The Gut Bladder Connection
By Ibby Omole
Doctor of Naturopathic Medicine
What is IC/BPS?
Interstitial Cystitis (IC)/Bladder Pain Syndrome (BPS) is a painful bladder condition that affects approximately 3-8 million women in the United States and between 300-800,000 women in Canada. IC affects women of all ethnicities, socioeconomic backgrounds, ages and stages of reproductive development.
It is a condition that develops gradually and can worsen over time. One study showed that approximately 21% of patients started showing bladder symptoms as early as 10 years of age. IC symptoms are very similar to that of a UTI. For this reason, the condition is often misdiagnosed. It is important to know that IC is not an infection even though the symptoms might feel like an infection. By the time most women get a diagnosis, they would have been experiencing symptoms for approximately 8 years.
How do I know if I have IC?
Classic IC symptoms are experienced as chronic pain that is felt in the pelvic organs (bladder, uterus, vagina, rectum), pelvic floor muscle or external genitalia. In addition to pain, people experience urinary symptoms such as urgency, frequency, incontinence and nocturia (getting up to pee in the middle of the night). For some people, the pain is worse when the bladder is filling but improves after urinating. However, this is not true for everyone with some individuals experiencing pain after urination. Bladder symptoms may come and go for some, while others get minimal relief from the pain/discomfort.
IC triggers include sex, diet, stress and high-impact exercises such as running. It is a condition that can affect multiple organs, not just the bladder.
Non-bladder conditions such as fibromyalgia, chronic fatigue syndrome (CFS), anxiety disorders, migraine, Sjogren’s disease and irritable bowel syndrome (IBS) have been known to co-exist with IC. A 12-year study published last year showed that IBS increases the risk of IC/BPS. This bolsters the theory that IBS may lay the groundwork for the development of IC.
The Gut Bladder Connection
Similarly to IC, IBS is a chronic condition that affects 9-23% of the global population. It is characterized by alterations in bowel function and abdominal pain/discomfort.
The 3 main categories are IBS D (diarrhea), IBS C (constipation) or IBS Mixed.
- Altered gastric motility function
- Visceral hypersensitivity
- Post-infectious reactivity
- Brain-Gut interactions
- Altered microbiome flora
- Food sensitivities
- Carbohydrate malabsorption
- Intestinal inflammation
- Bacterial overgrowth
In recent years, there has been a shift in how IBS is perceived and addressed. Current research suggests that up to 84% of people diagnosed with IBS have SIBO (Small Intestinal Bacterial Overgrowth). Perhaps SIBO, like IBS, is a canary in the mine warning us of issues within the greater ecosystem of the body.
SIBO is a bacterial overgrowth in the small intestines, which leads to an imbalance within the digestive ecosystem. Symptoms such as gas, bloating, indigestion, reflux, nausea, diarrhea and/or constipation are prevalent in SIBO. In some chronic cases, SIBO might cause permanent damage to the intestines resulting in a digestive system that is more prone to food sensitivities.
It is worth noting that the causes proposed to be responsible for IBS are also proposed as causative in SIBO. There are several similarities between IC and SIBO such as host microbiome alterations and a leaky membrane. In both conditions, there is damage to the protective layer surrounding each organ. The damage to intestinal cells, due to SIBO leads to immune activation and visceral hypersensitivity; two common phenomena in IC.
Since the bladder and intestines are positioned next to each other and share similar nerve innervation, it is not surprising that one has an effect on the other for better or worse.
Fix the Gut, Fix the Bladder
Unresolved digestive problems such as SIBO can present as significant obstacles to healing from IC. For remission to occur, the root cause of IC must be discovered and treated.
Addressing digestive complaints in IC needs to go beyond a food sensitivity test and elimination diet. For this reason, dietary eliminations have proven unsuccessful in the treatment of IC in a subset of patients.
In my clinical practice, when patients present with IC and digestive complaints, my initial course of action is to test for SIBO.
The next step after testing is eradication of the identified bacteria in the digestive tract using a combination of herbs and a low FODMAP diet. After the eradication phase, the gut mucosa is restored to prevent relapse. Treating IC through a holistic lens that acknowledges digestive health can provide long-term relief that also improves quality of life.
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Saha L. Irritable bowel syndrome: pathogenesis, diagnosis, treatment, and evidence-based medicine. World J Gastroenterol. 2014;20(22):6759-6773. doi:10.3748/wjg.v20.i22.6759
Mullins C, Bavendam T, Kirkali Z, Kusek JW. Novel research approaches for interstitial cystitis/bladder pain syndrome: thinking beyond the bladder. Transl Androl Urol. 2015;4(5):524-533. doi:10.3978/j.issn.2223-4683.2015.08.01
Parsons CL. How does interstitial cystitis begin?. Transl Androl Urol. 2015;4(6):605-610. doi:10.3978/j.issn.2223-4683.2015.11.02