IC101 Master Class #20 - Bladder Wall Flares

Patients with Hunner's, estrogen atrophy and/or bladder wall inflammation are the most prone to bladder wall flares. They are usually triggered by foods, drinks and chemicals that are irritating to the bladder wall.

Triggers:
DIET: Foods high in acidity or alkalinity (pH extremes are the challenge), including: - coffees, teas, green teas, sodas, Vitamin C (ascorbic acid)
VITAMINS & SUPPLEMENTS: - Chemicals (i.e chemotherapy, ketamine, strong antibiotics and/or other medications)
HORMONES - It's very common for women to flare the day they ovulate or a day or two before their periods
CHEMICAL EXPOSURE - Chemotherapy, ketamine & some antibiotics

(This episode does NOT cover UTI)

RESCUE PLAN
First Hour
REST
DILUTE YOUR URINE with water
ALKALINIZE and reduce acid levels in urine with Prelief®, Tums or a very, very small amount of baking soda in a glass of water.
HERBAL TEA - Chamomile & peppermint herbal teas are smooth muscle relaxants and can calm bladder spasms
SOOTHING FOODS - Be gentle on your bladder during flares
HEAT - Relaxes muscles
COLD THERAPY can help calm nerves down

Second Hour -
OTC ANALGESICS - ibuprofen, acetaminophen
OTC PEA (palmitoylethanolamide) - calms nerves, including the pain of IC. Look for PEAORA® or PEAlief,
AZO BLADDER PAIN RELIEF TABLETS
ANTISPASMODICS - Ditropan, oxybutynin can calm bladder spasms
ALOE - has a soothing effect on the bladder. We prefer ALOEPATH® because it also uses PEA to calm nerves.
CBD (hemp, mmi) may help reduce pain. Patients preferred edibles over inhalants in our study.

Getting Serious About Pain
Pain is a message which tells you that your body is in great distress. Do not push through the pain. It's time to relax and focus on what can make you feel better.

Our national AUA IC/BPS Guidelines are very compassionate about pain levels, which they want assessed at every appointment. They encourage pain care using multimodal strategies. What this means is that we want to use many different methods at the same time, such as diet modification, physical therapy, mindfulness, anxiety management and, of course, a variety of pain medications. The challenge, of course, is that doctors are often reluctant to prescribe stronger pain medications, such as opiates. If you ask for pain medications directly, you may look like a drug seeker. Instead, tell your doctor how pain is limiting your ability to function and be specific. Can you sit, stand, walk, drive, shop, work?? Then, ask your doctor what they would suggest that could help you do the things you need to do to function normally.

At 24 Hours or Longer
If your flare has not responded to the self-help tips above, there are a variety of traditional treatments that may help.

BLADDER INSTILLATIONS: Rescue instillations act to numb the bladder wall and can be performed weekly for a period of time.
HUNNER'S LESION TREATMENT: If you have lesions, they can be treated with cauterization, laser therapy, steroid injections and other techniques that may significantly reduce your pain and discomfort.
PELVIC FLOOR TREATMENT: Tight muscles create ischemia which then weakens the bladder wall. It's important to keep working on tight muscles.
TRADITIONAL TREATMENTS: A variety of medications are available though they come with significant side effects including: Myrbetriq (for frequency/urgency), Atarax/Vistaril (for allergenic and mast cell driven symptoms), Amitryptiline & other low dose antidepressants to calm nerves down.
OTC SUPPLEMENTS - The AUA suggests that patients try supplements before the medications above because they come with fewer side effects. Learn about supplements in our shop at: http://www.icnetwork.org

Want more insight into flares?? Consider buying the IC101 Guide For Managing IC Flares.