Frequently, I am asked a myriad of questions from women who are suffering with intense pelvic discomfort as well as women who have the urge to urinate frequently. For a number of women, constant trips to the bathroom control their lives. Some of these women go to the bathroom as often as 60 times a day and 10 times during the night! Numerous women are desperate to minimize an extremely painful, stabbing pain in their pelvis. The good news is that today, women have a variety of avenues they can explore when it comes to these symptoms, a common one; however, often misdiagnosed – a bladder condition called interstitial cystitis (IC), or painful bladder syndrome (PBS) is something I want to talk about.
Interstitial cystitis affects more than 1.2 million people in the United States, 90% of whom are women. Interstitial cystitis can affect women at all stages of life, from puberty to menopause, all of which have unique challenges with this condition. The condition is extremely uncomfortable and leads many women to search for answers. It is important to understand that our hormones, particularly estrogen, play a large role in managing (or even preventing) the inflammation that relates to IC. Even though the symptoms can feel similar to a urinary tract infection (UTI), nobody has been able to identify an infectious agent to date: consequently the condition won’t show up on regular urine cultures for bacteria and other pathogens. Unfortunately, taking antibiotics won’t help either. Nor will drinking more cranberry juice — natural UTI treatments can in fact make IC symptoms worse.
Interstitial cystitis can be downright unbearable for some women, preventing them from going to school, work, or participating in any of their normal day-to-day activities, not to mention making their sex lives very painful. Too often women just “live with it” for years before looking for help. Or a woman could see up to five different practitioners over the course of many years before being accurately diagnosed with Interstitial cystitis! I would like to talk a little bit more about this remarkable condition as well as look at what you can do to protect your bladder — as well as your sanity and over all lifestyle. Many different techniques have been tried but none have a huge success rate to date.
The symptoms of IC are easily confused with a wide range of other problems, from bladder infections (UTI’s) and urge incontinence to bladder cancer, endometriosis, STD’s, and kidney stones. These disorders have different root causes and need different types of treatments. A lot of women with IC see their healthcare practitioners thinking they have a UTI and are told their urine is “clean” —that means on culture that no abnormalities were seen in the urine when it was evaluated in the lab. If there is no detected “problem,” it frequently means that there simply is no easy solution for women.
There now exists diagnostic criteria for IC established by the National Institutes of Health Let’s look at what they are:
Interstitial cystitis is most often recognized as a chronic neuroinflammatory disorder affecting the bladder — a complex interrelationship between bladder nerves, the immune system, and the urinary tract. Untreated, IC can lead to scarring or stiffening of the bladder walls as well as an inability to hold much fluid in your bladder. Glomerulations, which are identified as hemorrhages in the mucosal lining of the bladder, and can also develop star-shaped sores called Hunner’s ulcers, this is seldom seen in clinical practice.
As more medical professionals learn to identify the IC conditions, they are better able to help women manage as well as overcome this disorder. The Interstitial Cystitis Association and the Interstitial Cystitis Network are wonderful organizations that are promoting more awareness of the varied causes and symptoms so more women can get relief.
We are still learning about IC, and to date there is no known cause that has been identified. There are probably many “insults” to the bladder that could lead to interstitial cystitis. What is clearly understood though is that inflammation is at play, with immune dysfunction, specifically allergies and sensitivities, having a central role. Here are a few possibilities. There does seem to be some ties with autoimmune disorders as well.
Chemicals in urine: Urine itself can be an irritant in the urinary tract, mainly if tissues were previously damaged from other primary causes. Urine will change as the diet changes. Studies show that patients with IC have a molecule in their urine called antiproliferative factor (APF). APF inhibits the normal growth of bladder wall cells, making it problematic for your bladder to repair itself if scarred.
Mast cell activation. Studies have shown that some of the contents found typically in our urine (like potassium, for example) can infiltrate the bladder lining in IC patients, leading to mast cell activation and the release of histamine — which can then result in further damage to the bladder lining and amplified inflammation. More than 70% of women with IC have highly activated mast cells. Again this is an example of the inflammatory system being on high alert.
Previous bladder damage: A number of factors can damage the bladder, making it more susceptible to the interstitial cystitis. Some of which include:
So many women remark that symptoms of IC ebb and flow with the natural hormonal shifting that occurs in our bodies monthly. Furthermore, some notice their first symptoms throughout the perimenopausal time frame. Why, you might ask? Well, it most likely has something to do with estrogen levels. A reduction in estrogen levels can activate our mast cells. Estrogen is an anti-inflammatory agent.
When evaluating bladder mast cells researchers at Tufts who examined the mast cells under an electron microscope also noticed a large number of estrogen receptors in cells from women with IC. The net result in these women is similar to hormones that are imbalanced. They described this as similar to a progesterone deficient state which lead to increased mast cell secretion of histamine. This is the body’s immune response to an offender.
In looking at the bladder’s anatomy, the bladder lining and the muscle that essentially governs urination, the detrusor, are greatly affected by inflammation, mast cell activity, and estrogen. If we have ongoing low-grade inflammation over the course of multiple years, particularly when coupled with significant hormonal fluctuations during perimenopause and menopause, the tissues and muscle can become thinner and drier — and even more susceptible to inflammatory changes. As a result without restoring our hormonal balance, there is a greater chance that we can become more susceptible to IC.
However, women have options when it comes to treating and managing interstitial cystitis. A good place for women to start is by looking at their diet and lifestyle.
Subsequently a lot of women say that their symptoms decrease when they follow an alkalizing, anti-inflammatory diet by avoiding certain trigger foods, and by eliminating caffeine, alcohol and smoking. Tobacco is a particularly common trigger because it constricts the bladder’s blood vessels, making it harder for our bodies to naturally cleanse inflammatory substances from the bladder tissues.
Here are the some of the foods that the Interstitial Cystitis Network calls “the most problematic” because they trigger the most symptoms in the most people. These top offenders are an excellent place to start:
A few additional items to this list of top offenders.
In our experience, the following substances also have the potential to trigger symptoms:
Once you learn just what foods set you off, you can begin to create a list of your trigger foods. Once you feel a lot better – which frequently will happen in just a week or two – experiment with just how much of each and every food your body definitely will process comfortably. Take heart: even the strictest IC diet doesn’t have to last forever. (The initial dietary changes are about calming down the bladder). But changing to a more alkalizing diet has tremendous overall health benefits for your body, and I know plenty of women with IC who are able to enjoy all of the above foods in smaller amounts!
Presently, there is not a cure for interstitial cystitis; however there are effective treatment options that do exist. Because our bladders can have trouble repairing themselves when we have IC, it is important that women speak with their healthcare practitioner as well as their urologist about the best IC treatment for them.
Here are some options:
There are certainly choices for you when you have interstitial cystitis. The first thing I recommend that you do is to talk to your healthcare practitioner about a combination of natural approaches that would work best for you, along with the IC diet in order to seek relief. Because with the right treatments, whether naturally and holistically, or through conventional medicine, the majority of us can learn how to manage our IC symptoms well enough to get out of the restroom, and back to our lives!
IC is often misdiagnosed as…
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