Chronic & Interstitial Cystitis

Do you have recurrent Cystitis or Interstitial Cystitis …………..Please read this Blog and get in touch if you would like to take a different approach.

It is believed that 1 in 2 women will contract a UTI in their lifetime and for some it is recurrent/chronic and for others it is interstitial cystitis (IC) – and according to what we believe, IC is a lifelong inflammatory condition with no cure.

The cause of UTIs and IC is unknown and women have been suffering for years with:

• chronic debilitating pain,

• lack of sleep,

• disruptions in their daily life and

• a lifetime of NHS treatment and antibiotics that has not worked for them. There are often other crossover issues such as IBS, fibromyalgia and chronic fatigue syndrome. The diet many women follow to address IC is very restrictive and often just not sustainable.

However using Microgen Testing, which looks at the good and bad bacteria in your urine, it has been revealed that the infection is often embedded and chronic with an underlying bacterial infection, hidden by biofilms. So when you go for traditional testing, it is possible that nothing is found – and you get that sinking feeling as you know something is definitely wrong.

So what are biofilms? They are a sort of a cloaking device which renders the test inadequate – as the bacteria is protected and hidden.  According to Graziottin & Zanello (2015) “biofilms are a reservoir of microorganisms immune to antibiotics and to immune system effectors. Mimicking what happens in the outer world, they are equivalent of intracellular “terrorists” difficult to be reached by antibiotics and the host’ immune system, and yet capable of progressive tissue damage and inflammation. They cause chronic inflammation of the bladder wall, which can evolve to cause a “painful bladder syndrome”, and “interstitial cystitis”. Some bacteria even make their own biofilms to protect themselves- so before you test you should take a biofilm disruptor! This should remove the biofilm protection, cause the bacteria to be released and a test can pick it up.

There is a recent article, 8th November 2023, in The Independent talking about research conducted by University College London (UCL) who researched the same issue of "hidden bacteria" and their results support that it could be responsible for recurrent infections - have a read ‘Hidden’ bacteria could explain chronic urinary tract infections | The Independent

Some women have reported experiencing their first bout of cystitis following an infection of COVID. Research by Kangro et al. (2022/23) has indicated that there has been an increase since COVID possibly caused by the activation of coagulation, fibrin and associated biofilms.

But it’s not just any Biofilm Disruptor you should take – there are some questions to establish the right one to choose. The Microgen testing will identify what’s there, the percentages present and how to tackle the bacteria in a targeted way - but we would need to talk about which is the right Biofilm Disruptor for you.

Research has also indicated that the majority of women with ITUs and IC have Vitamin D Receptor mutations – meaning your body may not be processing the synthesis of your Vitamin D properly and it may be low. We all know how important Vitamin D is for so many things in the body; but specifically with regards to bladder health, Vitamin D induces cathelicidin which reduces the risk of infection in the bladder.

Another aspect is that the majority of women with ITUs and IC have a tendency to produce too much ammonia. This may create an alkaline environment in the bladder and a high urine pH which a number of pathogenic bacteria loves. But it is possible to lower the pH of the urine and ensure that you create an inhospitable place for the bad bacteria to thrive and cause problems.

So what does the current literature say about UTI’s?

Cystitis (Bladder Infection)

Cause: Often caused by Escherichia coli (E. coli), a type of bacteria commonly found in the gastrointestinal tract.

Symptoms: Frequent urge to urinate, burning sensation during urination, cloudy or strong-smelling urine, pelvic pain in women.

Urethritis (Urethra Infection)

Cause: Can be caused by E. coli or other bacteria transferred from the anus to the urethra, as well as sexually transmitted infections (STIs) such as gonorrhoea and chlamydia.

Symptoms: Burning with urination, discharge from the urethra.

Pyelonephritis (Kidney Infection):

Cause: Bacteria from a bladder infection can travel up the ureters to the kidneys.

Symptoms: Upper back and side pain, high fever, shaking and chills, nausea, vomiting.

And what about Interstitial Cystitis……….

Interstitial cystitis (IC), also known as bladder pain syndrome (BPS), is a chronic condition that causes bladder pressure, bladder pain, and sometimes pelvic pain. The pain ranges from mild discomfort to severe pain. Unlike typical urinary tract infections, IC is not caused by a bacterial infection and does not respond to antibiotic treatment.

Symptoms:

·       Chronic Pelvic Pain: Persistent pain in the bladder and pelvic region.

·       Urgency to Urinate: A frequent, urgent need to urinate, even though the bladder may not be full.

·       Frequent Urination: Often urinating in small amounts, sometimes up to 60 times a day.

·       Pain During Intercourse: Discomfort or pain during sexual intercourse.

·       Painful Bladder: Pain that worsens as the bladder fills and is relieved after urination.

 Causes and Risk Factors: The exact cause of interstitial cystitis is unknown, but several factors may

contribute:

·       Defects in the Bladder Lining: A defect in the bladder epithelium (the protective lining of the bladder) could allow toxic substances in urine to irritate the bladder wall.

·       Autoimmune Reaction: The immune system may mistakenly attack the bladder tissues.

·       Genetic Factors: IC may run in families, suggesting a genetic predisposition.

·       Infections: Previous bacterial infections could contribute to IC, though they are not the direct cause.

·       Nerve Involvement: Abnormal nerve signalling may cause the pain associated with IC.

Diagnosis: Diagnosing interstitial cystitis can be challenging as its symptoms overlap with other urinary

disorders. The diagnosis is often made based on:

·       Patient History: Detailed symptoms and medical history review.

·       Physical Exam: Including a pelvic exam.

·       Urinalysis and Urine Culture: To rule out infection.

·       Cystoscopy: Using a scope to look inside the bladder and possibly take a biopsy.

·       Bladder Distension: Stretching the bladder with water or gas to see if symptoms temporarily

improve.

Treatment: There is no cure for interstitial cystitis, but various treatments can help manage symptoms:

·       Lifestyle Changes: Dietary modifications, avoiding foods and beverages that irritate the bladder

(such as caffeine, alcohol, and acidic foods).

·       Bladder Training: Techniques to help the bladder hold more urine and reduce the frequency of

urination.

·       Physical Therapy: For pelvic floor muscle dysfunction.

·       Medications: Oral medications such as pain relievers, antihistamines, pentosan polysulfate sodium,

or antidepressants.

·       Bladder Instillation: Direct application of medication into the bladder.

·       Nerve Stimulation: Techniques such as transcutaneous electrical nerve stimulation (TENS) or sacral

nerve stimulation.

·       Surgery: In severe cases, surgical options may be considered.

References:

Nickel JC, et al. Interstitial cystitis/painful bladder syndrome and associated medical conditions with an emphasis on irritable bowel syndrome, fibromyalgia and chronic fatigue syndrome. J Urol. 2010 Oct 31;184(4):1358-63.

Graziottin A, Zanello PP. Pathogenic Biofilms as Triggers of Recurrent Vaginitis and Cystitis. Controversies In Obstetrics, Gynecology & Infertility (Cogi). 2015:3. 

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)**: [Interstitial Cystitis/Bladder Pain Syndrome] (https://www.niddk.nih.gov/health-information/urologic-diseases/interstitial-cystitis)

American Urological Association (AUA): [Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome] (https://www.auanet.org/guidelines/interstitial-cystitis/bladder-pain-syndrome-(2014-amended-2018))

Mayo Clinic: [Interstitial Cystitis] (https://www.mayoclinic.org/diseases-conditions/interstitial-cystitis/symptoms-causes/syc-20354357)

Kangro K, et al. Fibrinogen, Fibrin, and Fibrin Degradation Products in COVID-19. Curr Drug Targets. 2022;23(17):1593-1602