IC-Associated Gastrointestinal Problems
Something IC patients commonly complain about (besides our bladders) is
non-bladder abdominal pain accompanied by bloating and either constipation or
diarrhea (or occasionally, alternating bouts of diarrhea and constipation).
Some of these symptoms may be accounted for by the drugs we commonly take for
The tricyclic antidepressants for instance, are notorious for causing constipation. However, for at least one-third of all IC patients, such symptoms may be a
result of irritable bowel syndrome (IBS).
IBS is diagnosed via colonoscopy, a procedure
in which the doctor views the lining of the colon via a small flexible tube.
IBS is called a functional gastrointestinal disorder because, while the colon
looks perfectly normal, it functions abnormally. It is unusually sensitive
and may respond to even gentle stimulation with spastic contractions. Thus,
some doctors also refer to the condition as "spastic colon."
We've all eaten "gassy" foods at some time or other and had some bloating and mild discomfort as a result. But for those with IBS, it's much more than discomfort. The pain can be debilitating and last for days. Fortunately, IBS responds to dietary modification. As with IC, finding your IBS food triggers
requires some personal investigation. But in general, there are three dietary
guidelines that doctors recommend:
Here are some more tips to try:
- Avoid alcohol and caffeine. These will irritate nerves and make them even more sensitive.
- Avoid fructose (a fruit sugar) and sorbitol (a sugar substitute), particularly if found together in the same food. Beware of any sweenener called "high-fructose" (i.e., high fructose corn syrup). Sorbitol is found in many foods, and also toothpastes. Some people with IBS also find it helpful to avoid foods containing guar gum or cellulose gum.
- Minimize the intake of high-fat foods, particularly foods containing saturated fat (i.e., steaks or bacon).
- Eat five or six small meals (rather than three large ones) per day, and drink adequate water.
(1) Rice and pasta can be constipating. Large amounts of calcium carbonate (as in Tums or Prelief, for instance) can be constipating. Iron supplements may not only bother an IC bladder, they are constipating too.
(2) Some people with IBS benefit from a very high-fiber diet, while others require a very low-fiber diet. Some experimentation may be needed to find out which works best for you. If you want to try a high-fiber diet to ease constipation, increase your fiber intake slowly, not suddenly. A gradual increase will allow your gut to adjust without increasing nerve sensitivity.
(3) The fiber found in fruits, vegetables, and whole wheat is an efficient laxative. The starch in potatoes is also somewhat of a laxative.
(4) And for certain people, onions, leeks, Jerusalem artichokes, beans, peas, or lentils can also have a laxative effect. A bland diet, avoiding "hot" spices is often helpful for some people too.
(5) For some IC patients a bit of baking soda in water can counteract the bladder pain caused by eating acid foods. It can also cause loose stools.
(6) Gas formed in the colon by eating foods like broccoli, cabbage, or bell peppers can be very painful for people with IBS. The gas can be effectively prevented from forming by taking Beano (an over-the-counter enzyme product) with your first bite of the food.
(7) The symptoms of lactose intolerance (abdominal cramps and diarrhea experienced after eating dairy products) are very similar to those of IBS, and it is possible for a person to have both conditions. Lactose intolerance is an inability to digest milk sugar (lactose), and the condition can be helped by taking an over-the-counter lactase enzyme product (Lactaid, for example) before eating dairy foods.
Lactose intolerance can be diagnosed with a hydrogen breath test. Dr. Jarol Knowles of the Division of Digestive Diseases and Nutrition, University of
North Carolina, Chapel Hill notes an interesting association, "...hydrogen breath tests were performed on patients who had been diagnosed with IBS but who had no apparent symptoms related to the ingestion of milk. Lactose malabsorption was diagnosed in 68% of these patients. Symptoms improved after a lactose restricted diet was introduced." He recommends this test for all of
his IBS patients.
(8) Another less common cause of gastrointestinal distress in IC patients can be the drug, Elmiron. Urologist and IC researcher Dr. Lowell Parsons of the University of California, San Diego emphasizes that Elmiron needs to be taken on an empty stomach. In a long term study however, a small number of patients (less than 4%) reported that Elmiron caused nausea, diarrhea, or abdominal
cramping. Dr. Parsons now advises patients to take it this way if it causes gastrointestinal distress for you: Break open the capsule and empty the contents into a glass of water. Stir, and drink it an hour before
(9) Finally, if you have chronic indigestion or a burning stomach pain it is wise to see your doctor. You may have ulcers or gastroesophageal reflux.
Though stomach and duodenal ulcers are not known to be associated with IC, a small but interesting study did appear in the journal, Infections in Urology. Researchers found that about 87% of the patients with IC, trigonitis of unknown cause, and/or urethral syndrome (but no bladder infection) tested positive for Helicobacter pylori, whereas only about 62% of those with diagnosed bladder infections did. It is also interesting to note that in the U.S., about 40% of adults have either been exposed to it and have developed antibodies, or actually have an active H. pylori infection. Why might IC patients get an H. pylori infection more often then others? No one knows right now, but this small study does lend credence to the view that IC involves more than just the bladder.
Helicobacter pylori is a bacteria which can live in the stomach and is now known to be responsible for about 80% of all upper gastrointestinal ulcers. It has also been linked to some gastrointestinal cancers. This bacteria is anaerobic, meaning it doesn't need oxygen, and can thrive despite the stomach's acidity. The organism has been found in dental plaque and feces.
It's not known how H. pylori is transmitted between people. The bacteria continues to be investigated in connection with several chronic disease states. Dr. Barry Marshall, the researcher who discovered H. pylori, explains why. "Patients with HP [Helicobacter pylori] have increased intestinal permeability of the gastric mucosa and so are potentially exposed to unprocessed antigens from food.This might predispose to immune problems."
H. pylori infections in most people can be treated and cured with appropriate antibiotics in as little as three weeks. A possible IC-H. pylori connection has been the subject of scientific scrutiny before but urological studies using very sensitive PCR assay methods and bladder biopsies have found no evidence that H. pylori inhabits IC patients' bladders. So far, any connection between H. pylori and IC is still very speculative, but interesting nonetheless.
(10) As with IC, keeping a diary that records your foods, activities, medications, and gastrointestinal symptoms is well worth the investment of time. Be sure to bring it with you when you visit your doctor. Together, you and your doctor may be able to uncover your pattern of food reactions, and put you on the path to symptom relief.
For further reading about the effect of diet on IBS, fibromyalgia, and some other IC-associated disorders, see my cookbook and diet guide "A Taste of the Good Life: A Cookbook for an Interstitial Cystitis Diet." It is currently available directly from the ICN.
High-fiber foods seem to work best for my IBS. Here is a delicious fiber-
rich change of pace use for pumpkin. On Thanksgiving I enjoy these served
slightly warm, but they freeze well for later use.
1-1/4 c. all purpose flour (see note)
1/4 c. quick-cooking oats
1/2 c. sugar
2-1/2 tsp. baking powder
3/4 tsp. ground cinnamon
3/4 tsp. salt
1/4 tsp. ground nutmeg
1/8 tsp. ground allspice
1 slightly beaten egg
1/3 c. cooking oil
1/2 c. cooked, pureed pumpkin or butternut squash (canned is easiest)
3/4 c. low-fat milk
Preheat oven to 400 degrees F. Thoroughly combine dry ingredients in a
bowl. In another bowl combine the egg, oil, pumpkin and milk. Add the liquid
ingredients to the dry ingredients all at once. Stir just until all the dry
ingredients are moistened (batter will be lumpy). Place paper bake cups in
twelve muffin tins (or use non-stick tins) and divide batter evenly among the
cups. Bake at 400 degrees F. for 20 to 25 minutes, until tops are golden.
If you have vulvodynia, you may find that cinnamon and pumpkin bother you.
Try substituting finely grated fresh zucchini squash for the pumpkin, omit the
cinnamon, and increase nutmeg to 3/4 tsp. One-quarter cup of brown raisins
compliment the pumpkin well (if you can tolerate them-- some IC people
can tolerate raisins, but not grapes). Chopped cashews or almonds (additive-free) also add interest if they don't bother your bladder.
Note: Flour without malted barley may be more comfortable for extremely sensitive IC bladders and IBS colons. Most wheat flours now contain malted barley but Arrowhead Mills (a division of Hain Celestial) does produce a malt-free all-purpose flour. Natural foods stores may carry it, or you could get your local grocer to special order it for you. Their customer service number is: 1-800-749-0730. They also have a website: www.arrowheadmills.com
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1. Madhu Alagiri, Sherman Chottiner, et al. Interstitial cystitis: unexplained associations with other chronic disease and pain syndromes. 1997. Urology, Vol 49, supp 5A, pgs 52-57.
2. Jarol B. Knowles, M.D. Dietary factors in gastrointestinal diseases. 1998. Participate, Vol. 7, #3, pgs. 1-3., publ. by International Foundation for
Functional Gastrointestinal Disorders (IFFGD).
3. Philip M. Hanno. Analysis of long-term elmiron therapy for interstitial
cystitis. 1997. Urology, Vol. 49, supp 5A, pgs 93-99.
4. Stacy J. Childs, Robert J. Egan. Microbiology and Epidemiology of Recurrent Lower Urinary Tract Infections. 1998. Infections in Urology, Vol 11, #3, pgs
5. Barry Marshall, M.D., Helicobacter Foundation website, October 1998. http://www.helico.com/newsite/disease.html
6. James L. Duncan, Anthony J. Schaeffer. Do infectious agents cause
interstitial cystitis? 1997. Urology, Vol 49, supp. 5A, pgs 48-51.
This article originally published Nov 1998, revised and updated by the author Jan 2004.
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