Interstitial Cystitis- The Evil Twin?

Located in Endometriosis (click link to see other articles).

Have you been diagnosed with endometriosis?  If so, have you heard of Interstitial Cystitis?  Did you know that painful menstrual cycles and painful intercourse may not only be due to endometriosis?  Do you know that studies have shown that 50-84% of women with endometriosis may also have Interstitial Cystitis (I.C.)?

Whereas endometriosis is treated with either medical management or surgery, I.C. is not treated by surgery!  That’s right. I.C. is known as “Endometriosis’ Evil Twin”.  The symptoms of I.C. can be identical to endometriosis.  Some women with I.C. may experience only pelvic pain, while others may also describe urinary frequency (urinating more than 7 times a day), urinary urgency, or getting up to urinate several times at night.

I.C. occurs when there is a defect in the lining of the bladder.  Eating foods high in acids (such as tomatoes, coffee, spicy foods) or those high in potassium (such as oranges, Gatorade, coconut water, grapefruit, bananas), causes acids and potassium to permeate through the bladder wall and set off chain reactions of inflammation resulting in pain.  Carbonated beverages also set off pain.  Histamine and other pain cascades are initiated after eating/drinking items that are acidic, contain potassium or are carbonated.

Interestingly I.C. is worse during ones menses.  I know it’s hard to believe that something emanating from your bladder can be causing so much suffering.

So what do you do about it?

First make sure that your endometriosis is treated properly either by medical management or by excision surgery. Next, take a look at the I.C. diet at http://www.ic-network.com/diet/  There are many other websites with I.C. food lists but to simplify things lets use only one I.C. food diet.  This diet is divided into three columns.  The far left is labeled as “bladder friendly”, the far right as “caution” and the middle column as “try it”.  For three weeks try to eliminate all foods from the middle and right columns, only eating food from the far left column.  This also means stopping multivitamins which usually have potassium in them and often have acidic binders, discontinuing all herbs and medicines from your acupuncturist or herbalist, as those too can be high in acids and potassium.  If you use Metamucil, make sure you stick with the plain variety,  as the ‘berry burst’ flavor can be acidic.  Also check your bottled water as many add potassium to their water.

I know coffee is tough to discontinue, but if you cannot stop it, at least switch to a low acid variety as you wean yourself off.  Many women resort to caffeine to stay awake, particularly those who get up multiple times at night to urinate and never have a good night sleep.  The acidic coffee is feeding the problem and discontinuing it may actually give you a good nights rest!

After the three weeks of only eating off the left column, add back one “irritating” food from the right or middle column for 3 days straight.  Say you choose tomatoes, eat them each day for three days in a row and see if pain or any symptoms develop.  After those 3 days, go back to the strict diet of following the left sided column for three days.  Then, add back another food such as oranges and follow the same approach.  Do this until you figure out your food triggers, keeping a diary/journal as you go along.  The approach that does NOT work, is simply eliminating some items on the right or middle columns and not strictly adhering to the rest of the diet.  In general you will be eating many foods/drinks with low level acids or potassium which collectively will be causing pain.

Stay tuned…one of my next blogs will address why women with endometriosis and I.C. may benefit from pelvic floor physical therapy.