizinated licorice).

  • Powder & Tea: The dosage for whole root, whether as powder or tea can range from 2-15g daily. For acute inflammation a high dose used for 1-3 days may be therapeutic, but for daily use, it is best to use lower doses to avoid side effects.

  • Tinctures range in strength and should be taken according to label instructions or according to the direction of a trained herbalist or health care provider.

  • DGL tablets tend to be 300-400mg per tablet and are recommended to be taken before meals for digestive support. The dose used clinically to heal duodenal ulcers was higher, but high doses should be monitored by a trained herbalist or health care provider.


References

  • Bone, K. (2003). A clinical guide to blending liquid herbs: Herbal formulations for the individual patient. St. Louis, MO: Elsevier Churchill Livingstone.

  • Braun, L. &. (2015). Herbs & natural supplements: An evidence-based guide, 4th edition. Australia: Churchill Livingstone.

  • Houck C, S. A.-H. (2010). Measurement of urinary substance P as an indicator of bladder hyperreactivity after ureteral reimplantation in children. The Journal of Pain, 11(4), S6. Retrieved from https://www.jpain.org/article/S1526-5900(10)00046-5/fulltext

  • Kim D-S, S. E.-J.-M.-B.-S. (2010). Antiallergic Herbal Composition from Scutellaria baicalensis and Phyllostachys edulis. Planta Med, 76(7), 678-682. Retrieved from https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0029-1240649?device=desktop&innerWidth=412&offsetWidth=412

  • Robbins M T, D. J. (2008, Aug 15). Chronic Psychological Stress Enhances Nociceptive Processing in the Urinary Bladder in High-Anxiety Rats. Physiol Behav., 91(5), 544-550. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2084207/

  • Rothrock N E, L. S. (2001, Mar). Stress and symptoms in patients with interstitial cystitis: a life stress model. Urology, 57(3), 422-1. Retrieved from https://pubmed.ncbi.nlm.nih.gov/11248609/

  • Shan H, Z. E.-W.-D. (2019). Differential expression of histamine receptors in the bladder wall tissues of patients with bladder pain syndrome/interstitial cystitis – significance in the responsiveness to antihistamine treatment and disease symptoms. BMC Urol, 19(115), 1-6. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6852726/pdf/12894_2019_Article_548.pdf

  • Stansbury, J. (2018). Herbal Formulas for Health Professionals; Digestion and Elimination (Vol. 1). White River Junction, VT: Chelsea Green Publishing.

  • Yarnell, E. (2019). Natural Approach to Urology (Second ed.). London: Aeon Books Ltd.

  • Zhao Q, C. X.-Y. (2016). Scutellaria baicalensis, the golden herb from the garden of Chinese medicinal plants. Sci Bull (Beijing), 61(18), 1391-1398. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5031759/


About me:


My name is Jillian Bar-av and I am a registered herbalist and licensed nutritionist who works with busy women to help them have the energy to do what they love. I specialize in conditions that affect the reproductive system and urinary tract, such as PCOS and Interstitial Cystitis. I believe that it takes healthy people to create a healthy planet, and I want to make a difference for both.


For more information, to sign up for my newsletter, or to book an appointment, go to: www.greenspringherbs.com



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