Interstitial cystitis (IC) is a condition that can cause moderate to severe pelvic or bladder pain and increased bladder pressure. Additional symptoms include the persistent need to urinate, frequent urination with small volumes of urine, bladder pain with relief only post urination, pain during sex, and more. Those suffering from IC may sometimes confuse signs with a urinary tract infection.
CC: Bladder Pain, Fatigue
Sarah was a 25-year-old female experiencing chronic bladder pain 1-2 times per month that would last for days. The pain started after her honeymoon two years ago. After visiting her primary care physician (PCP), they found her urine analysis clear. There were no signs of infection. However, based on symptoms, Sarah was given antibiotics. Initially, her symptoms had gone away, but they returned the next month and the following month. She went back to her PCP and took another round of antibiotics. After a total of 10 rounds of antibiotics, she was referred to a urologist, who diagnosed her with IC. Aside from additional testing/procedures, such as exploratory surgery for endometriosis, she was told there was nothing that they could do for her. At this point, she turned to functional medicine.
Additional History
Sarah had a very normal menstrual cycle. She denied pain with intercourse or abnormal vaginal fluids/discharge. She did get back pain associated with her IC pain. Otherwise, she reported feeling fatigued but wasn't sure if it was correlated to her IC. Sarah had no gastrointestinal issues but noticed that some foods made her feel itchy and would get random rashes, but she could not pinpoint what foods caused them. She had no special dietary restrictions and worked at a diner, so she admitted to eating a lot of "diner food."
Initial Lab Work
Complete Blood Count Panel: Within Normal Limits
Urine Analysis: Within Normal Limits
Lab Analysis
Sarah's blood work was able to rule in and rule out various concerns:
Her labs showed low nutritional status. Her omegas, vitamin D, and iron were low. Low values could be indicative of a lack of dietary intake or lack of absorption. Low levels of omegas could lead to increased inflammation and cardiovascular concerns. Levels of all markers could aid in her fatigue.
Sarah's labs showed evidence of inflammation with an elevated GlycA. She showed sensitivity to casein and wheat, which could elevate her inflammatory status.
Her labs showed high histamine and tryptase, which could be linked to mast cell issues, inflammation, and exposure/ingestion of various allergens. When mast cell concerns are suspected, there must be a full workup to understand their origin.
The thyroid panel was mostly within normal limits. Sarah's fT3 was low, which shows evidence of a lack of conversion of fT4 to fT3. This could indicate liver issues, prolonged fasting, stress, nutritional deficiencies, and more. This also could be aiding in her fatigue. Sarah did not seem stressed and exhibited a normal RT3.
Interventions
IC can be linked to many factors, such as chronic bacteria infection, autoimmunity, allergic reactions, exposures to irritating substances, food reactions, inflammation, bladder trauma, disruption of glycosaminoglycan (GAG), pelvic floor dysfunction, and more. It's important to rule out infections, kidney stones, and endometriosis. Many factors were ruled out based on her labs and history. Knowing that she had no episodes before her honeymoon was particularly important.
Sarah stopped eating gluten and dairy and was put on a low-histamine diet. It's difficult to eliminate all histamine foods since many are healthy. However, she was suggested to reduce the overall load and not pair high histamine foods together, like avoiding eating a strawberry and spinach salad with a kombucha.
Sarah was given nutritional support with supplements that included omega-3 fatty acids (2 g daily) to help increase serum levels, decrease inflammation, and support bladder tissue. She was given 5,000 IU of vitamin D daily and 60 mg of ferrous iron daily for a short term. Vitamin D was given as the patient was very low. Iron was given short term because low iron can be a sign of multiple health concerns such as GI bleeds, parasites, absorption issues, etc. (that were not suspected). It was speculated that Sarah was not absorbing her nutrients well. Low doses were given temporarily as she was starting to make dietary changes, intending to eventually maintain healthy levels without supplementation.
Due to the slow conversion of fT4 to fT3, Sarah was given "Clean Sweep" (a mixture of liver-supporting herbs) that contained milk thistle, NAC, dandelion, and artichoke to help with the high tryptase and histamine. This was important since the liver contributes to breaking down histamine. She was also given trace minerals for thyroid support.
Sarah was given glucosamine sulfate (750 mg BID), Quercetin (500 mg BID), Vitamin C (500 mg BID, or to tolerance), and GI Core (1 scoop daily) which includes demulcent herbs, vitamin A, zinc, and glutamine. The purpose of these supplements was to support Mast cells and glycosaminoglycans found in the bladder. Based on Sarah's history, it was suspected that she was having food reactions to the foods she was eating. Although she presented with minimal GI symptoms, her bladder tissue was irritated (GAG), which may have stemmed back from her honeymoon.
Follow-Up 3 Months Later
Sarah presented as completely gluten and dairy free and followed the low histamine diet to the best of her ability. Her pain was 90% better. Occasionally, she would get some pain 1 hour before starting menstruating, but it was very mild. That could be due to the increase in histamine with menstruation. Her back pain was gone, and she noticed no more itchiness with food. Sarah was taken off the iron supplements and was told to continue her dietary changes.
Follow-Up 5 Months Later
At 5 months, Sarah's pain was 100% gone. Her energy was rated 8-9/10. She felt great overall and was thrilled to be living pain-free. She was told to remain gluten and dairy free, but she could slowly come off the low histamine diet and watch out for any reactions.
Below are Sarah's 5 Month Lab Values which showed a positive results in increasing vitamin and mineral levels while lowering overall inflammation and histamine.
Complete Blood Count Panel: Within Normal Limits
Urine Analysis: Within Normal Limits
Summary:
IC can be caused by many factors. By taking a thorough history and a deep dive into labs, it was thought that the main driving force of her symptoms was her diet, food sensitivities, and the disruption of GAG found in the bladder tissue. By changing her diet and supporting her bladder tissue, Sarah was able to eliminate 100% of her pain and did not have to do additional invasive testing. However, if diet and supplements did not change her outcome, additional testing would be crucial in assessing the root cause.
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