Genomics: A Novel Solution for Chronic Bladder Pain
By Ibby Omole
Doctor of Naturopathic Medicine
For ten solid years, I ate foods that negatively affected my health although I believed they were good for me and I was convinced I was doing something great for my body. The kicker was that as a naturopathic doctor, I wasn’t even aware that these foods were having a negative effect on my health.
If you are suffering from Interstitial Cystitis, you might be going through the same phenomenon. Interstitial Cystitis (IC) also known as Bladder Pain Syndrome (BPS) or Chronic Pelvic Pain Syndrome (CPPS), is a chronic condition that affects the bladder and surrounding structures such as the pelvic floor, uterus, rectum, vulva and urethra. It is a frustrating condition to have because the cause of this condition is largely unknown and contributing factors to having it can range from pelvic floor dysfunction, genetics, bladder wall trauma, systemic pain disorders, allergies, gynecological disorders, systemic neurosensitivity disorder, inflammation to viral infection. To complicate matters more, it can take up to 8 years of being symptomatic before diagnosis is finally made or suggested.
There are five subtypes of IC as proposed by Dr. Christopher Payne:
- IC: Hunner’s Lesions: This affects approximately 10% of the IC population who present with pinpoint bleeding lesions on their bladder wall
- BPS: Bladder Wall Phenotype: These are common in patients whose symptoms start after an injury to their bladder wall. The injury can be due to diet, bladder infection, chemical exposure or chemotherapy. There might be more pain with bladder filling and relief when the bladder is emptied. Estrogen might have a role to play in this subtype.
- BPS: Myofascial Pain Phenotype: Patients in this category often have a history of sports, orthopedic injuries or trauma in childbirth. They tend to have a more hypertonic pelvic floor tone and may also present with trigger points in their pelvis, abdomen, hips, buttocks and back. They may not have as many food-related sensitivities and might do better with pelvic floor physiotherapy.
- BPS: Neuralgia Phenotype: This is more common in patients that have a combination of pelvic floor hypertonicity and pudendal nerve compression. Patients in this category will present more with neurological sensations such as severe burning and shooting pains, which may not necessarily be linked to bladder symptoms.
- Chronic Overlapping Pain Disorders/Central Sensitization: Patients in this category usually present with multiple body pains and sensitivities. They may also have fibromyalgia, Irritable bowel syndrome, vulvodynia, food sensitivities and chemical sensitivities. Individuals in this category are in a state of sympathetic overdrive and may be experiencing neurological wind-up.
As a naturopathic doctor, I have noticed that a significant proportion of treatment approaches tend to focus primarily on the bladder while oftentimes ignoring other contributing factors. This care model in essence fails a lot of patients and leaves them isolated and despondent. What works for one IC patient may not work for another. This is because each IC patient is an individual and the reasons for developing IC is unique for each person.
However, what if there was a way to tease out some of the underlying causes of IC that cannot be identified via blood/urine samples or imaging? What if there was a way to be more targeted with solutions for IC symptoms? This is where the field of genomics comes in.
Genomics is the study of a person’s genetics and the interaction between genes and the environment. It offers a way to find out underlying predispositions to having certain food sensitivities/allergies, inflammation, autoimmunity, HPA (Hypothalamic Pituitary Adrenal) dysregulation, hormonal imbalances and sleep dysregulation. It can serve as a viable and helpful piece of the IC puzzle because it helps to narrow down not only the cause but also treatment direction so valuable time and resources are not wasted.
Remember in the beginning when I talked about eating the wrong foods? Through doing my own genomics, I discovered that a significant portion of my health issues were due to histamine sensitivity and inflammation that I wasn’t aware of. While I had been gluten and dairy free for years, I didn’t even consider being histamine intolerant, but I was eating on a daily basis a very highly histaminergic diet which was filled with healthy foods such as avocados, bananas, kiwis, kombucha, kim chi, sauerkraut, cashews and walnuts. Shocker, right!? By addressing my health predispositions through the lens of genomics, my allergies have since improved, my sleep is better, my joint pain is non-existent and I feel better overall in general despite my very busy and full life.
A one-size-fits-all approach to this condition is not viable or helpful. While there is currently no cure for IC, it can be managed and people who live with it can lead a better quality of life. As a practitioner, genomics offers a new and exciting way to help people make their healthcare less complicated and more personalized.
Dr. Ibby Omole is a licensed naturopathic physician and registered acupuncturist. She has 13 years of experience treating bladder and pelvic health issues. She was previously core faculty at Boucher Institute of Naturopathic Medicine in BC, but now maintains a virtual online practice. Learn more about her at www.driomole.com.