Dietary sensitivity of interstitial cystitis - Bane and opportunity

The chronic pelvic pain condition interstitial cystitis (IC) causes major morbidity due to severe pelvic pain and voiding dysfunction. Recent patient survey data have clarified the association of specific comestibles with exacerbated bladder symptoms, yet the precise mechanism of these effects is unknown. Previous studies of pelvic neurophysiology, combined with more recent studies of pain behaviour, demonstrate significant cross-talk between the bladder and the gastrointestinal(GI) tract. This cross-talk reveals that the gut positively and negatively modulates bladder-associated pelvic pain, raising the possibility of IC therapies that target the bladder indirectly viahe GI tract. Dietary modification represents one such strategy already employed by patients to minimise IC symptoms. Another potential therapy extrapolates the current use of intravesical anaesthetics to the lower GI tract. Finally, recent microbiome studies suggest that GI probiotics may be harnessed to treat IC via organ cross-talk. Therefore, the initial observation that IC patients exhibit dietary sensitivities may lead to novel therapeutic opportunities.