Supplements can be an important part of holistically treating interstitial cystititis. They are less expensive than medications and often have fewer side effects. But which supplements are best for IC, and which supplements may irritate bladder symptoms and you should avoid?
You'll see recommendations for a wide variety of supplements for IC, and it's hard to know where to start: aloe vera, l-arginine, quercetin, magnesium, collagen, Prelief and Omega-3 fish oils all have their proponents in the IC community. And there are several combinations like Bladder Builder, Cystoprotek, and others purporting to help with IC symptoms.
We do a full review of all the most important supplements we recommend to our patients with IC symptoms, and the ones that can be irritate bladder symptoms in the IC: Roadmap to Healing online course ($47). but here is a great summary!
Supplements can be a great tool for IC and bladder pain, but generally aren't enough by themselves to provide lasting relief. Instead, they are best when combined with a holistic treatment approach and pelvic floor physical therapy to resolve the underlying "why' of your symptoms.
Supplements to Avoid with Interstitial Cystitis
We want to make sure anything we put in our bodies isn't flaring symptoms, and some supplements can be triggers for IC symptoms and should be avoided. As always, let your symptoms be your guide! In the course, we recommend creating a Symptom Log to track what is - and what isn't - affecting your symptoms.
Patients often report multi-vitamins irritate their bladder and pelvic pain symptoms. Vitamin C, which is found in almost all multi-vitamins, may be a trigger for many. We also want to avoid any supplements causing constipation, diarrhea or GI issues. These gut health issues can have a major effect on IC symptoms. Probiotics and high amounts of aloe vera can contributing to bowel issues as well.
Benefits of Supplements for IC
Supplements can have many benefits for IC - they are far less expensive than prescription medication, often have fewer side effects, and can be purchased online or over-the-counter at stores. In general, supplements are not rigorously proven in clinical trials, and the claims on the bottles are not evaluated by any regulatory agency (that's why you'll see the little *Statements not evaluated by the Food and Drug Administration* disclaimer on most bottles). We've included links below to some of the brands we typically recommend to our patients.
As with medication, there is no 'one size fits all' approach - everyone with IC is unique and responds differently. You may want to try several of the options below and see what works best for your body. Using a symptom log (you can download and print the PelvicSanity Symptom Log for IC) can help you evaluate if the supplement is showing a benefit for you. Finding the right supplement can have significant upside for you, and little downside. As we always say: if it works, keep it; if not, discard it!
Supplements for IC that Fight Inflammation
Inflammation, when trapped in a region, can increase pain and cause dysfunction (think of a knee swollen with arthritic pain, for example). With IC, inflammation tends to gather in the lower abdomen, just above the bladder, and on the inner thighs. You can test yourself by trying to (gently) lift the skin on your stomach or inner thighs up and away from the muscle underneath - if it feels tender or difficult to lift, it's likely that inflammation is playing a role in your condition.
L-Arginine - A common amino acid that is both made by the body and found in many foods, L-Arginine isn't generally included in many multivitamins or supplement blends because there is generally enough already present. It is a precursor to nitric oxide, a molecule that helps open up blood vessels and increase circulation.
The idea behind L-Arginine is that increasing blood flow and opening up blood vessels can help clear away some of the inflammation that builds up in the pelvic region with IC. It's one of the only supplements that has been truly evaluated in a published, scientific study specifically for interstitial cystitis. In a double-blind, randomized, controlled study of about fifty patients, 48% reported a significant overall improvement with their symptoms with 1,500 mg daily of L-Arginine. (As a comparison, two similar trials of the prescription drug Elmiron showed only 28% and 32% of patients showed a global benefit.) The group that received the placebo (sugar pill) only reported a 24% improvement. Improvements were noted in pain intensity, pain frequency, and urinary symptoms.
Omega-3 Fish Oil - Omega-3 is a type of oil found in (you guessed it!) fish that helps to fight inflammation. It's counterpart, Omega-6, is found in processed foods and increases inflammation - not surprisingly, most of us consume far more of the bad Omega-6 than the good Omega-3 oils. One study found that the American diet has more than twenty times as much of the 'bad' oils than the good Omega-3s.
Interstitial cystitis and pelvic pain both cause inflammation to build and linger around the bladder and pelvic floor, causing additional pain and dysfunction. Taking Omega-3 supplements (or trying to eat more fish!) can help balance out the bad oils in our daily diet and fight inflammation. When looking for a good Omega-3 supplement, try to find one with a 1.5:1 ratio of EPA:DHA, the two major components.
Quercetin - Quercetin is a bioflavonoid that may help IC symptoms and inflammation. It occurs naturally in apples broccoli, onions, blueberries and more! It reduces inflammation by scavenging free radicals within the body, stopping inflammation before it starts. Studies have shown Quercetin was effective in reducing pelvic pain in the closely related condition of chronic prostatitis, and may be beneficial for patients with IC. In supplements, it's often combined with Bromelain, which may have some analgesic or pain-reducing properties as well.
Antacids for Interstitial Cystitis
The majority (around 80%) of patients with IC have some level of food sensitivity. For many, this involves only a small handful of trigger foods - common triggers include citrus fruits and juices, caffeine, alcohol, tomatoes, artificial sweeteners, and spicy/exotic foods. Others are more diet-sensitive and have to be more careful about the foods they avoid.
Calcium Glycerophosphate (Prelief) - A mineral supplement and antacid, Prelief is the most common brand name for IC patients. Calcium glycerophosphate is taken before meals, particularly before eating or drinking a known trigger, to try and mitigate the dietary trigger. While there is conflicting evidence around the impact of acid - and 'acid in' does not always equal 'acid out' - in a survey conducted by the Interstitial Cystitis Association, Prelief was the highest-rated supplement, with nearly 75% of patients reporting a positive effect. When taken right before meals or eating a trigger food, the supplement has been reported to reduce both pelvic pain and urgency. This may be a great option for patients who are highly food-sensitive.
General Health Supplements for IC
The following supplements are for general, overall health and may positively impact IC symptoms
Vitamin D - Created naturally by the body, Vitamin D helps almost all body processes. Most of us live in latitudes where our body can't make enough Vitamin D, especially during winter months or if we're not regularly outside.
One study showed women with chronic pelvic pain were significantly more likely to have a Vitamin D deficiency than the general population, so it can be a good general supplement for health with IC.
Magnesium - Magnesium has a variety of effects in the body. It can help relieve constipation, reduces inflammation, supports muscle health and can help reduce anxiety in some studies. Obviously all of these are potentially beneficial to patients with IC!
Who are We at PelvicSanity?
At PelvicSanity, it's our mission to support patients with pelvic pain and pelvic floor symptoms, regardless of where you live. We can help with:
In-person treatment for those in Southern California at the PelvicSanity clinic
Immersive Out-of-Town program for those able to travel
Remote Consultations to get you expert 1:1 help, advice and an action plan
Online patient courses on Interstitial Cystitis and Movement for Pelvic Health
A Facebook support group for patients called Finding Pelvic Sanity.
Aloe Vera for IC
Some patients (about 10%) have very clear damage to the bladder lining. Known as Hunner's lesions, these bladder wounds can be cauterized and sealed to reduce symptoms. It has been hypothesized - but never convincingly proven - that some other patients may have microscopic damage to the bladder wall. Not large enough to be seen or to treat conventionally, breaks in the bladder lining may allow the irritants within the urine to penetrate and irritate the bladder. The supplements on this list attempt to provide the molecules that make up the bladder lining, giving the body the 'building blocks' to repair the bladder lining.
Aloe Vera - A cactus plant, aloe vera is one of the world's oldest known herbal remedies. It's commonly found in many cosmetics and lotions, and used to sooth burns and on healing wounds.
Preliminary research in animal models has found that oral aloe vera actually increased the production of GAG molecules in healing wounds - GAG molecules are the major component of the bladder lining. While this theory remains unproven in humans, it's an interesting hypothesis to treat the bladder right at the source.
In a large survey of 600 patients with IC conducted by Desert Harvest Aloe Vera, 92% of respondents reported "significant relief" from oral aloe vera. Although the results are not from a controlled study, and may self-select for patients who had benefit from the supplement, respondents reported improvements in pain, urethral burning, and urinary urgency/frequency.
If you're interested in Desert Harvest Aloe Vera you can find it here, and use the coupon code "PelvicSanity", which may give you additional savings!
Combination Supplements for IC Symptoms
Combinations of different supplements and medications can often be more beneficial than a single treatment, especially for a condition like IC where everyone responds differently. You can create a combination yourself of some of the above supplements, or some manufacturers have created a pre-mixed combination of different supplements for IC.
CystoProtek - A combination of different supplements, CystoProtek is another common choice for patients with IC. It combines elements from the anti-inflammatory and bladder building block segments above. These pills contain three components that are building blocks of the bladder lining, as well as two anti-inflammatory supplements. Chondroitin sulfate (150 mg), sodium hyaluronate (10 mg) and glucosamine sulfate (120 mg) are all GAG molecules that are found in the bladder lining, while Quercetin (150 mg) and Rutin (20 mg) are both anti-inflammatory flavonoids. Little scientific evidence is available about how this supplement affects interstitial cystitis, but anecdotally many patients report relief.
Bladder Builder - A relatively new supplement combination, Bladder Builder combines several of the supplements on this list, including L-Arginine and Quercetin. It also contains probiotics (which may or may not be helpful) and other vitamins like Vitamin D and magnesium.
Summary of Supplements for IC
Supplements can be an important adjunct to your IC treatment. While they likely be effective at finding lasting relief, they can certainly help and are best when combined with proven treatments like pelvic floor physical therapy for IC.
While these are some of the most common and most studied of the supplements on the market for interstitial cystitis, there are many more that may have similar benefits that have been less studied. Your symptom log can be a crucial resource as you evaluate which (if any) of these supplements has the most benefit for you. Hopefully this article will help you find a supplement that gives some relief without the side effects of many medications! For more information on everything IC-related and a deeper dive into nutrition, the IC Diet, and supplements, check out the IC: Roadmap to Recovery online course!
Dr. Nicole Cozean is the founder of PelvicSanity Physical Therapy in Orange County, CA. PelvicSanity treats patients from all over the world with remote consultations and the Immersive Out of Town Program. She also runs Pelvic PT Rising, training other pelvic PTs to better serve patients.
Named Physical Therapist of the Year, Dr. Nicole is author of the award-winning book The Interstitial Cystitis Solution and the first PT to serve on the ICA Board of Directors, Her passion is helping those with pelvic health issues - regardless of where they live - find lasting relief.