Clinical work specializing in mast cell and other immunological conditions naturally leads to frequent contact with patients dealing with interstitial cystitis and chronic bladder pain syndrome (IC/BPS). The role of mast cells in the urogenital tract, specifically in the bladder and reproductive organs, is covered in a separate article exploring how interstitial cystitis, chronic bladder pain, endometriosis, and mast cells can be connected. This article focuses on natural treatment approaches used for IC/BPS.
Natural treatment for interstitial cystitis generally focuses on two things: supporting the bladder's protective mucous lining (the GAG layer) and using plant-based substances and nutrients that raise the irritation threshold for nerve and mast cells, helping ease symptoms.
It is worth emphasizing clearly: this kind of treatment should never be self-directed, and should always happen in coordination with a doctor or experienced practitioner. Plant-based substances in particular can carry a wide range of interaction risks and should not be combined with medications without guidance.
What are mast cells?
A quick refresher: mast cells are part of the immune system and belong to the white blood cells (leukocytes). Only a small portion circulate in the blood, most are found in mucous membranes, where they are involved in a broad range of inflammatory processes. They also play a key role in mediating allergic symptoms through the histamine they release.
It is worth understanding that, despite how the word is often used colloquially, inflammation is not inherently bad. It is an important part of the immune response, part of the body's defense mechanisms.
A dedicated article on mast cells, their mediators, and mast cell activation syndrome (MCAS) is also available on this site.
Diet for chronic bladder pain (IC/BPS)
There is no single "IC diet," understandably, as much as patients might wish there were one. Some people tolerate acidic or heavily spiced foods particularly poorly. Histamine or salicylates can also worsen symptoms for some. This topic deserves its own dedicated article, so it won't be covered in full detail here.
Herbal medicine for interstitial cystitis
Not everyone tolerates plant extracts well. Some patients also have NSAID intolerance, also known as salicylate intolerance, and can react sensitively to concentrated plant extracts, which sometimes contain substantial amounts of salicylic acid.
Quercetin: a mast-cell-stabilizing compound
A study involving 22 IC/BPS patients found that the antioxidant quercetin was often associated with significant symptom improvement. Unfortunately, studies in this area tend to be small and less conclusive than larger trials with bigger participant numbers. [1]
Quercetin's effect in IC likely comes down to both its general anti-inflammatory properties and a mast-cell-stabilizing effect that reduces histamine release. It is not a coincidence that medications blocking specific histamine receptors, H1 and H2 blockers, are also used in IC/BPS treatment.
Patients with mast cell activation syndrome or allergies often benefit from quercetin as well, since it also slows the release of pro-inflammatory mediators like histamine and leukotrienes from mast cells that can drive symptoms. [2]
An important caveat with quercetin: at higher doses, this plant compound inhibits the liver enzyme cytochrome 3A4 (CYP3A4), which can cause a range of drug interactions with other medications metabolized through the same pathway.
Aloe vera: the evidence is not there yet
Aloe vera contains certain polysaccharides that may potentially support mucous membranes. However, there is currently no solid supporting evidence in the form of actual studies in chronic bladder conditions. Some information online suggests a study on aloe vera in IC/BPS patients may be planned.
Given its high salicylate content and the currently limited evidence, aloe vera is not used by default for IC/BPS in clinical practice, particularly since many IC patients show notably elevated urinary leukotriene levels. Elevated leukotriene excretion can indicate increased mast cell activity and, alongside other findings, may point toward salicylate intolerance.
Herbal blends and teas
Various herbal blends have been used in studies with IC patients, sometimes successfully. One such blend included dogwood (Cornus), rhubarb, a gardenia species, and a Psoralea species. Individual tolerance plays a major role here. [1]
Traditional Chinese medicine and acupuncture for IC/BPS
There is generally no standardized approach in TCM, each patient is treated individually. To date, only case reports are available.
Acupuncture is also used for IC/BPS. Beyond its classic use for pain relief in general, one small study suggests it may also positively affect bladder symptoms like frequency and urgency. (Acupuncture does not technically fall under herbal medicine, but is grouped here under TCM.) Unfortunately, the evidence here is mostly limited to case reports and a few small patient series, so more research is still needed. [1]
Building up the GAG layer
Chondroitin sulfate, hyaluronic acid, and more
The glycosaminoglycan (GAG) layer plays a particularly important role. It protects the deeper layers of the bladder from aggressive substances in urine. Chondroitin sulfate, heparan sulfate, and dermatan sulfate are among its components. These are sometimes delivered directly into the bladder through instillation treatments. Gepan®, for example, contains chondroitin sulfate, while Instyllan® contains hyaluronic acid.
In clinical practice, oral chondroitin sulfate and glucosamine sulfate have repeatedly shown positive results for patients. Chondroitin sulfate has mast-cell-stabilizing properties [3] and is often available in combination products with glucosamine sulfate, methylsulfonylmethane (MSM), and hyaluronic acid, typically marketed for "cartilage support." These combination products can be used off-label for this purpose. It is worth noting that not everyone tolerates MSM or hyaluronic acid well. Chondroitin sulfate on its own tends to be well tolerated in clinical experience.
Vitamins and minerals
Vitamins and minerals for IC/BPS are covered in a separate, dedicated article, since certain vitamins, or specific forms of them, can significantly worsen symptoms in some patients. Caution is warranted with strong acids like ascorbic acid (vitamin C), which can irritate the bladder. Buffered forms, such as calcium ascorbate, are a helpful alternative here.
Pelvic floor focus and physical therapies
Chronic pelvic discomfort, pelvic pain, and bladder or pelvic floor symptoms often occur together or are closely linked. This is not surprising, since constant bladder pain and urinary urgency can lead to pelvic floor muscle tension, which can then cause additional pain of its own.
Physical therapy and massage
Physical therapy has proven effective for IC/BPS patients, particularly when pelvic floor tension is elevated. Since these therapies carry minimal risk of side effects, they are generally worth trying to see whether they bring relief.
It often helps if the therapist has experience working with chronic bladder pain or pelvic floor patients, though this is not strictly necessary. Rapport and empathy matter a great deal given how personal, and often stigmatized, this topic can feel. Finding the right approach together, quite literally, is often part of the process.
Thiele massage (transvaginal, intravaginal)
Several small studies, involving around 20 participants each, have shown that massage of the internal pelvic floor muscles (twice weekly for 15 minutes) led to a statistically significant reduction in symptoms within a few weeks. [4] This approach tends to work best for patients with elevated pelvic floor tone.
Biofeedback
Biofeedback techniques can also positively affect symptoms of an overactive bladder when aimed at reducing excessive muscle tone. The focus here should be on relaxing the pelvic floor rather than tensing it. Maximum tension before conscious relaxation can be uncomfortable for some patients, so a moderate level of tension is usually the better target.
Yoga for chronic bladder pain
Certain yoga poses can positively affect the pelvic floor muscles, including frog pose, fish pose, and supported shoulder stand. Alternate nostril breathing is also considered particularly beneficial. [5]
Breathing techniques and breathwork more broadly can have a profound effect on the nervous system, and are worth exploring further; research on breathwork is summarized in a separate article.
Probiotics for interstitial cystitis (IC/BPS)
Ruling out an underlying intolerance or allergy in patients with irritable bowel symptoms is particularly important, since there are known interactions between the gut and bladder.
Similar to patients with irritable bowel syndrome, people with interstitial cystitis also show notable differences in their gut microbiome, including significantly reduced levels of Eggerthella sinensis, Faecalibacterium prausnitzii, and Lactonifactor longoviformis. [6]
No specific probiotic has been shown to be particularly effective for IC/BPS so far, so no clear recommendation can be made. For sensitive individuals, it is best to avoid probiotic strains known to produce histamine.
Conclusion
Interstitial cystitis should be considered in cases of chronic pain during urination without a bacterial infection, along with urinary urgency and bladder pain, particularly when an autoimmune condition or mast cell disorder is also present. In these cases, a tailored diet and treatment approach aimed at reducing mast cell mediator release may be worth trying.
Supporting the GAG layer is worth attempting in most cases as well.
Natural approaches within herbal medicine and TCM should be evaluated and tried on an individual basis. Physical therapy and body-based relaxation techniques appear well suited to easing tension and pain.
References
[1] Pang R, Ali A. The Chinese approach to complementary and alternative medicine treatment for interstitial cystitis/bladder pain syndrome. Translational Andrology and Urology. 2015;4(6):65361-65661. Accessed May 26, 2021. https://tau.amegroups.com/article/view/7816
[2] Mlcek J, Jurikova T, Skrovankova S, Sochor J. Quercetin and Its Anti-Allergic Immune Response. Molecules. 2016;21(5):E623. doi:10.3390/molecules21050623
[3] Theoharides TC, Patra P, Boucher W, et al. Chondroitin sulphate inhibits connective tissue mast cells. Br J Pharmacol. 2000;131(6):1039-1049. doi:10.1038/sj.bjp.0703672
[4] Oyama IA, Rejba A, Lukban JC, et al. Modified Thiele massage as therapeutic intervention for female patients with interstitial cystitis and high-tone pelvic floor dysfunction. Urology. 2004;64(5):862-865. doi:10.1016/j.urology.2004.06.065
[5] Ripoll E, Mahowald D. Hatha Yoga therapy management of urologic disorders. World J Urol. 2002;20(5):306-309. doi:10.1007/s00345-002-0296-x
[6] Braundmeier-Fleming A, Russell NT, Yang W, et al. Stool-based biomarkers of interstitial cystitis/bladder pain syndrome. Sci Rep. 2016;6:26083. doi:10.1038/srep26083
