Could constipation be causing cystitis?
There are a number of possible mechanisms as to how a slow moving bowel could be contributing to uncomfortable bouts of cystitis, and particularly, in cases of interstitial cystitis:
- The compacted bowel may affect proper emptying of the bladder
- Dysbiosis or an imbalance in bacteria is common in instances of constipation1 and this could influence the bladder
- Sub-clinical inflammation may be more likely in cases of chronic constipation2,3 which again, may exacerbate a sensitive bladder.
Throughout this blog we explore these themes in more detail and offer some tips to help manage the symptoms.
What causes cystitis?
In most cases of cystitis, bacteria are thought to be at the root of the cause. This is known as infectious cystitis. However, in another type of cystitis, called interstitial cystitis, the root of the cause isn't thought to be infectious.
Instead, interstitial cystitis, otherwise known as 'painful bladder syndrome' involves long-term inflammation of the bladder, of which, the causes are poorly understood.
Whilst many of the symptoms are still characteristic of traditional cystitis including pelvic pain and discomfort, frequent urination, urinary urgency or nocturia (needing to pee frequently during the night), the likely causes are somewhat different in comparison to traditional cystitis. Some of these include:
- Damage, ulceration or scarring of bladder lining. This could be caused by previous infections, urine retention or inflammatory substances in the urine and can give rise to further irritation and inflammation. It's also possible that, in rare cases, people could have an allergic reaction to substances in their urine
- A problem with the nerves surrounding the bladder which causes them to send pain signals in response to normal bladder function, such as filling up or emptying
- Weakened pelvic floor muscles affecting the flow of urine and frequency of needing to go to the loo
- The immune system attacking the bladder
- Chronic stress affecting immune, allergic or inflammatory responses or the frequency of needing the loo
- Physically and chemically, constipation could also be influencing the functions of the bladder and surrounding areas.
Whilst there may be some degree of overlap in many of the above causes, here we aim to explore underlying constipation as a possible mechanism, in more detail.
Causes of constipation
As a recent A.Vogel survey revealed that over 1/3 of people considered themselves to be constipated, it's important to try and understand some of the possible causes of this. These are as follows:
- Diet – In many cases of adult constipation, dietary factors are thought to play a major part in the onset of this state. One of the main contributing factors is thought to be a lack of dietary fibre. Much of this is down to eating too little fresh foods including fruit, vegetables and wholegrains, and instead having too high a proportion of processed foods which have been stripped of their vital fibre content.
- Dehydration – Whilst food choices are an important factor to consider when it comes to constipation, drinking enough liquids, and most importantly enough water, is also crucial. Sufficient water intake helps to keep waste moving through your system; see water is naturally absorbed in the large intestine so if we don't have enough water content there to start thing, our stools can end up drier, overly bulky and naturally slower moving
- Weak digestion – Before we even reach the large intestine, digestive processes before this need to be working optimally in order to give us the best chance of having more regular bowel movements. Sufficient chewing is required to get us off to the best possible start, whilst sufficient bile movement is also required to stimulate peristalsis, the unique muscles contractions throughout our digestive tract
- Withholding the loo – Whilst this contributing factor is often more common in children, adults can be guilty of it too! Whether you feel it isn't convenient, are embarrassed of going in public or are worried about cleanliness, putting off going to the loo can make the symptoms of constipation worse. This can cause waste to become even more compacted within your system and, therefore, more difficult to move; plus the need to go to the loo can risk becoming less frequent
- Medications – Sometimes conscious diet and lifestyle habits aren't always to blame for the symptoms of constipation; it's possible that side effects of medications from your doctor could also be having an impact. Commonly prescribed medications including painkillers, anti-depressants or blood pressure medication are all common culprits when it comes to constipation, so always read the product information leaflet or talk to your doctor if you are worried.
How could constipation cause cystitis?
Although it isn't so well recognised by the allopathic medical community, from a more holistic standpoint, there are a number of possible ways that we suspect constipation could have an impact on the prevalence of the symptoms of cystitis.
Luckily, some of this is also starting to have some backing from the available research as I outline some of the possible mechanisms below:
1. The physical impact of constipation
One of the main things to appreciate when it comes to constipation and cystitis is the close proximity of your colon to your bladder. This can have a number of implications but the physical relationship is one to consider first of all.
If your colon is full of old waste, this can apply pressure to your bladder and compromise on space and proper functions. Firstly, this added pressure could affect the proper emptying of your bladder (much like some of the processes involved in instances of enlarged prostate). This can result in more frequent infections as bacteria is able to populate within stagnant pools of urine.
Secondly, this intrusion by a bunged up bowel could also potentially contribute to the backwards flow of urine. This means any bacteria lingering towards the extremities of your urinary tract could be carried backwards towards your bladder and pose a problem.
2. Dysbiosis
We've already discussed the more direct transport of bad bacteria as a result of altered urine flow thanks to an overly-bulky bladder, but in a more indirect (harder to detect) way, the delicate balance of bacteria throughout our system more generally, could also be having an impact.
See, billions of bacteria naturally exist throughout our digestive system already, but depending on how well your digestive system is functioning, (together with a number of other diet and lifestyle factors) this can become altered.
Slow moving waste is a prime target for bacteria (especially the bad guys)1, and due to the close proximity of the bladder to the bowel, this could potentially be having an influence. This wouldn't necessarily show up as a typical, infectious bout of cystitis, as the imbalance in bacteria may be more subtle than this; we call this dysbiosis.
3. Inflammation
With slow moving waste and/or dysbiosis, come degree of inflammation is also inevitable.2,3 Nowadays, more chronic, also known as 'sub-clinical' inflammation is thought to be an underlying factor in a number of health conditions including those affecting the digestive system including IBS. Interestingly, it's becoming more recognised that the symptoms of IBS and interstitial cystitis often go hand in hand, and some underlying inflammatory processes may be involved.4
Tips for managing the symptoms
After touching on some of the processing mentioned above, by addressing the underlying constipation, we're hopeful that we could therefore also help to improve some of the symptoms of interstitial cystitis. Some ways to approach this are as follows:
1. Diet
Naturally, many of the foods that can help to manage constipation are also anti-inflammatory, so this is a win-win if both constipation and cystitis trouble you!
Dietary fibre should firstly be a primary focus. This dietary element can be found in a range of fresh foods including fruit, vegetables and whole grains. Next, sources of omega-3 would also be a good addition for an extra dose of anti-inflammatory action. Good sources include oily fish, walnuts, chia and flaxseeds.
2. Don't forget about drinks
Especially if you're actively upping your dietary fibre intake, consuming more water is a must. This helpful habit is vital for managing both the symptoms of constipation or cystitis.
Aim to drink at least 1.5-2l of water daily, and remember this should be separate from any warm drinks. Another thing to consider with any drinks other than water is the inflammatory ingredients that they may contain. Watch your consumption of sugar or caffeine (limiting both can be helpful), whilst including herbal tea options such as rhubarb or liquorice could help to get things moving along in the right direction.
3. Re-training your toilet habits
When it comes to both constipation and cystitis, getting into bad habits where going to the loo is concerned, can have long-lasting, detrimental effects. The best advice from me is when you feel the urge to go to the loo – just go! Don't put it off as this could affect how your bladder or bowel continues to operate in the future.
4. A herbal helping hand if need be
Depending on your primary symptoms, some herbal remedies could help to normalise your toilet habits initially. If constipation is occasional, remedies such as Linseed and Senna can certainly make a welcome addition. Although I don't often recommend using it in the long-term, alongside some of the aforementioned diet and lifestyle tips, it can help to get you off to a more regular start.
Then, despite your best efforts, if the symptoms of cystitis are still lingering, adding in some Uva-ursi & Echinacea complex may be a good option for you. This remedy has been used traditionally to help counter the symptoms of cystitis and can be taken up to 5 times daily during a course.
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4951383/
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3206564/
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6207018/
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3415690/
