Got painful bladder syndrome/IC? Check out your gut…

Bladder pain, burning, spasm, urgency and frequency are some of the most exquisitely heartbreaking symptoms that can be experienced, for the persistence and permeation into all levels of your awareness, to the fact that conventional outcomes for non-infectious/non-UTI bladder symptoms are notoriously poor.

Im talking about interstitial cystitis/painful bladder syndrome (IC/PBS), which affects twenty million American men and women.

There is a large overlap between IC/PBS and IBS (irritable bowel syndrome) and IC/PBS and the complex pain syndromes (fibromyalgia, chronic fatigue syndrome). Up to thirty percent of people who experience IBS or a complex pain syndrome – or both – will also experience painful bladder symptoms. It is thought that IC is the urological extension of these other syndromes.

This suggests a common cause, a common root. As ever, I cannot help but look to the gut to shed some light. It is also the basis for my IC/PBS Program.

The gut is the Grand Central Station of your body. Its role in health is foundational. Every other system and cell interact with your gut virtually every second of every day.

Here are *some* things your gut does, besides digest

Defense. It is a major player in defense – containing the mighty stomach with its stomach acid, capable of killing an enormous amount of pathogens. Another avenue of defense is the intestinal lining, a smart filter that brings the good stuff in and keep the bad stuff out. Your gut also houses about 2/3 of your immune system.

Detox. Your gut is pivotal in detoxification – the liver and large intestine are two of the big five organs of detoxification (the others are the skin, kidneys and lungs). Many hormones are created, activated, recycled, detoxified and excreted via the gut, making it important for hormonal balance as well.

Inflammation. Since the lion’s share of the immune system resides in the gut, the gut is also a potent driver of inflammation when things go awry. Immune cells release inflammatory compounds when provoked. The high population of immune cells in the gut coupled with the enormous surface area of the small intestine (about the size of a tennis court) means the inflammation generated within your gut can get hot indeed, and spill outside of your GI tract (more on that below, under inner fire).

The gut-bladder connection

With as far-reaching and integral as your gut is for all systems of the body (it hits your hormonal and neurological systems as well, but you knew that right?), it should come as no surprise that there aredefinitive links between your gut and bladder as well.

Not in all cases, certainly, as IC/PBS can be a result of child birth, trauma to the pelvis, a wild bladder infection, neurological changes or injury from medication or radiation.

Inner fire/autointoxication

One of the mechanisms proposed that links the two conditions is the greater-than-normal level of inflammation that comes from the digestive tract in folks with IBS. This inflammatory process, called metabolic endotoxemia or autointoxication or meta-inflammation,can permeate any organsystem, including the urogenital tract.

Why do people with IBS have greater than normal levels of inflammation in their guts? It’s a response to dysbiosis, the imbalance of gut flora that is one of the major markers of IBS. A combination of metabolic byproducts from the bad guys, LPS (lipopolysaccharides, a compound of bacterial walls) and an elevated immune response create a greater-than-normal level of inflammation,beginning in the gut. If this goes on long enough, it will impact the entire body.

This is the very same chronic inflammatory process that is thought to underlie a wide swath of diseases and syndromes like diabetes, obesity, depression, neurodegenerative conditions and cardiovascular disease.

An inflammatory response, over time, will initiate changes in the lining of the bladder and change the conduction of pain signals to be more reactive. This, of course, sets the stage for IC and painful bladder syndrome.

Beneficial bugs

Your large intestine hosts a colony of beneficial bacteria numbering from one trillion to one hundred trillion cells. For context, the amount of human cells in your entire body is roughly one trillion. You are at least as bacterial as you are human ;) These guys provide innumerable functions for us, both inside and beyond the gut.

Your urogenital system also hasbeneficial bacteria, albeit in smaller numbers. Urine was long thought to be sterile, but this is actually not the case. Small amounts ofbeneficial bacteria are normal and help keep pathogens at bay,inflammation to a minimum and your system happy.

​​​​​​​These twomicrobiomes – the gut and bladder – are related. If the gut microbiome is robust and healthy, being so much bigger, it has apositive influence on the microbiome of the bladder. As we learned above, the reverse is also true. Dysbiosis in the gut can lead to dysbiosis of the urogenital tract.

Lining issues

​​​​​​​The bladder and the gut both depend on linings for optimal function and comfort. The bladder has a mucin layer which protects against the irritating effects of urine. The stomach has a thick mucous layer to protectagainst acid, the large intestine has a mucous layer, and the small intestine has a single-cell-layer thick,absorptive layer that is rapidly turned over.

These linings have some things in common. Not only are they subject to the same forces of irritation, they are also helped by common lining-building inputs. Classic collagen builders like gelatin, bone stock, collagen/collagen peptides, glucosaminoglycans (GAGs) andblueberries arebeneficial for the gut and bladder alike.

The IC/PBS Program

A big component of treating IC and PBS is therefore to address and shore up any digestive complaints. Strengthening the digestive system helps to strengthen the bladder. Supporting the microbiome of the gut supports the flora of the genitourinary tract. Fortifying the lining of the gut will help the lining of the bladder.

By taking a broader approach to bladder pain – one that captures the gut as well – we can often strike at the very roots of discomfort and get rid of them, rather than manage them. To that end, I have created the IC/PBS Program, a comprehensive system that utilizes a targeted elimination-challenge diet, specific bladder building and soothing herbs and supplements, an IC specific exercise protocol, bladder retraining, and specific support protocols to add in if there is autoimmunity, histamine intolerance, neurogenic changes and other potential drivers for symptoms.

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