Interstitial Cystitis Part V

Treatment Modalities: Probiotics

Contrary to popular belief, the bladder is not sterile, a concept relatively recently presented as truth.⁴² In a detailed article regarding the history and current discoveries of the urinary microbiome, authors displayed evidence for the validity of a microbiome housed in the bladder.⁴² Not only is the urinary microbiome in existence, but in most people, it plays a protective role much like the microbiomes found in the rest of the body.⁴² It has been postulated that disturbances in the urinary microbiome may contribute to the symptomatology that accompanies urgency urinary incontinence.⁴² The authors of the review stated that future work is needed to better understand the intricate world of the urinary microbiome as well as what contributes to its development and healthy maintenance.⁴² Though this review does not pertain directly to IC, it does bring up questions as to whether or not the use of probiotics to ensure healthy microbiota would be warranted in IC patients.

Though not a well-referenced site, the Interstitial Cystitis Association (ICA) has presented the potential benefit of probiotics for IC patients, stating that adding this supplement may provide support for general wellness.⁴³ The ICA states that probiotics initiate growth of good bacteria that will in turn help to boost he body’s natural immune defenses, thus encouraging whole-body wellness.⁴³ Further, the ICA site reports that some IC patients have found benefit to taking probiotics, therefore presenting the possibility of positive effect.⁴³

In a cross-sectional study, researchers compared variance between the urinary microbiome and the cytokine levels of IC-diagnosed women and healthy controls.⁴⁴  Results demonstrated that the urinary microbiome of IC participants was less diverse, less likely to be colonized with lactobacillus, and linked with higher levels of proinflammatory cytokines.⁴⁴ These results present the assumption that the microbiome of IC patients is damaged or altered and would perhaps benefit from the introduction of probiotics as an adjunctive treatment option.

A systematic review was performed on the topic of the microbiome in the urinary tract  and the use of prebiotics and probiotics as useful treatment for various urological disprders.⁴⁵ Eighty-nine studies were included in the review and focused on a variety of urologic disorders including urinary incontinence, urologic cancers, interstitial cystitis, neurogenic bladder dysfunction, sexually transmitted infections, and chronic prostatitis/chronic pelvic pain syndrome.⁴⁵ Following an assimilation of the data and subsequent investigation of the study outcomes, the authors concluded that the microbiome in healthy individuals likely changes from a healthy one to a damaged one with the presence of urologic disorders.⁴⁵ Authors posed the hypothesis that the use of prebiotics and probiotics may provide a useful modality in the treatment of urologic disorders but the need for further study is apparent.⁴⁵ Again, though the accumulation of data regarding the proven benefit of using prebiotics and probiotics to treat urologic disorders has not yet been widely collected, enough evidence exists to support the assumption that this may offer a promising therapy for those suffering from these disorders.

Treatment Modalities: Dietary Intervention

Dietary intervention has been widely suggested as a possible way to reduce flare ups and symptoms of IC.³ Though dietary changes do not appear to provide a curative effect, studies reveal that the elimination of certain foods may be helpful in the management of symptoms. One study on dietary triggers and IC was performed to determine which foods most exacerbated symptoms.^46.Three hundred forty-four foods were considered in regard to problematic potential to effect urinary frequency, urgency and/or pelvic pain symptoms.⁴⁶ Researchers discovered that out of the 598 responses submitted, 95.8% of the participants answered affirmatively that certain foods and beverages contributed to their IC symptoms.⁴⁶ The majority of food and beverages tested posed no effect on symptoms but the items most frequently identified as problematic were citrus fruits, tomatoes, coffee, tea, carbonated and alcoholic beverages, spicy foods, artificial sweeteners, and vitamin C.⁴⁶ In addition, calcium glycerophosphate (a calcium salt) and baking soda offered symptom relief in some participants.⁴⁶ Researchers concluded that though IC diets do not necessarily need to be significantly restricted, it would behoove patients to abstain from the above-listed foods in order to provide preventative measures as well as alleviate symptoms.⁴⁶  

In a survey of 374 IC patients, the affect of certain beverages was tested in regard to IC symptomatology.⁴⁷ Researchers discovered that the inclusion of acidic, alcoholic or carbonated beverages, and coffee or tea caused an increase in overall pain in more than 50% of the participants, thus suggesting that the elimination of such liquids would be beneficial to IC patients.⁴⁷

In a study of 104 IC patients, researchers investigated the effect of 175 different foods and beverages.⁴⁸ Out of those surveyed, 90.2% reported that the consumption of particular foods irritated their symptoms, though no correlation was found between allergic reactions and the effect of certain foods on symptoms.⁴⁸ The foods and beverages most widely identified as problematic in terms of increased symptoms were caffeinated, carbonated and alcoholic beverages, certain fruits and juices, artificial sweeteners and spicy foods.⁴⁸ Looking at a compilation of the data, it appears fairly apparent that certain groups of foods cause an increase in symptom presentation and IC patients have potential benefit from eliminating such foods from the diet.

References

42. Thomas-White K, Brady M, Wolfe AJ, Mueller ER. The bladder is not sterile: history and current discoveries on the urinary microbiome. Current Bladder Dysfunction Reports. 2016; 11(1): 18-24. 

43. Interstitial Cystitis Association. Do probiotics work? Available at: https://www.ichelp.org/diagnosis-treatment/treatments/ic-diet-self-management/do-probiotics-help-ic/. Accessibility verified July 18, 2018.

44. Abernethy MG, Rosenfeld A, White JR, Mueller MG, Lewicky-Gaupp C, Kenton K. Urinary  microbiome and cytokine levels in women with interstitial cystitis. Obstetrics and Gynecology. 2017; 129(3): 500-506.

45. Aragón IM, Herrera-Imbroda B, Queipo-Ortuño MI, et al. The urinary tract microbiome in health and disease. European Urology Focus. 2018; 4(1): 128-138.

46. Bassaly R, Downes K, Hart S. Dietary consumption triggers in interstitial cystitis/bladder pain syndrome patients. Female Pelvic Medicine and Reconstructive Surgery. 2011; 17(1): 36-39.

47. Koziol JA, Clark DC, Gittes RF, Tan EM. The natural history of interstitial cystitis: a survey of 374 patients. The Journal of Urology. 1993; 149(3): 465-9.

48. Shorter B, Lesser M, Moldwin RM, Kushner L. Effect of comestibles on symptoms of interstitial cystitis. The Journal of Urology. 2007; 178(1): 145-152.