Painful Bladder Syndrome (PBS) or Interstitial Cystitis is a chronic inflammatory condition of the bladder. As a result of repeated irritation, and damage to the epithelial lining, the protective layer of mucous and its soup of ‘good’ bacteria is stripped away leaving the nerves irritated and bladder wall increasingly exposed, red raw and eventually ulcerated and scarred.
With each attack the stretchy walls of the bladder are weakened and hold less and less urine. It causes frequent urination, especially during the night and a constant dull nagging pain as soon as the bladder begins to fill with even the tiniest trickle of urine.
It’s not painful to pee like ordinary cystitis. It doesn’t respond to antibiotics because it’s non-bacterial. Pain killers can ease the pain but when taken too often can eventually do more harm than good to the bladder wall. It can come on in bouts of muscle spasm and irritation and then settle down. Or it can dig in for good. It can also be difficult to diagnose. Sometimes being wrongly treated with antibiotics which strip the gut and bladder of more protective bacteria or cranberry and high dose vitamin C – which is the right thing to do for bacterial bladder infections or cystitis but the wrong thing to do for IC – as it’s just like pouring acid on a red and inflamed bladder wall.
So how does the bladder become so damaged and what’s stopping it from healing? There’s often a perfect storm of causative factors – damaged or weakened pelvic floor, often from childbirth, or as a result of age and the menopause, stress. It’s often described as Bladder Pain Syndrome (BPS) or IBS of the bladder, and very often women who suffer from IBS, food allergies and poor gut health, especially an impaired gut microbiome are more prone to IC. The whole nervous system can become over-reactive and on edge including the nerve fibres of the bladder which become hyper-reactive and easily irritated. Even by too much exercise, too vigorous exercise, sex or sitting or standing for too long.
Beneficial or ‘good’ bacteria support the immune health of the large intestine, urethra and the bladder and will translocate or move between the gut, the vagina, and the bladder. Repeated courses of antibiotics or a poor diet, high in sugar, food additives and refined carbohydrates is often linked to IC – because these women are more likely to have a reduced number of good bacteria throughout the GALT – gut immune system or mucosal layer of the large intestine and bladder.
Repeatedly taking anti-inflammatories or NSAID’s can also result in irritation along the length of the epithelial lining of the large intestine and bladder. NSAID’s also known as COX 1 and 2 inhibitors do an excellent job of blocking inflammatory prostaglandins which cause inflammation and pain but they also block the repairing action of the epithelial lining and strip the protective mucosal layer.
To improve bladder function, lessen symptoms and completely heal from IC – if its caught soon enough – you have to quite simply, switch off the inflammation by not irritating the bladder any further with acidic foods and drinks, fruits (especially citrus); or those high in tannins (like tea) or caffeine (coffee, coca cola, hot chocolate, green tea and mate) which all stimulate and set the nervous system jangling. Read labels carefully so you cut out food preservatives, even natural ones like citric acid, ascorbic acid, or vitamin C can fire up your IC. All carbonated or fizzy drinks, are not only sugary, but also the bubbles are made by adding carbon dioxide which contains carbonic acid and is an irritant. No vinegars or pickles. Reduce salt. Limit sugar and choose organic maple syrup, honey and coconut sugar, stevia or xyilitol if you need to sweeten anything.
Stick to an unrefined anti-inflammatory Mediterranean diet of good quality protein – meat, fish, especially oily fish (mackerel, sardines, salmon, herring and anchovies), seafood, olive oil, coconut oil, grass-fed organic butter, nuts, seeds, legumes, tofu, tempeh, all vegetables, especially dark green leafy vegetables, salad leaves, watercress, cucumber, rocket and the less acidic fruits ( no citrus, no tomatoes instead choose all berries eg: raspberries, blueberries, but not cranberries, coconut, bananas, dates, pears, watermelon, aaples, homemade applesauce, apricots, cherries, mango, melon.)
Have more LOW GI grains, wholegrain and wholemeal grains, brown rice, quinoa, buckwheat, oats and sweet potatoes which have a more blood sugar balancing effect on your body, contain more fibre and more nutrients.
Don’t Skip Meals eating 3 meals a day and 2 snacks protects your body from the damaging effects of unregulated blood sugar balance. The roller coaster effect of a refine, sugary diet and meal skipping on your cortisol levels. Over time this roller coaster effect leaves the body exhausted and stressed.
Identify food allergies – find out what foods might be irritating your gut and causing leaky gut. Order a Food Allergy or (IGg) kit via your nutritionist or naturopath. Check to see whether you need to have gluten and dairy free diet. Do you bloat when you eat gluten? Do you feel tired after eating gluten. Are there other foods you know give you symptoms – tomatoes, potatoes, aubergines – deadly nightshade family or certain nuts or legumes. An elimination diet, followed by a 4R or 5R gut healing programme can restore your digestive health and halt the inflammatory backlash of IBS, IBD, diarrheah or constipation. But get some help – some of you will need a FodMaps diet or a restricted fibre diet to start with. Those of you who already have auto-immune issues may need to be on an Auto-Immune diet – which cuts outs gluten, dairy grains and legumes. So seek support from a nutritionist or naturopath to properly guide you for a few months. As all of you will be individual. Some of you need to start the gut healing process more sensitively or intensely than others. Get guidance. Otherwise you’ll lose heart trying to interpret what your body’s sensitive to or not.
Hydrate well –It’s important to drink at least 6-8 glasses of water per day to stay hydrated, reduce inflammation, stave off constipation and keeping urine from becoming too concentrated and acidic. Sipping fluids throughout the day can keep the body more hydrated and lessen trips to the bladder. Most inflammatory pain conditions become more noticeable at night when we’re trying to sleep. The more hydrated and calmed the inflamed walls of your bladder are before you go to bed the less pain and the more sleep you’ll have.
Drink plenty of herbal teas – preferable loose leaf relaxing teas, chamomile, lavender, cinnamon, turmeric, fennel, calendula, lemon balm or verbena, mint, valerian, rose buds, hops, spearmint and (DGL) licorice will all help down regulate, or switch of the pain pathways and allow your bladder repair. Cucumber water – strips of cucumber, use a vegetable peeler, in a jug of water. Parsley and cornsilk are also wonderfully soothing for the bladder.
The herb Gotu Kola is an adaptogenic herb which supports adrenal and nervous system health and has also been shown to heal ulcerations of the bladder wall in IC.
Aloe Vera Juice is well known for its cooling anti-septic and anti-inflammatory effects but for IC sufferers it has an added magic ingredient. It’s high in glycosaminoglycans or (GAGS) which help fix the damaged GAG layer of the bladder itself. Make sure no citric acid, vitamin C or other preservatives are added in to the juice you buy. It has to be pure.
The biggest star in your bladder pain fixing firmament is Marshmallow Root Tea – loose leaf dried herb, just add a large pinch or two to a teapot and add hot water, is particularly effective, but you can take it as a powder or in tablet form. Marshmallow Root Tea is balm to the struggling bladder wall. It contains mucilage which buffers and soothes the bladder wall protecting it from the acidic action of the urine and supporting the repair of its own mucous or GAG layer. Drink often.
Slippery Elm powder is another magical mucilaginous herb which helps repair the damaged protective GAG layer of the bladder and entire digestive tract. Use a teaspoon or two three times a day – particularly before bed and before meals – place in a cup, mix with a small amount of boiled water to form a paste then add cold or hot water or nut milk, stir well and drink, add honey if you need it sweeter.
Alkaline Water – to balance acidity in the urine – drink ½ – 1 teaspon of bicarbonate or soda, start with a quarter teaspoon, until you get used to it.
Reduce stress before bed by switching off all mobile devices. Get a good book. Meditate. Take a relaxing, detoxing and muscle-spasm reducing Epsom salt bath ( 2-3 large handfuls) and soak for at least 20 miuntes. The magnesium in the salts will be absorbed through the skin and will add relaxation of your nervous system and the jangled muscles and nerves of your pelvis and bladder.
Have a milky drink (either organic whole cow or goats’ milk or oat, coconut, almond or brown rice milk with nutmeg, cinnamon and honey) before bed to line and soothe the epithelial lining of the bladder. Or a Turmeric Latte – grate fresh turmeric into your favourite milk or nut milk. Add honey and cinnamon to taste. Or make your own Turmeric Paste.
Avoid exercise which is too traumatising for the pelvic floor like jogging, step classes, long vigorous walks. Exercise sensibly and regularly, several times a week. Try pilates, yoga, swimming and don’t overdo it.
1 x 1000-2000 mg of Fish Oil daily – the anti-inflammatory effects of fish oil will help turn round the inflammatory cascade driving your bladder pain.
A daily high strength multi-strain 30 billion or more strength probiotic blend will begin to replenish the gut micro biome of the entire pelvic area – gut, urethra, bladder and support the rolling back of the inflammatory process.
Include natural prebiotics and probiotics into your diet only if you can handle them – if you have gut dysbiosis go slow and get help with a Low FODMAP bladder friendly diet or if you have issues with histamine then follow a low-histamine diet and only have Kombucha, kefir, Sauerkraut and Kimchi when you know you can tolerate it.
Bladder Pain and Interstitial Cystitis are multifactoral tie: there are many root causes of your condition which need to be unravelled with care and nurtured one layer at a times as you fix and repair.
Working closely with a nutritional therapist, a pelvic floor physio or a trauma psychotherapist in conjunction with your medical team will help you begin t understand and recover.
If you would you like further personalised nutrition advice to help ease your symptoms, Hanna offers both in-person appointments at her London or Lewes clinics, or online consultations to help you wherever you are in the world – simply contact her to arrange a booking.