Perhaps the most important question that physicians and patients have asked is “how and why does the bladder wall break down in some patients with IC?” It’s the root question that we all want the answer to. Let’s consider eight possible causes of bladder injury.

1 – Chemical Exposure

The first and most logical assumption is that some external force has damaged the bladder. For example, a chemical exposure. Both chemotherapy(1) and ketamine(2) are well known for their ability to damage the surface of the bladder. A decade of drinking harsh acidic beverages, like diet soda, can gradually irritate the bladder and are well known to trigger IC flares.(3)

2 – Bladder injury

Bladder injury can occur after childbirth or an over distention of the bladder. One man ruptured his bladder when he jumped into a lake with a full bladder.(4) Children playing soccer with a full bladder could also suffer an injury or rupture if they are hit in the abdomen with a soccer ball. Doctors have compared this effect to throwing a water balloon at the side walk. Ouch, right?

3 – Aging

Aging makes the bladder more vulnerable. Both men and women may experience a reduction in bladder capacity, slower emptying, a reduced urine flow with aging(5) but, for women, the loss of estrogen due to menopause results in a substantial loss of the mucosal protective coating in their bladder, urethra, vulva, vagina and mouth. Many women (and men) who have spent decades drinking soda or coffee eventually notice that what used to be a daily pleasure becomes a daily irritant due to the natural aging of their urinary tract. That green tea or soda that you enjoyed every day in your 20’s, 30’s and 40’s may become irritating in their 50’s and beyond. Aging is, after all, inevitable.

4 – Bacterial Infection

Of course, bacterial infection can damage the bladder lining (UTI or Lyme disease). How? Bacteria burrow into the surface cells on the inside of the bladder wall and turn them into bacteria factories. In just a few hours, that cell is destroyed and releases the next generation of bacteria. Eventually, superficial and poten- tially deeper damage occurs as cells are successively destroyed.

5 – Pelvic Floor Dysfunction

Pelvic floor dysfunction can also contribute to bladder wall deterioration. How? When the pelvic floor muscles are tight, they restrict blood flow to the bladder which then reduces the oxygenation and delivery of nutrients to those tissues. The end result?? A weaker and probably more vulnerable bladder wall. One key goal of physical therapy is to restore good blood flow to the pelvic organs.

6 – Inflammation

Inflammation can cause the release of chemicals which creates a wide variety of damaging effects in nearby tissues. Case in point are Hunner’s lesions which, on biopsy, are filled with inflammatory markers. Inflammation is how our body protects itself from infection and injury but, when it becomes chronic, has been linked to a wide variety of diseases.

7 – Viral Infection

The recent discovery of the polyomavirus BK in the urine of patients ONLY with Hunner’s lesions is also suspect.(6) While this was very preliminary research, it shows us that the bladder is not immune to viral infections. Researchers have also been able to track viruses moving from the bowel to the bladder along the nerves in the pelvis.

8 – The DIPP Mystery

Now we have another intriguing point to consider: the DIPP mystery! The MAPP Research Network studied the urine, vaginal secretions and stool of IC patients and discovered that we are deficient in several good bacteria that help to feed and sustain the cells lining the bowel.(7) Also linked with Crohn’s Disease, these bacteria are essential to the health of our bowel and, perhaps, our bladder. Could it be that decades of antibiotic use have fundamentally changed our biome? Could we be deficient in bacteria that sustain the health of our bowel and, possibly, the bladder wall? Makes you think, doesn’t it?

Focus On Bladder Healing

I find the bladder, an organ designed to hold strong toxins through a very thick, robust bladder wall, fascinating. It’s so sturdy and reliable that most people never experience bladder symptoms. But, when it’s injured, it speaks loudly to that patient with a language we’ve all come to learn: frequency, urgency, pressure and pain.

The question is how do we support bladder healing. First and foremost, a healthy diet. Yes, junk food junkies, that means giving up the habit of quick meals from mysterious and occasionally questionable sources. I do not believe that the bladder can heal with a daily wash of strong acids, artificial colorings, flavorings, sweeteners and so forth. Eating real meat, fruits and vegeta-bles (IC friendly of course) rather than junk, pre-manufactured or fast foods is essential. So rather than buying a burger at a drive through, how about rediscovering your kitchen and cooking. The best part? You’ll know every ingredient put into it. We have several good cookbooks available in our shop the provide a variety of easy meal ideas.

I encourage you to take some time to learn about probiotics and prebiotics. Probiotics (aka various acidiphilous and bifidobacteria products) repopulate the bowel with good bacteria. They can be found in kefir, yogurt, pickles, sauerkraut, kimchi, miso and products containing acidophilous. Yes, some of those aren’t IC friendly but some are. If you’re lactose intolerant, consider using a coconut milk yogurt instead. Look for foods containing “live cultures.” Prebiotics provide the food that feed the good bacteria, most often in the form of healthy fiber. Foods such as asparagus, chicory, garlic, leeks, beets, corn, peas, beans and lentils provide essential nourishment for the often ignored and underestimated good bacteria.

Could it be that decades of antibiotic use have fundamentally changed our biome?

I suspect that every person reading this has taken more than one unnec- essary antibiotic for their IC symp- toms, colds, viruses, etc. When my first bladder symptoms appeared as a young teen, I was given dozens of antibiotics over several years that, I suspect, may have contributed to some of my issues later in life (i.e. IBS). Worse, some newer antibiotics have been linked to very serious, life threatening adverse events. (See IC Patient Suffers Aneurysm After Taking Cipro on page 21).

We must to stop taking antibiotics like candy “just in case” we have infection. Use a home UTI test (avail- able at or demand a urine culture first. If it’s positive, antibiotics may be necessary. If it’s negative, it’s time to begin your flare management tips!

Twenty years ago researchers were, at best, speculating on the potential causes of IC. This newest study show that we’ve gained clarity and insight into both causes and now very diverse treatment approaches. If you have not responded to treatment or are progressively worsening with time, ponder the list above. Where do you think you fit?

Have you tried ALL the treatments listed in the AUA guidelines? Have you had your Hunner’s lesions treat- ed recently and appropriately (i.e. fulguration, laser therapy, steroid injection or LiRIS clinical trials)? Have you had a pelvic floor assessment? This is especially important if you have a history of pelvic injury, athletics and/or prior pelvic surgery. Are you following the IC diet? This is essential for patients with bladder wall trauma. Have you been tested for Lyme disease?

Don’t give up! This might be the perfect time to try something new. Read up on the latest information on our website and call your doctor!


  1. Bladder damage and chemotherapy. Canadian Cancer Society. Accessed 07/20/16 – cancer-information/diagnosis-and-treat- ment/chemotherapy-and-other-drug- therapies/chemotherapy/side-effects-of- chemotherapy/bladder-damage-and- chemotherapy/
  2. Shahani R, Streutker C, Dickson B. Ketamine associated with ulcerative cystitis: a new clinical entity. Urology 2007: 69:810- 812
  3. Friedlander J. et al. Diet and its role in interstitial cystitis/bladder pain syndrome (IC/BPS) and comorbid conditions. BJU International. BJU Int. 2012 Jan 11.
  4. Pappas St. “Off The Deep End: Man’s Drunken Live Dive Bursts His Bladder.” Live Science. October 22, 2015 – injury-alcohol.html
  5. Jaipual N. Effects of Aging on the Urinary Tract. Merck Manual. Accessed 07/20/16 – /home/kidney-and-urinary-tract- disorders/biology-of-the-kidneys-and- urinary-tract/effects-of-aging-on-the- urinary-tract
  6. Van Der Aa F, et al. Polyomavirus BK–a potential new therapeutic target for painful bladder syndrome/interstitial cystitis? Med Hypotheses. 2014 Sep;83(3):317-20
  7. Braundmeier-Fleming, A. et al. Stool-based biomarkers of interstitial cystitis/bladder pain syndrome.Sci. Rep. 6, 26083; 2016