You couldn’t resist. You had been so good. You avoided the cranberry sauce. Said no to the wine. You ate really well until dessert arrived. Grandma’s irresistable chocolate cake started calling your name and wouldn’t let go. Wanting to show her that you appreciated her cake (right?), you indulged and enjoyed every bite. Hours later your bladder starts to scream. If you’re like most patients who are diet sensitive due to Hunner’s lesions or a sensitive bladder wall, the holidays present with many opportunities to eat foods which later come back to haunt you with a wicked IC flare. If you’ve imbibed in a cocktail, enjoyed some cranberry sauce or fell for that slice of decadent chocolate cake, here are some strategies that you can use to nip this flare in the bud.

Potential Triggers: Coffees, teas, sodas, citrus fruits, multivitamins, tomatoes, chocolate and other IC foods. Some medications can irritate the bladder (i.e. ketamine, chemotherapy, some antibiotics). Chemical exposures. Stress can exacerbate nerve sensitivity in the bladder.

Symptoms: Bladder wall pain can be very sharp and shrill with some patients describing it as ground glass or razor blades in your bladder. Bladder wall flares may trigger intense frequency and urgency. A severe bladder wall flare can cause a false sense of fullness, as if your bladder is very full with urine even when it’s fairly empty. It’s important that you not try to strain to empty your bladder or get those last few drops out. Relax and let urination happen naturally.

Bladder Wall Flare Rescue Goals

  • Dilute urine to reduce irritants
  • Calm & sooth the bladder wall
  • Prevent muscle tension from developing
  • Fight pain early.

Bladder Wall Flare Rescue Strategies

First Hour

  • Stop & Rest – Don’t push through the pain
  • Use a heating pad or take a hot bath or shower to relax muscles
  • Drink a glass or two of water to dilute your urine. Your urine should be a pale, clear yellow. If it’s dark yellow or brown, it is concentrated and more irritating. If it’s clear, you’re drinking too much water.
  • If you’ve eaten something acidic, reduce your urine acid levels by using Prelief or Tums. You could also try 1/4 teaspoon of baking soda in a glass of water.
  • Drink a soothing herbal tea, like chamomile or peppermint tea.
  • Try a bladder analgesic to numb the bladder wall (i.e Azo Bladder Pain Relief Tablets). These are available at most drug store and supermarkets.
  • OTC oral pain medications can help reduce mild to moderate pain such as ibuprofen (Advil) or acetaminophen (Tylenol). Do not take more than the recommended dosages. If used in large amounts, ibuprofin can cause stomach irritation while acetaminophen can irritate the liver.

2 to 4 Hours – Get Serious About Symptoms (All of the above plus)

  • If your pain has lasted longer than two hours, then it’s clear that your bladder has become very irritated or inflamed and you may be in this for several hours or until your bladder calms down. Again, it’s important that you not push through the pain. Focus on what will make you feel better.
  • Only eat soothing, bladder friendly, foods and beverages until the flare has resolved. This is NOT the time to be drinking coffee, green or black teas, sodas, alcohol or eating spicy foods. Keep your foods mild and gentle.
  • Use pain medication as directed by your physician. Remember, pain is like fighting a fire. If you catch it early, you might only need a very small amount of medication to stop it (i.e. 1/4 or 1/2 of a pill). Please note that some time release medications can NOT be cut in half. Talk with your pharmacist or doctor to determine if your specific medication can be used this way.
  • While OTC food supplements do not have a pain fighting effect, they may be soothing (i.e. DH Aloe, Cysto Renew, CystoProtek, CystaQ).
  • Bladder spasm can occur just after the last few drops of urine are leaving your bladder causing sharp pain at the end of urination or an unusual a fluttering sensation in the pelvis. It’s a sign that the bladder is very seriously irritated or infected. These can be treated with specific antispasmodic medications (i.e. oxybutynin/Ditropan). Both chamomile and peppermint herbal teas have gentle antispasmodic properties.
  • CBD oil or medical marijuana if legal in your state

24 Hours or Longer (All of the above plus)

  • Rescue instillations – If the flare has persisted, you can call your doctor and ask for a rescue instillation (aka – HepLidoA, heparin & lidocaine) to numb the bladder wall. Rescue instillations can be done at home if trained by your medical care providers. Some patients may use these daily until the symptoms calm while others may go to their urologist once a week for several weeks.
  • Traditional treatments: Antihistamines (Vistaril, Atarax), Low Dose Antidepressant (Elavil), Bladder coating (Elmiron)

How long does a bladder wall flare last?

The duration of the flare depends upon the degree of irritation of the bladder wall. Bladder wall flares can be fairly short term. If the bladder is in good shape (i.e. IC symptoms are very mild), a cup of coffee (decaf please) might cause a few hours of increased symptoms, perhaps accompanied by an uncomfortable, sleepless night but the symptoms should resolve fairly quickly. On the other hand, patients who continue to drink coffee every day trigger cumulative irritation in the bladder that can extend bladder symptoms indefinitely.

With luck and early action, you’ve successfully nipped this flare in the bud!! Don’t let IC diminish your holidays nor feel bad that you’ve eaten the wrong thing. We’ve all made that mistake and thankfully have some very flare management tips that work!