Hydration and IC
How well are you hydrated? What do you personally use to determine if you are hydrated or how much to drink?
This is a very controversial topic for someone who has interstitial cystitis, as it poses a double edged sword for us. We are told we need to stay hydrated so to prevent infections, particularly of the urinary tract. But because of our issues with urinary frequency and pain, we avoid drinking water to avoid the discomfort. I am afraid to admit this, but I am normally chronically dehydrated. This was evident with my elevated creatinine levels on my blood chemistry. Also, when I am dehydrated, my urine is concentrated and I notice particulates in my urine, which may be signs of chronic infections. I have to take herbs often to keep my urine clear, and I do notice my urine is cleaner when I drink more water. I found the book “The Body’s Cries for Water” by Fereydoon Batmanghelidj very interesting. My summary below is based on this book, however I would like to explore this further by reading other evidence based journals on this topic. This book is also changing my view on how to evaluate when I am dehydrated. Currently I only use the color and concentration of my urine, but moving forward I will be using other markers that I am learning from this book, such as headaches, low back pain (which I have often), and occasional colitis pain.
It is very important to stay hydrated when you have a chronic illness that involves pain. According to Batmanghelidj (1997), “when the neurotransmitter histamine generation and its subordinate water regulators become excessively active, to the point of causing allergies, asthma, and chronic pains in different parts of the body, these pains should be translated as a thirst signal—one variety of the crisis signals of water shortage in the body.” This is the first time I have read that chronic pain is related to indicators of body thirst! According to Batmanghelidj, “Noninfectious ‘recurring’ or chronic pains should be viewed as indicators of body thirst.” (Batmanghelidj, 1997) This is an area I would like to look into further in regards to non-infectious cystitis. Other chronic pains that he says are related to dehydration are “dyspeptic pain, rheumatoid arthritis pain, anginal pain (heart pain on walking, or even at rest), low back pain, intermittent daudication pain (leg pain on walking), migraine and hangover headaches, colitis pain and its associated constipation.” (Batmanghelidj, 1997) What I found interesting is that all pain medications cut the connection between the brain regulators of pain( histamine) to subordinate regulators (prostaglandins) to signal water rationing. Long term, the pain meds can also cause GI bleeding. Unfortunately, taking such a high dose was recommended by my physical therapist in 2010, which later I found out was bad advice. Back in 2007 when I was my sickest, I was taking 8 ibuprofen pills a day to manage the pain!
Another area that I have constantly dealt with most of my life is stress and depression. I never thought that perhaps this was linked to my water intake! In fact, he makes a great point, that dehydration puts the body in a state of stress, and this can create the cascade of HPA axis dysfunction. “Consequently, dehydration causes stress, and stress will cause further dehydration.”(Batmanghelidj, 1997) In fact, I have noticed when I am most stressed, I am also the most dehydrated based on my urine output and concentration! During stress, several strong hormones become secreted and will remain “triggered” until the body gets out of its stressful circumstances. “These hormones are mainly endorphins, cortisone release factor, prolactin, vasopressin, and renin-angiotensin.” (Batmanghelidj, 1997) Another interesting point he mentions is the effects on alcohol and hydration. Thank goodness I do not drink! However, I have had many people who drink often also complain of chronic health related issues as well as chronic fatigue. There seems to be a link. “Alcohol will suppress the secretion of vasopressin from the pituitary gland. Lack of vasopressin in circulation will translate to general dehydration of the body—even in the brain cells.” (Batmanghelidj, 1997) He explains some of the contributory factors to the development of chronic fatigue that can occur from regular intake of alcoholic beverages (and caffeine) in place of water. “Vasopressin receptor is naturally designed to keep the waterways in the nerve systems fully topped up. Naturally, in dehydration of the nerve system, the energy and volition to do new work is drastically reduced.”(Batmanghelidj, 1997) I will admit I do have a bad habit with caffeine, and I drink a cup of coffee and I eat energy dark chocolate that has caffeine as well. Perhaps it’s time to switch to something else for my morning routine. “These are central nervous system stimulants; at the same time, they are dehydrating agents because of their strong diuretic action on the kidneys.”(Batmanghelidj, 1997) In fact, he correlates excessive caffeine consumption to chronic fatigue due to its depleting effects of the ATP-stored energy in the brain and body.
In regards to urine color, I typically look for my urine to be pale in color with minimal particulates. When my urine is concentrated and “foggy”, it is usually a bad sign. According to Batmanghelidj, urine should be almost colorless to light yellow. If it begins to become dark yellow or orange, it means your kidneys are working too hard to get rid of toxins!
Another thing I used to do was follow a very low salt diet. According to Batmanghelidj, A “salt free diet is utterly stupid.” I now use celtic sea salt because of the mineral composition. According to Batmanghelidj, low salt intake can contribute to a build-up of acidity in some cells. (Batmanghelidj, 1997) High acidity can damage DNA and contribute to cancer. He says that muscle cramps (which I used to get often), are due to salt shortage in the body. Also dizziness and feeling faint (which I had often) can also indicate salt and water shortage in the body. He has developed a good rule of thumb that I would like to explore further. “For every 10 glasses of water (about two quarts), one should add to the diet about half of a teaspoon of salt per day.”(Batmanghelidj, 1997)
So how does the water consumption relate to interstitial cystitis? I found some really good journals on this, however, I am still trying to put the pieces together on what this all means. There seems to be a link to hydration, water avoidance stress and chronic bladder pain syndromes according to a few studies I read. A study done in 2017 by Wang et. al evaluated the effects of water avoidance on peripheral and central responses during bladder filling in the rat. This was done to study chronic pelvic pain syndrome in conditions such as interstitial cystitis and bladder pain syndrome. “At the experimental level, it has been shown that chronic adrenergic stimulation produces pain and bladder changes through an alpha 1A adrenoceptor mediated mechanism. Water avoidance stress (WAS) in rodents reproduces signs of nociception and bladder changes seen in BPS/IC patients.” (Matos et al., 2017) BPS/IC patients present increased sympathetic activity and high levels of urinary noradrenaline. (Matos et al., 2017) According to Wang et al, chronic emotional stress plays a role in the exacerbation and possibly the development of functional lower urinary tract disorders (LUTD). “These disorders can be viewed as a spectrum of bladder hypersensitivity syndromes sharing the common symptoms of urinary frequency and urgency, with bladder pain syndrome/interstitial cystitis (IC/BPS) patients experiencing pain as an additional symptom.”(Wang et al., 2017) Work over the past decade in chronic pain disorders such as IC/BPS, irritable bowel syndrome, fibromyalgia and vulvodynia suggests the presence of altered sensory perception. (Wang et al., 2017) My goal is the do some more research on the link to hydration and chronic pain disorders, and how they may be related to chronic stress.
In conclusion, I do not think I am well hydrated most of the time. I also think it’s possible that my chronic stress levels I tend to endure may be contributing to my chronic dehydration and consequently my bladder issues. I do have HPA axis dysfunction and low cortisol sum and have had for much of my life with IC. I have made much improvement recently by making a conscious effort to drink more water. I also do not avoid salt and use sea salt often in my cooking. However, I do need to do more work in stress management and timely bladder voiding to break the cascade of stress and my LUTD. I have utilized some other techniques besides hydration, such as using a TENS unit and acupuncture to help optimize the peripheral and central responses to my bladder and hope to see continued improvement with my efforts.
Batmanghelidj, F. (1997). Your body’s many cries for water: You are not sick, you are thirsty! Falls Church, VA: : Global Health Solutions, Inc.
Matos, R., Serrao, P., Rodriguez, L., Birder, L. A., Cruz, F., & Charrua, A. (2017). The water avoidance stress induces bladder pain due to a prolonged alpha1A adrenoceptor stimulation. Naunyn Schmiedebergs Arch Pharmacol, 390(8), 839-844. doi:10.1007/s00210-017-1384-1
Wang, Z., Chang, H. H., Gao, Y., Zhang, R., Guo, Y., Holschneider, D. P., & Rodriguez, L. V. (2017). Effects of water avoidance stress on peripheral and central responses during bladder filling in the rat: A multidisciplinary approach to the study of urologic chronic pelvic pain syndrome (MAPP) research network study. PLoS ONE, 12(9), e0182976. doi:10.1371/journal.pone.0182976