Researchers have discovered that IC patients have significantly different levels and types of bacteria in our digestive tract (bowel) rather than our urinary tract (kidney, bladder). These distinct deficiencies (known as DIPP) hint that the lack of beneficial bacteria as well as an overabundance of pathogenic bacteria play a role in the cause and intensity of bladder and pelvic pain. This vital research is worth the consideration of both patients and medical care providers who often turn, inappropriately, to antibiotics.
Understanding The Human Biome
Millions of bacteria live in the human body where they perform essential functions that keep us healthy. Known as the human “biome,” these bacteria live abundantly on the skin, in our mouths, nasal passages, stomach and gut. They help digest food, provide nourishment and control pathogenic fungi and bacteria. Both candida (aka yeast, thrush) and Clostridium difficile (aka C-Diff) infections occur after antibiotic treatment destroy the “good” bacteria that keep more dangerous bacteria under control.
For several years now, the MAPP Research Network has been exploring the “biome” of patients with interstitial cystitis and chronic prostatitis. Their long term goal is to identify, by species, bacteria that live in the gut and urinary tracts of IC and chronic prostatitis patients and what role, if any, they might play in pelvic pain. They’ve already had one major breakthrough, the discovery of candida/yeast in the urine of some patients struggling with IC flares, rightly pointing out that urine cultures rarely (and should) screen for fungal infections.
IC Patients Found Deficient in Gut Bacteria
While they have NOT found bacteria in the urinary tract and urine distinctive to IC (i.e. such as an elusive infection), they have found significant differences in the gut. They isolated bacteria from the stool of women with interstitial cystitis as well as normal controls. IC patients had significantly lower levels of five species of bacteria – O. splanchnicus, F. prausnitzii, C. aerofaciens, E. sinensis, and L. longoviformis. They’ve dubbed this group as “deficient in interstitial cystitis pelvic pain (DIPP).”
They also found higher than normal levels of other bacteria that could, perhaps, increase pelvic pain. Researchers have labelled this population of bacteria as “increased in IC pelvic pain (IIPP).” One bacterial species, E. lenta, as well as several bacterial families were found to be elevated in the IC patient.
A closer look at these bacteria reveal new, potential insights into IC and its related conditions:
- L. longoviformis – metabolizes phytoestrogens, perhaps contributing to the higher number of women with IC.
- E. sinensis – may contribute to alterations in the gut-brain axis or pelvic organ crosstalk.
- F. prausnitzii – is highly abundant in the human GI tract and produces critical fatty acids.
- C. aerofaciens – is significantly associated with symptoms in IBS patients.
- O. splanchnicus – a bacterial mystery, very little is known about it.
- E. lenta – associated with the bacteria in the blood stream
Good Bacteria Nourish The Cells Of The Gut
Here’s where it gets interesting. F. prausnitzii is the perfect example of a good bacteria. It plays a very important job in bowel health by consuming dietary fiber to produce an essential fatty acid – butyrate. Butyrate is basically the food which nourishes the cells lining the colon. If butyrate isn’t available at adequate levels, these cells lack the nutrition they need to function normally. Deficiencies of butyrate and the bacteria F. prausnitzii have been linked to the development of irritable bowel syndrome, a strong related condition to IC. The research team also found different levels for two other fatty acids, arachidonic acid and lineolic acid.
Questions For Future Studies
- Do bacterial levels change during flares? Could DIPP species decrease? Do IIPP species increase?
- Do bacterial levels normalize during period of remission?
- Could the cells of the bladder also be suffering from the lack of F. prausnitzii and access to butyrate and/or other nourishing fatty acids?
- Could bacterial and fatty acid metabolite levels be used to diagnose IC patients using a simple stool test?
- Would the restoration of existing bacterial levels improve symptoms?
- Do men with chronic prostatitis have similar altered biomes? (Studies are currently underway!)
Could Antibiotic Use Be A Contributing Factor?
The average IC patient spends a significant amount of time worrying about bladder infection and “bad” bacteria. It’s natural given that the symptoms of frequency, urgency, pressure and often intense pain are most commonly associated with bladder infection. Thus, we often ask for and/or self-medicate with antibiotics. Many physicians also prescribe antibiotics when symptoms of frequency and urgency appear even when urine cultures are negative.
Of course, urinary tract infections support billion dollar industries. Laboratories offer to do expensive testing to find that elusive bacteria that might be in your bladder. (Remember, Mapp Research Network studies have found no difference in bacterial populations in the urine of patients with IC vs. control patients.) Cranberry companies benefit tremendously from the fear of UTI in their promotion of cranberry juice and other supplements. Look no further than the pharmaceutical industry who, too, are trying to making a substantial profit selling millions of pounds of antibiotics used, primarily, in cattle, pork and chicken farms.
There are clear consequences to the overuse of antibiotics, both subtle and dramatic. By destroying the good bacteria, essential functions that keep our gut and our body healthy are weakened and disrupted thus contributing to chronic pelvic pain conditions in the bowel (i.e. irritable bowel syndrome) and, perhaps, the bladder (i.e. interstitial cystitis). The worst case scenario has also occurred. Last month that the first true superbug, a completely antibiotic resistant E-coli, has arrived in the USA. It was discovered in a woman in Pennsylvania with a bladder infection and in TWO separate pig slaughterhouse samples from Illinois and South Carolina.
Many IC patients have been prescribed antibiotics “prophylactically” when no bacteria has been found in their urine. The AUA Guidelines clearly state that antibiotics are not considered a therapy for IC. It will be incredibly ironic if we discover that the overuse of antibiotics (perhaps in our childhood) and the disruption of the natural, healthy population of bacteria created the foundation for bladder and pelvic pain. As patients, we must support and nurture good gut flora through a healthy diet and the use, if necessary, of good probiotics. We should also challenge the use of antibiotics when cultures are negative.
DIPP or IIPP – Something has changed our biome!
Antibiotic use may not be the only contributing factor. The first case of IC was documented in England in the mid 1800’s well before antibiotics were developed. It may also be true that our “modern” diet and the lack of beneficial foods that contain probiotics and/or the fiber may also be involved. Perhaps higher levels of sugar or heavily processed foods also manipulate the good vs. bad bacteria. Clearly something has changed our gut biome and it is in our best interests to eat a healthy diet, rich in fresh vegetables, meats and fruits (IC friendly, of course).
The MAPP Network is continuing this line of research and are currently studying biome variations in men with prostatitis. One of the more important studies to come is if bacterial levels in the gut change during flares and/or if they become normal in patients who go into remission. You can be involved in this very important research effort. Study centers are located throughout the USA. Click here to see a list of participating centers.
- Braundmeier-Fleming, A. et al. Stool-based biomarkers of interstitial cystitis/bladder pain syndrome.Sci. Rep. 6, 26083; doi: 10.1038/srep26083 (2016). Read the full article!
- Christensen J, Goldschmidt D.A dreaded superbug found for the first time in a U.S. woman. CNN. May 27, 2016
- Sun L, Superbug found in Illinois and South Carolina. Washington Post. June 16, 2016