CYSTITIS (Interstitial, Infection)

Interstitial cystitis (“painful bladder syndrome”) is a painful and puzzling bladder condition, in which irritation and/or inflammation of the bladder wall can eventually lead to scarring and diminished bladder capacity. The bladder wall may also bleed, either from pinpoint areas called glomerulations, or from larger open sores called Hunner’s ulcers.

The exact cause of interstitial cystitis remains a mystery, although some researchers suspect that the basic problem stems from some unidentified disturbance in the protective inner lining of the bladder. There is also some evidence that interstitial cystitis may not be just one illness, but several illnesses that share similar symptoms.

Currently, about 500,000 Americans suffer from interstitial cystitis, usually during their middle decades (ages 20-50). Although approximately 90% of these patients are women, the precise reason why interstitial cystitis favors females remains a mystery. There is also no known genetic (inherited) or toxic-environmental basis for the illness.

Symptoms
Interstitial cystitis may cause:

* frequency (unusually frequent urination)
* urgency (an intense urge to urinate)
* nocturia (awakening from sleep to pass urine)
* dysuria (burning sensation during urination)
* pain, pressure, or tenderness in the area of the bladder (midline, below the navel), or in some other portion of the pelvis
* increasing discomfort as the bladder fills
* pain during sexual intercourse
* in men, pain or discomfort in the penis and scrotum.

In women, symptoms of interstitial cystitis may worsen during menstrual periods.

Bladder Infection

A bladder infection, also called cystitis, is the abnormal growth of bacteria inside the urinary bladder. Since the normal internal environment of a healthy urinary bladder should be sterile (germ-free), any growth of bacteria inside the bladder is considered to be an infection, whether or not it produces symptoms. In general, bladder infections are classified into two basic types, community-acquired and nosocomial (hospital-acquired).

Community-acquired bladder infections – Community-acquired bladder infections occur spontaneously in persons who do not have urinary catheters or other reasons for bacteria to enter the bladder (such as a history of diagnostic or surgical procedures of the urinary tract). Community-acquired bladder infections are very common in women between ages 20 and 50, but are very rare in men of the same age group. In adult women, these infections are almost always caused by bacteria from the intestines, especially E. coli. This seems to be related to the fact that the urethral opening (opening where urine comes out) is very close to the rectum in women, allowing intestinal bacteria to be easily transferred to the urethra during sexual intercourse. Even in young girls, back-to-front wiping with toilet tissue after a bowel movement often helps to transfer bacteria from the rectum to the urethra. Once bacteria enter the urethra in females, it is only a short distance (about 4 cm, or less than 2 inches) until they arrive at the base of the bladder. Women should always try to wipe front to back. When bladder infections affect men over age 50, they are almost always related to an obstruction of the urethra due to an enlarged prostate or a prostate infection. Other factors which increase the risk for community-acquired bladder infections include: pregnancy; use of a diaphragm and/or spermicide for contraception; kidney stones; bladder tumors; nerve problems affecting the bladder; and structural abnormalities of the urinary tract.

Nosocomial bladder infections – This type of bladder infection commonly occurs in a hospitalized patient who has a urethral catheter (a tube inserted into the urethra to collect urine), or who has undergone a diagnostic or surgical procedure of the urinary tract. In catheterized patients, bacteria enter the bladder along the route of the catheter tube, either along the outside wall of the tube, or inside the tube through the column of collected urine. As in community-acquired infections, E. coli is a common culprit in nosocomial bladder infections; however, other bacteria such as Proteus, Pseudomonas, Klebsiella, or Serratia may also be seen. Because these bacteria are accustomed to living in a hospital environment where antibiotics are common, they tend to be resistant to many of the typical antibiotics, which are normally used to treat community-acquired bladder infections. Treatment of these infections may require more high-powered antibiotics.

Symptoms

Most nosocomial bladder infections associated with catheters cause few symptoms and no fever. In patients with community-acquired bladder infections, however, symptoms usually include one or more of the following:

* frequency – the need to urinate more often than normal
* urgency – a persistent feeling that you need to pass urine
* dysuria – pain, burning, or other discomfort during urination
* lower abdominal pain
* hematuria – blood in the urine
* urine that is cloudy, has an unpleasant odor, or has an unusually strong smell

There may also be a generally “sick” feeling and a mild fever. In younger patients, there may be new episodes of nocturia (bed-wetting) in a child who was previously “dry” through the night.

NOTE: IF THERE IS AN INFECTION OF THE BLADDER DIAGNOSED YOU SHOULD BE UNDER THE CARE OF A COMPETENT MEDICAL PROFESSIONAL WHO WILL PROBABLY USE AN ANTIBIOTIC. The following program suggestions are for those who continue to have problems with their bladder.

Pre-Disposing Factors:

a. Bladder irritation and/or inflammation.

b. Very high or low urinary pH.

c. Immune dysfunction.

d. Food and/or environmental sensitivity.

e. Bacterial, viral or yeast infection (infrequent).

f. Insufficient water intake.

Dietary Suggestions:

a. Sip 2 to 3 oz. (1 mouthful) of distilled or filtered water every 30 minutes, while awake, daily (no well water or water containing fluoride or chlorine); more if you are perspiring.

b. If food sensitivity is suspected, eliminate dairy products, gluten-containing grains, citrus, and gelatin.

c. Avoid refined carbohydrates and processed foods.
d. Eliminate all hydrogenated fats and oils. Eat only fish oils, extra virgin olive oils and coconut oil as your only oils. Coconut oil is a very health and anti-infective oil.

e. Increase raw foods. Use only quality proteins like sea vegetables; however, insure protein intake
is reduced until the problem resolves.

NUTRITIONAL SUPPLEMENTS

Primary Nutrients:
1. BIO-MULTI PLUS – 1 tablet, 3 times daily after meals.

2. BIO-C PLUS 1000 – 1 tablet, 3 times daily after meals.

3. M S M POWDER – 1/2 teaspoonful 2 to 4 times daily depending on the severity of symptoms. NOTE: Try to take MSM with your Vitamin C.

4. BIOMEGA-3 – 4 capsules, once daily after a meal.

Specific Nutrients: When symptoms or condition begins to subside, gradually, as needed, wean yourself from the Specific Nutrients & stay on the Primary Nutrients. If any symptoms re-occur resume taking Specific Nutrients.

5a. SUPER PHOSPHOZYME – 3 tablets, 3 times daily after meals if urinary pH is above 6.5 (average of 8 samples). Maintain this acid ash diet low in heavy diatary proteins until problem resolves.

or

5b. K-ZYME – 1 Tablet, 3 times daily after meals if urinary pH is below 5.5 (average of 8 samples).

6. BIO-AE-MULSION FORTE – 5 drops, on the tongue and washed down with water once daily after a meal to repair the smooth muscles of the bladder.

7. ARGIZYME – 2 capsules, 3 times daily after meals.

8. RENAL PLUS – 3 tablets, 3 times daily after meals.

9. INTENZYME FORTE – 5 tablets, 3 times daily between meals and at bedtime on empty stomach for pain and inflammation.

ALSO, for on: control specific to the bladder:

10. BIO-CYANIDINS – 2 tablets, twice daily after meals.

11. L-ARGININE – 1 capsule, 3 times daily after meals.

12. BIO-HPF – 2 capsules, twice daily after meals to relax the smooth muscles of the bladder.

ADDENDUM

Interstitial Cystitis: A Bladder Disorder

The urinary system consists of the kidneys, ureters, bladder, and urethra. The kidneys, a pair of purplish-brown organs, are located below the ribs toward the middle of the back. The kidneys remove liquid waste from the blood in the form of urine, keep a stable balance of salts and other substances in the blood, and produce erythropoietin, a hormone that aids the formation of red blood cells. Narrow tubes called ureters carry urine from the kidneys to the bladder, a triangle-shaped chamber in the lower abdomen. Like a balloon, the bladder’s elastic walls relax and expand to store urine and contract and flatten when urine is emptied through the urethra. The typical adult bladder can store about 1 1/2 cups of urine.

Adults pass about a quart and a half of urine each day. The amount of urine varies, depending on the fluids and foods a person consumes. The volume formed at night is about half that formed in the daytime.

Normal urine is sterile. It contains fluids, salts and waste products, but it is free of bacteria, viruses and fungi. The tissues of the bladder are isolated from urine and toxic substances by a coating that discourages bacteria from attaching and growing on the bladder wall.

People with interstitial cystitis (IC) have an inflamedt, wirritated, bladder wall. This inflammation can lead to scarring and stiffening of the bladder, decreased bladder capacity, glomerulations (pinpoint bleeding) and, in rare cases, ulcers in the bladder lining.

IC, also known as painful bladder syndrome and frequency-urgency-dysuria syndrome, is a complex, chronic disorder that has baffled doctors for as long as it has been recognized.

Estimates of the number of people who have IC run as high as 500,000, but no one knows for sure how many people have it. About 90 percent of IC patients are women. While people of any age can be affected, about two-thirds of patients are in their twenties, thirties, or forties. IC is rare in children. In a few cases, IC has afflicted both mother and daughter, but there is no evidence that the disorder is hereditary, or genetically passed from parent to child.

Two Types of IC

Because IC varies so much in its symptoms and severity, most researchers believe that it is not one but several diseases. Two types of IC are usually described; they are mainly distinguished by whether ulcers have formed on the bladder wall. Most researchers believe that IC does not generally progress from the non-ulcerative to the ulcerative form.

1. Non-ulcerative IC

This disorder is the most common type of IC. It usually affects young to middle-age women who have a normal, near normal, or increased bladder capacity when measured under general anesthesia. Glomerulations can be seen in the bladder wall.

2. Ulcerative IC

This type of IC tends to be found in middle-age to older women. Bladder capacity is low (less than 1 1/2 cups) when measured under general anesthesia. The decrease is thought to result in part from fibrosis, the formation of threadlike tissue that makes the bladder stiff and small. Cracks, scars, and Hunner’s ulcers (star-shaped sores) in the bladder wall may bleed when the bladder is filled to capacity during a cystoscopy.

Cause

No one knows what causes IC, but doctors studying the disorder believe it is a real, physical problem–not a result, symptom, or sign of an emotional problem.

One area of research on the cause of IC has focused on the lining of the bladder called the glycocalyx, made up primarily of substances called mucins and glycosaminoglycans (GAGs). This layer normally protects the bladder wall from toxic effects of urine and its contents. Researchers at the University of California, San Diego, found that this protective layer of the bladder was “leaky” in about 70 percent of IC patients they examined and may allow substances in urine to pass into the bladder wall and trigger IC symptoms. The researchers also found that patients with Hunner’s ulcers had “leakier” bladders than patients without the ulcers.

Some people are diagnosed with IC after taking antibiotics for a presumed urinary tract infection. Therefore, it has been suggested that antibiotics may damage the bladder wall and make it “leaky.” This idea has been studied carefully, but antibiotics have never been found to harm the bladder wall. Thus, other ideas are more likely to explain why some IC patients are diagnosed after a urinary tract infection. It is possible that the infection started an autoimmune response against the bladder, the patient’s original symptoms were from IC all along, or an infecting organism is in bladder cells but is not detectable through routine tests.

Prevention

Since doctors do not know the cause of interstitial cystitis, there are currently no guidelines for its prevention.

In persons who have already been diagnosed with interstitial cystitis, symptoms may be less likely to flare up if the patient: quits smoking cigarettes; avoids drinking beverages containing alcohol, caffeine, or citrus juice; and avoids eating chocolate, spices, or high-acid foods, such as tomatoes and citrus fruits. SEE BELOW

A Top Ten Food Trigger List

The following selections show the most common foods which have provoked flares in some IC patients. This doesn’t mean that you need to avoid all of these foods, but you should pay close attention to how you feel after eating them. If you feel worse, then there is a good chance that this is a trigger food for you. Information is power. Whenever possible, talk with other patients and compare your trigger foods. The may help you discover some hidden triggers in your own diet.

#1: Cranberry Juices & Extracts
Otherwise known as the ACID BOMB when it hits the bladder, cranberry juice may be the most frequent irritant in an IC patient’s diet. Recommended for consumption during urinary tract infections, cranberry juice can be very difficult for an IC bladder to tolerate. If you’re addicted to it, try diluting it by half or more!

#2: Coffee & Tea Products
Yes, we know that “lattes” and other coffee products are all the rage in the 1990’s. However, in a sensitive bladder, coffee has little competition for causing intense bladder irritation. Some can tolerate low acid coffees, while others try teas. For the most sensitive IC patient, the best option for a hot drink in the morning is hot water and honey.

#3: Carbonated Beverages & Sodas of Any Type (diet & regular)
Whether it be plain carbonated water or flavored sodas, IC patients often complain about their effects on the bladder. Of particular note are fountain drawn sodas at movie theatres, which seem to be far more acidic than sodas available in a can. For diet soda fans, you should educate yourself about the controversies surrounding sugar substitutes (aspartame, saccharin), which may cause bladder irritation in even healthy bladders. The most difficult soda to tolerate appears to be diet cola, which is a quadruple whammy of carbonation, caffeine, aspartame and cocoa derivatives, four known bladder irritants. Taken all at once it can be one of an IC patients worst trigger. If you must have a soda, try a clear, non-diet soda, like Seven Up?.

#4: Tomatoes, Tofu and some Beans
Frequently found in our diets, red tomatoes can be very acidic and worth reviewing closely. Some IC patients can tolerate pizza and tomato sauces for pasta, while others cannot. Low acid yellow tomatoes may be good substitutes in pasta and salads. Fava, black, lima & soy beans are also potential irritants due to their high acid content.

#5: Herbal Teas
IC patients can be sensitive to herbs, particularly teas that have many ingredients. If you’re determined to continue, try experimenting with one or two ingredients at a time. That way, you’ll be able to tell if a particular herb irritates you!

#6: Tobacco
Veteran IC patients prefer less pain rather than more. Is that cigarette worth a night and day of pain?

#7: Alcohol & Vinegars
Do you remember how Bactine used to sting on small cuts. Just imagine how this would feel when inside your bladder on far more sensitive tissues. That means wine, beer, champagne and even wine sauces could be irritants due to their alcoholic content. Some patients find that white wines are more tolerable than red wines due, most likely, to their reduced histamine content.

#8: Chocolate
Yes, we know that chocoholics will hate this one but if you do your research you’ll discover that chocolate is considered one of the worst irritants for the body. It is known to contribute to migraine headaches and food allergies. Some recommend trying white chocolate as an alternative. But, wouldn’t it be better to avoid it all together for a while?

#9: Strawberries & other acidic fruits
One of the most acid of the fruits, strawberries can be deceptively healthy until they hit the bladder. Lemon, orange, grapefruit, pineapples and plums have also been known to inflame our sensitive bladders. Fruit juices seem to be particularly difficult for some patients to tolerate because each can of juice may represent the acid of more than just one fruit. If you are addicted to juice, try low acid fruit juices and/or diluting it 1:3 or 1:4.

Remember, quantity also appears to be an issue. An IC patient may be able to tolerate one or two strawberries with no symptoms, but more strawberries could cause additional symptoms. Be prepared to experiment.

#10: Food Additives & Seasonings
Food additives are known to provoke chemical sensitivities and allergic reactions in a small percentage of the general public, particularly monosodium glutamate (MSG), nitrates and BHT. MSG acts as a mast cell degranulator and can provoke a wide variety of allergic symptoms. Found frequently in prepared foods and mixes, a careful review of ingredient labels should eliminate foods that include MSG, including: hydrolyzed vegetable protein, texturized vegetable protein, autolyzed yeast, sodium & calcium caseinate. The nitrates found in prepared meats have long been suspected as IC triggers, in part due to recent research demonstrating the possible involvement of NO2 in triggering IC pain. BHT, commonly found in boxed cereals and breads, can also cause symptoms. More information on both preservatives can be found in the book “A Taste of the Good Life: A Cookbook for an Interstitial Cystitis Diet.” Please note that garlic, however, is usually okay! (Thank goodness!)

LINKS:

The National Kidney and Urologic Diseases Information Clearinghouse
3 Information Way
Bethesda, MD 2089ith 80
www.niddk.nih.gov Dth/kidney/nkudic.htm

American Foundation for Urologic Disease
1128 North Charles Street
Baltimore, MD 21201
Telephone: 1-800-242-2383

Interstitial Cystitis Association
51 Monroe St. Suite 1402
Rockville, MD 20850
(800) HELPICA
(301)610-5300

The Interstitial Cystitis Network

Interstitial Cystitis Organization

Urology Channel

Center for Bladder Control

Urinary Tract Infection Help Zone