5 Major causes of IC flares
Virtually every Interstitial Cystitis patient will experience flares in their lifetime. A flare is an increase in your IC symptoms that causes you to feel the affects of IC more severely than you typically do on a day-to-day basis. Flares may last for only a few hours, several days or even for some people weeks or months at a time. The reasons behind why flares occur are almost as varied as the number of IC patients who experience flares, because IC is such a highly individualized medical condition.
While many ICers will experience inexplicable flares (in other words you cannot pinpoint what you feel caused the flare), we all deal with flares that do often have a root cause behind them. When you flare you may notice a subtle or dramatic change in your symptoms, for example if you normally void 20 times a day and now you are going 45 this would likely be considered a flare. Other things besides frequency that can increase are – well every IC symptom technically – but especially pain levels (bladder, pelvic, abdominal, lower back), bloating, urgency (the feeling that you have to go right now!), a burning sensation when you void, the feeling that your bladder has not emptied entirely after you void, night time voiding (nocturia), gastrointestinal issues, and an increase in your pelvic floor dysfunction , if present in the first place.
It is important to make sure that the increase in your symptoms is in fact IC, as opposed to another reason behind your jump in bladder symptoms. It can be very difficult to tell the difference between an IC flare and an UTI (urinary tract infection), and you may need a urine test to determine if you do have a UTI. If one is found you will generally be prescribed a course of antibiotics, and sometimes pain killers. Other conditions like IBS, endometriosis, pelvic floor dysfunction, vulvodynia, Pudendal Nerve Entrapment, allergies, prostate problems, gynaecological issues, lupus, and fibromyalgia can all cause bladder related symptoms in some cases. These conditions are just some of the many different ones that tend to overlap with IC. And in fact at times an increase in the symptoms of a condition that you have, say vulvodynia, can cause a repercussion of IC symptoms. Sadly many ICers rarely have a flare that just affects their bladders, as a bladder flare can exuberate other conditions and vice versa. Just as your IC flare will require attention and treatment so too will they rise in symptoms relating to your other conditions.
When dealing with a flare you want to try and get a handle (if possible!) on it as soon as you can. If you take certain medications during a flare, begin to take these at the onset of your flare. Stop and rest – remember that you are only human and sometimes you can’t go full throttle 24/7. There is a reason why doctors literally prescribe bed rest (or rest in general) – it helps you to heal. Heed this time honoured advice and look for ways that you can rest more and allow your body and bladder time to recuperate.
Five of the most common reasons why IC flares occur:
-Sex: Sex is one of the biggest causes of flares for both men and women with IC. For many ICers some level of increase in their symptoms appears to be unavoidable when it comes to making love. Many things can help to lessen the severity of flares that start up both during and after love making sessions. Many ICers find that the positions they take make a substantial difference; as well lots of lubrication and patience are very important. Voiding and gently washing your genitals both before and after sex is also helpful as it can help prevent your risk of picking up a UTI.
Post sex you may want to take a pain relieving medication, sit in a warm bath (which will help to relax and sooth your pelvic floor muscles), apply an ice pack to your genitals, and take a rest or get some sleep if possible.
-Stress: Stress can have far very far-reaching affects on not only our IC but our entire bodies. Stress is a very well recognized IC flare trigger, though why exactly this occurs is unknown. One theory is that during times of flares our bodies produce higher than normal levels of mast cells (this applies to all people, not only ICers). Many ICers have been found to have higher than normal levels of mast cells in their bladders, and therefore antihistamines (which are sometimes prescribed to help combat IC symptoms) aim to try and reduce the histamine related mast cell irritation (inflammation) of the bladder lining. It's also been theorized by a few ICer researchers that perhaps the mast cells that ICers have do not function properly (in a normal way). Perhaps stress triggers an increase in the amount of mast cells that “attack” and therefore inflame our bladder linings.
The brutal catch-22 is that flares themselves can turn into big sources of stress in our lives. Flares can impact everything from our jobs to our personal relationships. While it may sound a lot easier than it really is, do try to look at ways that you can cut back on as much stress in your life as possible. Consider putting things on hold, or reducing the number of activates in your schedule. Talk and vent about how you are feeling, join an IC support group or chronic pain support group, eat as well as you can, try to get plenty of sleep, ask for help whenever you need it, visit your doctor to discuss your flare and ways to help manage it, and try to adopt as many stress reducing practices as you can.
-Diet: Diet can play a humongous factor in how your IC is doing. While not every one of us encounters (apparent) issues regarding how our bladders respond to food, the majority of us do. If you have not done so already you may wish to try an elimination diet, a through explanation of the IC diet and how to do an elimination diet can be found in the article ICadvice’s Guide to the IC Diet .
Food can be such a game of hit and miss because sometimes even when we stick to foods that do not usually give us a flare we get one any way! This might be due to the combination of two or more foods together (it’s a delicate science), what time of day you ate the food, or whether or not you took anything like Tums, baking soda, or Prelief to help counter balance the affects of acid and other bladder provoking irritants in your foods.
When you are flaring it is usually a good idea to stick to your safest foods. Assuming that you do not have any other (non-IC) special dietary needs you might find that things like potatoes, yams, rice, IC safe breads, pears, carrots, simply prepared chicken, turkey, beef and fish (steaming and baking are two methods that are both healthier than frying), eggs, and many grains. All of the recipes in the recipe section here on the site are very IC friendly, and most can be well tolerated during even your worst flares. Remember to try to cook foods with minimal seasonings and oil, and eat small meals often as opposed to two big meals a day, so that you are not as apt to be hungry and prone to eat something your bladder will later wish you hadn’t.
-New medications: Trying out new prescription medications or over the counter drugs (as well as vitamins and supplements) can cause a flare in symptoms. This flare may subside after a couple of days, as your body adjusts to the new drug or it may be problematic to the point where you have to stop taking the drug. If you experience any sort of flare from a new drug talk to the doctor who prescribed you the drug as you may find more success with a different dosage, brand or another similar medication. Sometimes things like the fillers and coatings on, and in, drugs can cause IC flares, and some ICers report encountering problems with the gelatine coating on certain medications.
Many supplements and vitamins can cause flares too, but this varies greatly form patient to patient. Look for brands with as few ingredients on the label as possible. Try to avoid those that contain artificial sweeteners, alcohol, citric acid, sulphates, preservatives, artificial colourings, and remember that for some people the presence of large amounts of potassium (this can be a bladder irritant for some ICers). If you are not sure about what an ingredient is ask your pharmacist or a health food store worker. Many vitamin and supplement products and ingredients can have multiple names and you are not expected to know what every word on an ingredient label means.
If you do have to stop taking a medication due to your IC record this information (like in your IC journal ) and make sure that all of your doctors and the members of your healthcare team are aware of what occurred with that particular drug. This way they may be less likely to offer you the same prescription again in the future, or prescribe medications from the same drug family. Always remember that if you experienced severe side affects you need to have this on your medical records, and may want to wear a MedicAlert bracelet stating that you have an actual allergy or severe reaction to that drug.
-Menstrual cycle: For many women and teenage girls with IC their menstrual cycle can be a predictable monthly flare. Some “fortunate” ICers actually experience a decrease in their IC symptoms during their periods but this is a lot rarer than those who encounter a flare.
The role of estrogen in the female body may have a lot to do with how your IC responds to your period (the time of the month when you experience vaginal bleeding). Interestingly just as stress can bring about an increase in mast cell creation, so too it is demised that estrogen levels can cause a jump in mass cell production. The exact role of estrogen and other hormones in conjunction with IC is not exactly known or understood, but there appears to be no denying the fact that these things affect our IC. This is something that women may really begin to notice as they hit menopause and pre-menopause and their hormonal levels shift and change.
IC can also seem to bring on its own kind of PMS, so to speak. Many ICers note that a few days before (and for some women, after) their periods begin they see a noticeable increase in their IC symptoms. Urgency, tenderness, bloating, pain and nighttime voiding are common IC symptoms that increase before and during a woman’s period.
These are just a few of the underlying causes behind why a person might experience a bladder flare. In time you may realize that some things (say long car trips) are way more likely to give you a flare than other activates. When you do flare it’s important that you seek medical help if needed, and also emotional support. Talking to other IC patients about what you are going through can also be very beneficial if only for the comfort that comes with knowing that you chatting with other people who know firsthand what it means to have an IC flare. Whatever you do, just make sure you take care of yourself and your bladder so that your flare will hopefully begin to heal.