Conditions, Cystitis, Interstitial Cystitis

The Bladder-Gut Connection

Hippocrates already said over 2000 years ago that ‘all disease begins in the gut’. Today, we’re understanding more and more how right he was.

For me personally, gut issues preceded the onset of chronic cystitis and interstitial cystitis. When my gut was at its worst, so was my bladder. I have no doubt that, similarly to many other conditions, the gut is implicated in bladder problems.

Why the Gut plays such a big role in Health

Essentially, the gut is a barrier between our insides and the outside world. From mouth to anus, the digestive system is one continuous tube.

A large part of our immune system is therefore found in the gut, where it helps us deal with all the outside intruders entering the body on a daily basis.

The small intestine is the place where most nutrients are absorbed. Normally, only nutrients should make it through the barrier and into the bloodstream whilst everything else stays out.

Everything that can’t be digested by our bodies is excreted through the faeces.

The gut also provides a defensive barrier against pathogens entering the body.

Moreover, the gut houses the majority of our microbiome, which plays a very important part in our health. Disturbances in the balance of microbes in the gut have been implicated in many chronic disease states.

How the Urinary Tract is connected to the Gut

The urinary tract is one of the excretory organs of the body, meaning it is one of the organ systems dealing with waste products.

The urinary tract works with the intestines, as well as the lungs and skin (the other excretory organs).

After the nutrients have been absorbed in the gut, waste products are left behind in the bowel and blood. The blood is filtered through the kidneys, where urea (a protein waste product) is removed.

Other water-soluble waste products and toxins are also removed, and together with excess water urine is formed and passed into the bladder from where it can be excreted from the body.

Problems with increased intestinal-permeability (a.k.a ‘Leaky Gut’)

As mentioned above, the gut is normally selectively permeable – meaning some things (such as nutrients) get through into the bloodstream and lymph, whilst the rest is kept out.

Therefore, the cells lining the intestines are bound together by so-called ‘tight junctions’. These little structures are designed to open and close so that specific nutrients can be absorbed.

Problems arise when the mechanism for regulating the opening and closing of the tight junctions fails and they are left open.

This creates a situation where substances from the gut that normally aren’t supposed to enter the body can enter the bloodstream (and ultimately the urinary tract).

This can include food particles, microbes, pathogens and toxins. As you can probably imagine, this can create many problems for the body:

  • The immune system recognizes these foreign particles and microbes as invaders and may mount an immune response, which always includes an inflammatory response. Inflammation plays a role in most chronic health issues.
  • Food particles may be recognized as intruders, potentially leading to food intolerances.
  • Pathogenic microbes may be able to get into the body.

Examples of factors that may cause tight junctions to open:

  • Certain dietary proteins (especially gliadin from gluten)
  • Alcohol
  • Stress
  • Some drugs
  • Some infectious microbes

Implications for the Urinary Tract

It has been implicated that many infections on various body sites may stem from the gut, including urinary tract infections [1].

It has been suggested that microbes may translocate from the gut to other body sites such as the bladder, which in turn could play a role in urinary tract infections as well as IC [1].

Microbes could translocate via the anus and perineum to the bladder, or it may be possible that in cases of a ‘leaky gut’ they could enter from the gut via the bloodstream and the kidneys.

The translocation of bacterial waste products through an increasingly permeable gut wall into the blood may play a role in kidney disease by increasing inflammation [2] and in turn this could impact the bladder as what passes through the kidneys eventually ends up in the bladder.

Bacteria in the gut ferment the amino acids tyrosine and tryptophan, which results in waste compounds, including indoles that are excreted via the kidneys. An imbalance in gut bacteria may contribute to an excess of these compounds, which can create problems in the urinary tract [2].

In IC sufferers, it has been found that many also have issues with the gut (such as IBS) [3]. IC has also been linked with autoimmune disorders [4], which in turn have been linked with increased intestinal permeability [5].

Moreover, research has shown that IC sufferers also have an imbalance in gut flora: they are deficient in certain microbial strains, namely O. splanchnicus, F. prausnitzii, C. aerofaciens, E. sinensis, and L. longoviformis [6]. Two of these are of particular importance: F. prausnitzii is one of the butyrate producing bacteria, the fuel that keeps the gut cells healthy. L. longoviformis plays a role in oestrogen metabolism, and hormones in turn can play a role in bladder health.


For me, bladder issues have always gone hand in hand with gut issues. My bladder health improved significantly when I targeted my gut health.

Therefore, I think it is always important to look at the gut when someone has chronic bladder issues. Gut testing is part of the protocol I use for my clients.

How I your gut health? Do you think your bladder issues are connected to the gut? Let me know in the comments!

Pin it for later:


  • Kidney & Urology Foundation Urinary System and How it Works October 2006
  • BioCare Education Series: Digestion in Practice
  • Ballantyne, Sarah The Paleo Approach (USA, Victory Belt Publishing: 2013)
  • IC Network The DIPP Mystery – Why are IC patients deficient in some good bacteria? June 16th, 2016


  1. Latorre, M., Krishnareddy, S., & Freedberg, D. E. (2015). Microbiome as mediator: Do systemic infections start in the gut? World Journal of Gastroenterology : WJG, 21(37), 10487–10492.
  2. Al Khodor, S. & Shatat, I.F. Gut microbiome and kidney disease: a bidirectional relationship Pediatr Nephrol (2017) 32: 921
  3. Warren, J. et al Interstitial Cystitis/Bladder Pain Syndrome and Nonbladder Syndromes: Facts and Hypotheses Urology [78 (4): 727-732)
  4. Van De Merwe, J. et al Systemic aspects of interstitial cystitis, immunology and linkage with autoimmune disorders Int J Urology October 2003 [10: S35-S38]
  5. Fasano, A. Leaky Gut and Autoimmune Diseases Clinic Rev Allerg Immunol (2012) 42: 71.
  6. Braundmeier-Fleming, A. et al. “Stool-Based Biomarkers of Interstitial Cystitis/bladder Pain Syndrome.” Scientific Reports 6 (2016): 26083. PMC. Web. 29 Apr. 2018.


  • Reply


    May 1, 2018

    This was really helpful. Since my new IBD diagnosis I feel like there is always an issue with my bladder unless I’m drinking fluids constantly.

  • Reply


    May 1, 2018

    I have IC & I think ic could possibly be linked to the gut. I find it strange that when I have a big meal, it calms my frequency for a few hours but then soon as I have an empty stomach, my frequency returns and sometimes it’s horrendous, especially all night. I feel it’s always a lot worse during the night because the stomach is empty for a lot longer. I stick to a strict healthy diet which I’ve been doing for years now, cutting out all the things on the ic list that you shouldn’t have but yet I still have frequency and pain. I have tried cheat meals and I do find it always makes my symptoms worse. I found also that before I was on the contraceptive pill, I was constantly having severe flare ups. Most of the time I ended up in ambulances or the hospital on high doses of morphine for the Amount of severe pain I was in?I wanted to die all the time. I can’t describe the pain, it is extremely severe. I always found my flare ups were worse during my build up to my period and especially the first day I came on. The contraceptive pill has been a life saver now, I take around 63 days worth of pills before I have a 7 day break and since taking it, I don’t have them same severe flare ups anymore. I don’t know how the pill has helped but I do believe now that it is linked to my hormones so I agree.. hormones play a big part in the bladder/IC. I really wish there was a cure for this evil disease. I hardly get any sleep and work full time. It’s exhausting and has caused me to take so much time off work. I’m now close to losing my job so I can understand why a lot of ic sufferers don’t work. Please help find a cure for us ??

    • Reply


      May 2, 2018

      Dear Paula, I’m sorry your suffering so much. I think ‘cure’ is such a strong word and I don’t think there is ever going to be one single ‘cure’ for IC. But I believe we can improve our health by finding the root causes of the issue. You have already identified hormones as a potential issue ( I would say to anyone with chronic flares that it’s a good idea to make sure you don’t actually have an infection (read this With regards to frequency I’ve successfully overcome this by eating more and drinking less, eat a snack at night if you need to. When our blood is too diluted the body gets rid of excess water via urine. We want a salty blood solution, so one thing that helped me whenever I had this frequency (usually paired with cold hands and feet) is to eat carbohydrates and salt (e.g. a banana and a bit of sea salt – the carbohydrate helps absorb the salt). I know this sounds different to the standard advice but may be worth a try.

  • Reply

    Diana Georgescu

    July 8, 2018

    Hi Layla,

    What type of gut testing do you use for your clients? I am in the UK and although we don’t have as many options, there are some tests. I read about comprehensive stool tests for bacteria and yeasts, but I don’t quite understand how this is used in treatment. By indicating what kind of probiotics we should supplement with? My situation is complicated by the fact that I don’t seem to tolerate probiotics (bladder flare from yoghurt and the probiotics I tried). I have lived with IBS-D for at least 10 years and urgency/frequency for about 20 (peed once an hour at least), although pain/burning only started with a kidney stone 1 year ago. I have never had a positive urine test in my life although I was treated with antibiotics for urinary problems in my 20s. I recently sent a urine sample to Pathogenius/MicroGen and it only came up with 93% Lactobacilus crispatus and 3% Staphyloccocus hominis. Not terribly relevant.

    Thank you!

    • Reply


      July 8, 2018

      Hi Diana,
      I’m in the UK as well and I use a lab in Germany through BTS, which is a practitioner only service but I like it as it’s much cheaper than the Comprehensive stool analysis by other labs – you’d need to order through a practitioner though.
      I use it to give me an idea of any pathogens that are there which I may try to reduce and also which beneficial bacteria may need some support. I also like the urine organic acids test which can give us an idea of what’s going on in the upper gut (stool test can’t really do this) but this is more expensive than the BTS test.
      Issues with probiotics can be due to histamine issues as some strains produce histamine.
      Even these advanced urine tests could miss hidden infections but there is also the chance of organ cross talk, so if there’s an issue in the gut it could be felt in the bladder.

  • Reply

    Diana Georgescu

    July 8, 2018

    Thanks, Layla! Do we have a clearer understanding of the “normal”/”healthy” gut microbiome to guide treatment? I know the problem with the bladder microbiome is that we know too little to determine what might be a pathogen, but the gut microbiome has been studies for quite a while. Even so, there must be differences based on age, gender, race, area/diet in the normal microbiome. And surely the microbiome changes with age, and clearly in response to diet.

    • Reply


      July 8, 2018

      Well, there’s been a lot more research into the gut than the bladder, that’s for sure. We may never really know what a ‘healthy’ microbiome exactly looks like as the Western microbiome has been changed too much already (and it may be very indicidual). But we do have an understanding of some key players in the gut that produce important metabolites and help protect the gut, which seem to be present in most healthy people and also centenarians. We also know about some microbes that can cause issues, especially if they manage to ‘overgrow’. So far I have always found an imbalanced gut microbiome in people I test, including myself.
      And yes, the microbiome changes with age, but some researchers believe that maintaining some of these ‘gut guardian’ species plays a role in longevity. And of course food can change the composition, which is one of the reasons I like to know what’s in there so that the diet can be adjusted accordingly.

  • Reply


    July 25, 2018

    Layla, I looked at the tests you recommend on your consultation site, uBiome (I think), and it’s cheaper than what another bladder and gut sufferer recommended (the Genova comprehensive stool test). The online description for both tests is very basic and it makes it difficult to understand if Genova is more comprehensive than uBiome or maybe uses a more advanced DNA technology or checks for a larger list of bacteria. I know urine DNA tests vary in price depending on how large the database of bacteria tested is. Could you comment on these differences?

    • Reply


      July 26, 2018

      Hi Diana, so uBiome offers 2 different tests, the Explorer for consumers and the SmartGut as a clinical test. Both are based on sequenced DNA data but for the Explorer it doesn’t give any clinical information but you can see what bacteria are there – so you’d need to know what to look for. I like this but won’t be using it anymore as it takes too long to get results. The SmartGut test lists the bacteria with regards to health conditions – this is currently only available to US citizens but available on insurance. Both tests only look for bacteria but they do seem to have quite a large database.
      Now the Genova test looks at bacteria and yeasts, and there’s the option to include parasites as well. It also looks at inflammation and digestive markers. The cheaper test is a culture test as far as I know, while the expensive test also uses DNA sequencing and lists a range of key bacteria, but not as many as the uBiome. Personally I find their tests very expensive and I’ve picked up some issues with other testing that they hadn’t picked up, therefore it’s not my favorite test. Other similar tests are Doctor’s Data (which I haven’t used) and Great Plains. In the UK I use a lab called BTS for a more basic (but cheaper) stool test and I’ve started using the organic acids test, which is great for yeasts and also some bacteria but also offers loads of other markers.

  • Reply


    August 6, 2018

    This is very useful, Layla! I did have a look and have a few questions:
    1. Is “sequencing” the same as PCR? Is this the technology these two tests are using? I wish they gave a clear indication of their database of bacteria (there are tests saying they test for the 15 most common strains, for example. And does BTS’s German lab also use PCR?
    2. For uBiome SmartGut, do I need to be a US citizen (which I am) or have US health insurance (which i dont)? If the latter, is there an option to pay out of pocket?

    Thanks! I missed your message for so long as for some reason I don’t get email alerts on posts.

    • Reply


      August 9, 2018

      1. Yes, it’s the same and it’s what uBiome uses and I think the ‘big’ Genova tets. BTS uses culture but I have found them quite thorough. uBiome has a huge database of bacteria, you’d see them all in the Explorer results, whereas the SmartGut mainly looks at clinically relevant strains.
      2. You have to apply for SmartGut – this is what it says on the website: ‘SmartGut™ is healthcare provider-prescribed, insurance-reimbursed test. Your test request will be sent to a healthcare provider in an external clinical care coordination network to determine medical necessity.
      A claim will be sent to your health insurance once a completed sample is received in our lab, and we have patient assistance programs in place to assist eligible patients with the remaining patient responsibility.’

      Hope that helps!

  • Reply

    Marie Jeffries

    May 29, 2019

    Are there any test like these in the uk and are they as good.

    • Reply


      June 4, 2019

      Yes, all the stool tests are also available in the UK, they are the same US labs.

  • Reply

    Sherri Burich

    October 16, 2020

    I’m in the USA. I found your site, while researching chronic utis.
    I’ve had severe urinary retention, for years, and have to self-cath, at least twice a day, and void in my own in between. Initially, I was getting back to back UTI s, and was becoming increasingly antibiotic resistant. I was out on Macrobid, prophylactic, and I got my life back, somewhat.
    I also suffer from RA, and now SIBO, which is probably a result of the medications.
    As of the beginning of September, I’ve been on 5 different antibiotics, and 5 doses of Monoural for an E Coli UTI, that either doesn’t clear up, or hits again.
    Each time, I have a large BM or loose stools, and I feel burning in my intestines, then BOOM: a bladder infection! I’m convinced their coming from leaky gut, but cannot get any help!
    Does anyone have advice, or been through a similar experience? I cannot go on like this, especially since it’s further destroying my gut!

  • Reply

    Zully Diaz

    November 23, 2020

    Hello. I’ve been experiencing painful bladder spells for the last 5 weeks. I’ve had pelvic exams, basic blood work, Transvaginal ultrasound to ensure that my reproductive organs were on. A renal ultrasound, and just recently a cystoscopy. All test came back fine, no signs of IC. just slight inflammation. My pain and discomfort is strictly localized in my WITHOUT the painful urination. It’s the bladder and sometimes it’s so painful that it radiates down south. There is no other pain, which now I’m beginning to wonder if my gut is causing these issues and irritating my bladder. HELP!

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