In last week’s post, I discussed how a host of imbalances in the body contribute to a state of dis-ease. What causes interstitial cystitis is not an easy question to answer, since it is a multi-faceted disease and your body most likely began to lose homeostasis long before your diagnosis of IC.
One common thread amongs those with IC, or any chronic disease, is that the body is in a chronic state of stress, often from a combination of physiological, emotional, psychological and environmental factors that all interact and effect one another.
What came first and does it matter?
This week, I discuss some of the root causes and contributing factors involved in the development of interstitial cystitis. It is often very difficult to determine what physiologival stressor came first, second, third, etc. and you can drive yourself crazy trying to figure it out! Trust me, I’ve been there and I still catch myself falling into this type of never-ending, cyclical thinking pattern at times.
Although it can helpful to know what came first, you can still begin to heal by identifying every contributing factor possible and then prioritizing which to work on first.
In order to heal, you need to not only address that emotional root cause (if there is one and in a lot of cases there is an emotional or mental stressor that throws the system out of balance first), but also the physiological imbalances that resulted and prevent any further harm by being making changes to your environment when necessary.
What causes interstitial cystitis? Here are some root causes and contributing factors to consider.
Candida albicans is a naturally occurring yeast in the body. When the immune system is depressed and/or a diet is very carbohydrate heavily, especially consisting of simple sugars, Candida can get out of hand.
An overgrowth can occur anywhere in the body, including the mouth and throat (known as thrush), the gut, the vagina, the urethra, in skin folds like under the breasts and on toenails. Candida overgrowth usually begins in the gut, known as dysbiosis, and can spread to other parts of the body, especially with a leaky gut.
In the case of interstitial cystitis, the GAG layer may be compromised, allowing foreign invaders, such as Candida, to attach to the bladder wall. This leads to irritation and inflammation of the tissues and can also result in an autoimmune response as the immune system is continually stimulated and can become confused as the body tries to deal with this foreign invader, but accidentically attacks healthy tissue.
Candida in its fungal state releases toxins and poisons into the body, putting additional strain on the immune system and polluting our digestive system, compromising nutrient absorption and elimination. It is well known that candida infections can mimic IC bladder symptoms. They can cause frequency, urgency and irritation to the inside of the bladder and outside tissues of the vagina. Mild cases of IC could in fact be due to systemic candida (Simone 82).
Leaky gut and autoimmune disease
Leaky gut is a hyperpermeable intestinal lining that allows antigens and toxins to leak through the gut wall and into the bloodstream. An antigen is a substance that induces the formation of antibodies because it is tagged by the immune system as a threat. An antigen can be a food protein, inhalant, bacteria, yeast, virus, waste product from bacteria, chemical or toxin.
With leaky gut, large food particles leak into the blood stream and create IgG allergic reactions (mast cell activation, histamine release and inflammation) that target organs. In the case of interstitial cystitis, the bladder would be a target (Willis 75).
With intestinal leakage and inflammation, bacteria and other harmful microbes are able to translocate from the gut and set up infection elsewhere in the body via the bloodstream. This could lead to an autoimmune reaction in the bladder. There have been some studies that suggest IC may be autoimmune related. Autoimmune disorders involve a process in which the immune system overreacts while trying to clear a threat (i.e. bacteria, toxin, virus), producing cytokines and other inflammatory substances in response to a perceived invasion.
An autoimmune response can be triggered by food allergies or sensitivities, gluten intolerance, celiac disease, leaky gut, dysbiosis, or as a result of a genetic predisposition. The immune system mistakenly attacks the tissues of the host. Autoantibodies, or antibodies that react against one’s own body, have been found in patients with IC, specifically autoantibodies that react against the bladder epithelium. There is a good deal of clinical evidence of possible immune involvement, including that IC tends to affect more women than men and the link between IC and other known autoimmune conditions, such as Sjögren’s syndrome (Cohan 42).
Toxins can come from food in the form of food colorings, chemical additives, preservatives, artificial sweeteners, hormones, antibiotics and pesticides. Our water contains lead, arsenic, chlorine and other harmful substances and our air is polluted with exhaust fumes, perfume, cigarette smoke, etc. Even in our homes we are exposed to toxins from chemical cleaners, carpet fibers and conventional beauty care products (Simone 10). In our mouths, mercury amalgam fillings can be a major source of toxicity and they’re also linked with chronic Candida infection.
Everyone is exposed to toxins, some more than others, but not everyone gets interstitial cystitis. Why is this? A person with IC will have other things going on in the body, such as allergies, digestive difficulties, chronic emotional stress or a fungal infections that are taxing to the liver, lymphatic system, kidneys and immune system, making it difficult to effectively eliminate toxins. Toxins trapped in the cells and tissues are acidifying to the body and lead to inflammation.
The liver can become congested with fats and/or accumulated toxins. When this happens, it cannot produce histaminase, which is the body’s protection against allergies. This is another component of the mast cell activation that occurs in the IC bladder.
Also, many IC patients are deficient in and also intolerant to the supplemental form of B complex and vitamin C, which are both essential for the liver to detoxify. Highly sensitive IC patients may also have to avoid foods high in B complex and vitamin C because they can cause a flare.
Also, if the liver is congested with toxins, bile production will be affected and digestion will be difficult, with constipation a likely outcome (Simone 21). The liver also produces our natural antihistamines and if it is sluggish, mast cell degranulation is left unchecked.
It should be clear by now that IC is a complicated, multi-faceted chronic disease with a lot of vicious cycles occurring in the body that promote acidity, inflammation and stress on many organ systems.
Hormonal imbalance is another piece of the IC puzzle. Many women with IC complain that ovulation and/or menstruation, pregnancy, perimenopause, or menopause exacerbate their IC symptoms. Others report that their cycles do not affect their IC, while some report feeling better or worse after starting or stopping hormonal therapy.
Increased IC symptoms around ovulation or just before menstruation may be attributed to the spike in estrogen seen just before ovulation. Estrogen falls quickly just after ovulation and then estrogen rises again with a spike just a few days before the period. Higher estrogen levels during these spikes provoke mast cell secretion with histamine release contributing to an increase in bladder inflammation. A decreased ratio of progesterone to estradiol has also been associated with kinin release, which results in increased release of the inflammatory prostaglandins and of histamines.
An increase in IC symptoms during and after menstruation could be due to an increase in pain-producing prostaglandins entering the bloodstream during this time.
When the adrenal glands are weak (often the case in IC) and cannot produce enough cortisol, the body will use progesterone to make cortisol. When this happens, we don’t have enough progesterone available to balance estrogen. This leads to estrogen dominance, which encourages mast cell secretion.
The liver functions in balancing hormone levels by breaking down estrogen to a weaker form of estriol. If the liver is weak and congested, which is often the case in IC patients due to toxicity, allergies and leaky gut, then this will also contribute to hormonal imbalances such as estrogen dominance and hence, mast cell secretion.
Allergies, sensitivities and intolerances
Allergies play a role in the development and inflammatory process of IC. It can be a reaction to food or something in the environment, such as a chemical or pollen. The severity of the allergic reaction depends on the degree of acidity in the body. When the body is overly acidic and mast cells are activated by an allergen, they will tend to break down more quickly and are more likely to generate histamines and other inflammatory chemicals.
When histamines are released from mast cells in the bladder due to an allergic reaction, inflammation and burning of the bladder tissue results. Chronic inflammation can, in turn, damages cells and tissues, causing them to become more acidic, thereby sending the body into a destructive downward spiral (Willis 85). Allergies are very common in those with a leaky gut and leaky gut is common in those with IC.
A diet that is too acidic
The average diet of Americans and Canadians consists of 80% acidifying foods (i.e. carbonated beverages, meat, grains, sugar, etc.) and 20% alkalizing foods (most vegetables and fruits, bone broth, etc.). This is the exact opposite of the ideal ratio for maintaining proper acid-alkaline balance in the body! This highly acid-forming diet puts a strain on the buffering system of the body to neutralize all the acid that is produced.
The blood pH must be maintained within a small margin of 7.35 to 7.45 and a healthy urine pH is between 6.8 and 7.5, but is usually even lower in the morning as the body rids itself of excess acids.
As we age our ability to maintain a slightly alkaline balance in our cells and tissues diminishes. We do not have an endless supply of bicarbonate ions and the alkaline reserve is only a back-up system with limited quantity to keep us from poisoning ourselves with too much acid-forming foods.
Maintaining the cells and tissues of the body in a slightly alkaline state helps to prevent inflammation. In contrast, over acidity promotes the onset of painful and disabling inflammatory conditions, such as IC (Willis 36). Thus, the more acidifying the food, the more inflammatory that food is to the body.
In the case of IC, when our alkaline reserves are critically low, acids are deposited into the extracellular spaces. Acid wastes cause an inflexibility and deformity of the red blood cells flowing through the capillaries of acid tissues. These red blood cells deform and obstruct the capillary flow of blood to the tissues. The lack of blood flow causes a decrease of nutrients and oxygen to the bladder and nerves. Also, when pH is too low, oxygen delivery to the cells suffers. With decreased oxygen and blood flow, pain is experienced. Minerals are stripped from bones, muscle, tissues and cells in order to maintain proper blood pH. The state of tissue depletion and toxicity will cause symptoms of pain and inflammation. Decreased blood flow to the bladder may also play a role in the reduction of the GAG layer (Willis 66).
A diet with an imbalance of essential fatty acids
A diet that has an imbalance of essential fatty acids can lead to inflammation in the body. If too much omega 6 fatty acids are consumed compared to omega 3 fatty acids, too much arachidonic acid (prostaglandin PGE2) is produced, which is highly inflammatory. It causes swelling, increased pain sensitivity and increased blood viscosity. Other compounds associated with PGE2 can cause blood platelet clumping, spasm of blood vessels and accumulation of inflammatory cells in an area over the long term can change the way in which nerve cells communicate. It also over-activates the immune system within the nervous system causing the immune cells to attack the host.
Leukotrienes are also made from arachidonic acid and are potent inflammatory substances. They are 1,000 to 10,000 times more potent than histamine and signal WBCs to travel to an area, which is good when you need them, but if they are in excess they create a lot of damage and the inflammatory process cannot be shut off due to a lack of other fatty acid messengers, PGE1 and PGE3. PGE2 is important within limits, but when the fatty acids are out of balance, such is the case when consuming a diet high in animal fats; this is when PGE2 can cause problems (Willis 130-131).
Infectious microorganisms and occult infections
An occult or “hidden” infection, caused by Lyme disease, Bartonella, Chlamydia pneumonia, Enterococcus, or another organism has been speculated as being a potential cause of interstitial cystitis (Cohan 11).
In one study at Vanderblit University Medical Center, the data, using polymerase chain reaction (PCR) analysis of the urine, revealed that 81% of patients with IC and 16% of controls were positive for Chlamydia pneumoniae, suggesting a potential role for this organism in the development of IC. The tissue biopsies showed 82% of those the IC patients (14/17) had tissue cultures positive for C. pneumoniae and in control patients 16% (1/6) had positive tissue cultures (Cohan 32). As part of our body’s immune system, any time there is inflammation, new blood cells are formed in that area, and C. pneumoniae is specifically drawn to these areas. This can mean that an insect bite, a viral infection, or an ordinary UTI can become the locus of a new, persistent cryptic infection with C. pneumoniae. Vanderblit researchers hypothesize that this is the mechanism by which this pathogen is implicated, not only in IC, but also in other chronic inflammatory diseases, including rheumatoid arthritis and fibromyalgia/chronic fatigue syndrome (Cohan 189).
An occult infection could also develop secondarily to an existing injury to the bladder lining caused by a UTI, an invasive procedure like a cystoscopy, sexual trauma, autoimmune inflammatory process triggered by eating gluten or other allergen, or even neurogenic inflammation from a musculoskeletal cause. A pathogen may then take advantage of the damaged bladder lining and initiate a process of long-term infection that would otherwise not be possible in a healthy bladder. For example, many women develop IC following a bladder infection that was successfully treated using antibiotics, but their bladders never really feel better. The organism they were being treated for is gone, but another less-easily identified pathogen has invaded the bladder during a vulnerable period (Cohan 12).
There is some evidence that infection with the organism that causes Lyme disease (Borrelia burgdorferi) can cause symptoms that mimic IC or that Lyme infection negatively affects the immune system and predisposes its victims to IC-like symptoms. Studies done with mice showed that mice infected with B. burgdorferi showed significant pathologic changes in the bladder, including an increase in the number of blood vessels, thickening of the vessel walls, immune system induced changes and inflammation. Nearly all (93%) of the mice examined in the studies had spirochete-induced cystitis (Cohan 13).
Candida albicans (discussed above) and parasites are two common microorganisms that can be difficult to detect and can contribute to inflammation in the bladder.
According to Louise Hay (18), bladder problems relate to anxiety, holding on to old ideas, fear of letting go and being pissed off. Inflammation relates to fear, seeing red and inflamed thinking. Whenever we look at an inflammatory condition, ending in “itis”, we should consider that unresolved anger may play a role.
Some studies have shown that a history of childhood trauma, especially sexual abuse, is more commonly reported in patients with IC than in controls. In one study, questionnaires were completed by 207 IC/painful bladder syndrome (PBS) patients and 117 controls matched for age, partner status and education. It was found that before 17 years of age, the IC/BPS cases reported higher prevalence of being “raped or molested” compared to controls. Within the IC/PBS group, cases reporting previous sexual abuse endorsed greater sensory pain, depression and poorer physical quality of life at the present time compared to IC cases without a sexual abuse history (Nickel et. al. 1-2).
That was quite a bit of info to throw at you in one post! And I’m not finished yet …
Next week, I will cover a few more contributing factors to the development of IC that are not commonly discussed or well known. See you then!
Cohan, W. (2011). The Better Bladder Book: A Holistic Approach to Healing Interstitial Cystitis & Chronic Pelvic Pain. Alameda: Hunter House, Inc.
Hay, L. (1984). Heal Your Body: The Mental Causes for Physical Illness and the Metaphysical Way to Overcome Them. United States: Hay House, Inc.
Nickel et. al. (2011, Dec.). Childhood sexual trauma in women with interstitial cystitis/bladder pain syndrome: a case control study, Can Urol Assoc J., 5(8), 410-415. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3235208/ (accessed July 9, 2013).
Simone, C.M. (2000). Along the Healing Path: Recovering from Interstitial Cystitis. Cleveland: IC Hope, Ltd.
Simone, C.M. (1998). To Wake in Tears: Understanding Interstitial Cystitis. Cleavland: IC Hope, Ltd.
Willis, A.K. (2003). Solving the Interstitial Cystitis Puzzle: A Guide to Natural Healing. Beverly Hills: Holistic Life Enterprises.