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Pepperoni Pizza: How the bowel can trigger bladder pain.

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  • Pepperoni Pizza: How the bowel can trigger bladder pain.

    What’s the worst that could happen after eating a slice of pepperoni pizza? A little heartburn, for most people.

    But for up to a million women in the U.S., enjoying that piece of pizza has painful consequences. They have a chronic bladder condition that causes pelvic pain. Spicy food — as well as citrus, caffeine, tomatoes and alcohol — can cause a flare in their symptoms and intensify the pain. Researchers had long believed the spike in their symptoms was triggered when digesting the foods produced chemicals in the urine that irritated the bladder.

    A surprising new discovery from Northwestern University’s Feinberg School of Medicine reveals the symptoms — pain and an urgent need to frequently urinate — are actually being provoked by a surprise perpetrator. It’s the colon, irritated by the spicy food, that’s responsible. The finding provides an explanation for how the body actually “hears” pelvic pain.

    The discovery also opens up new treatment possibilities for “painful bladder syndrome,” or interstitial cystitis, a condition that primarily affects women (only 10 percent of sufferers are men.) During a flare up, the pelvic pain is so intense some women inject anesthetic lidocaine directly into their bladders to get relief. Patients typically also feel an urgent need to urinate up to 50 times a day and are afraid to leave their homes in case they can’t find a bathroom.

    “This disease has a devastating effect on people’s lives,” said David Klumpp, principal investigator and assistant professor of urology at the Feinberg School. “It affects people’s relationships with family and friends.” Klumpp said some women who suffer from this become so depressed, they attempt suicide.

    Klumpp conducted the study with postdoctoral fellow Charles Rudick. The paper is published in the September issue of Nature Clinical Practice Urology.

    The Northwestern researchers discovered the colon’s central role in the pain is caused by the wiring of pelvic organ nerves. Nerves from this region — the bladder, colon and prostate — are bunched together like telephone wires and plug into the same region of the spinal cord near the tailbone.

    People with interstitial cystitis have bladder nerves that are constantly transmitting pain signals to the spinal cord: a steady beep, beep, beep.

    But when the colon is irritated by pepperoni pizza or another type of food, colon nerves also send a pain signal to the same area on the spinal chord. This new signal is the tipping point. It ratchets up the pain message to a chorus of BEEPEEPBEEPBEEP!

    “It was known that there was cross talk between organs, but until now no one had applied the idea to how pain signals affect this real world disease, how the convergence of these two information streams could make these bladder symptoms worse,” said Klumpp, who also is an assistant professor of microbiology-immunology at the Feinberg School.

    The findings suggest the bladder pain can be treated rectally with an anesthetic in a suppository or gel. Another possibility is an anesthetic patch applied to pelvic skin. Studies in back pain show anesthetic patches applied to the skin can reduce back pain, Klumpp said.

    “We imagine a similar kind of patch might be used to relieve pelvic pain, which might be the best solution of all,” he noted.


    For the study, Klumpp and Rudnick created a model of a mouse that mimicked an inflamed bladder with pelvic pain. Then they injected lidocaine into the bladder. The pain vanished. Next they injected lidocaine into the uterus. There was no diminishment of the pain. Lastly, they tried lidocaine in the colon.

    “In the colon it knocked down pain just as effectively as if we put it in the bladder. We thought if the colon can suppress bladder-associated pain, maybe it can make it worse in the way that foods irritate bladder symptoms,” Klumpp explained.

    So, Klumpp injected a small dose of red pepper into the colon of a normal mouse. The injection didn’t provoke any pain. But then he injected a small dose into a mouse with pelvic pain. The pelvic pain worsened.

    “We likened it to what happens to humans,” Klumpp said. “Pepperoni pizza does nothing to most people other than heartburn, but when you give it to a person with an inflamed bladder, that will cause their symptoms to flare because the nerves from the bladder and bowel are converging on the same part of the spinal cord.”


    When pain emanates from a visceral organ, the pain message is delivered to the spinal cord and bounces out to the corresponding skin surface, called the dermatome. To measure pelvic pain in the mice, Kumpp prodded their pelvic skin with nylon filaments of varying thickness and stiffness, beginning with one that was as thin as a human hair. The more pelvic pain the mouse was experiencing, the more sensitive its pelvic skin to even the finest filament.

    Source: Marla Paul

    Northwestern University
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  • #2
    Jill (and others)...
    I can see the logic in this but what are your thoughts on the state of our bladders...I can understand pain signals being sent from colon nerves irritated by foods and such to the bladder, but what about hunner's ulcers, inflammed bladders, blood in urine (microscopic or visible), etc. I hope this isn't a "colon is causing all IC symptoms" theory...but possibly just another theory for referred bladder pain.
    Thoughts and comments, Jill? Anyone?


    • #3
      oops can't edit in this forum...I meant to put the question mark icon, not the thumbs up


      • #4


        • #5
          This is interesting, and I do find the theory possible, But still VERY questionable..

          I know when I have bowel problems my IC is so much worse so I do think they are connected in some way..But like Bri said what about the other things that we have that co-exsist with an IC bladder..And there can be times that I go into a massive flare with spasms and have not eaten anything bad! But glad to see some research being done, but still I am iffy on this one ...

          ONE Second, ONE Bite, ONE Breath, ONE Pill, ONE Minute, ONE Teardrop, ONE Hour, ONE Sip.. ONE DAY! I will Prevail from this disease! IC Hoping for a Cure!

          Link to Patient Handbook:

          Diet Reference Sheet:

          Meds For IC: Lyrica-25mg Glucosamine-500 MSM-500mg, Prosed Ds -When Flaring

          Other Meds: Levlite- Continious Birtcontrol, Micardis-40mg for High Blood Pressure

          Meds I have Tried:
          Topamax,Tofranil, Elmiron, Atarax, Cymbalta, Elavil, Enablex, Detral La, Prydium.
          Lexapro< Bad reaction to this med!
          Intstills, could not continue them due to some kind of reaction after 3rd instill. Tasted the lidocaine in my mouth, tongue and lips went numb then went into what seemed like a panic attack. Shaking, racing heart, tingling face/head, blood pressure shot up..

          Dx With IC in Nov 2006 with Hydro/Cysto
          Hydro/Cysto Caused Bladder to Rupture.

          Other Dxs-Vulvodynia,Fibro, Endo, IBS, HPV, Migraines, Spastic Colon, Mild Dysplasia.

          ICN Volunteers are not medical authorities nor do we offer medical advice. In all cases, we strongly encourage you to discuss your medical treatment with your personal medical care provider. Only they can, and should, give medical recommendations to you.


          • #6
            I also am just glad to see that IC research is being done!! The more studies that people do the more likely we are to find better treatments.

            Briza - It is not 100% clear but I think the study is saying that if we already have bladder associated pain (due to bladder inflamation, etc.), then colon irritation can make the bladder pain worse and that treating the colon can help the bladder pain.
            Sudden onset of UTI like symtoms on Dec 27, 2006.
            Diagnosed with IC on March 12, 2007.
            Current Meds: 50mg Elavil
            "Be kinder than necessary, for everyone you meet is fighting some kind of battle" author unknown


            • #7
              Originally posted by lan View Post
              I also am just glad to see that IC research is being done!! The more studies that people do the more likely we are to find better treatments.

              Briza - It is not 100% clear but I think the study is saying that if we already have bladder associated pain (due to bladder inflamation, etc.), then colon irritation can make the bladder pain worse and that treating the colon can help the bladder pain.
              Leelee, Ian, thanks for your repsonses and yes, I do agree with both of you that colon problems can very well cause bladder related issues. I do not mean to negate the results of this study 100%, BUT...
              I just get very leery when anything suggests that THIS EXACTLY is the reason for your bladder problems....and then some (not all, by any means) doctors get wind of this and start a trend where colon/food sensitivity problems are THE cause of IC symptoms.
              I am a very firm believer that there are a multitude of issues that can cause/trigger IC.
              Just hoping that we can open a civilized discussion on this and am hoping to get Jill's input, as well.
              Thanks for your responsesBri


              • #8
                And yes, I too am very happy that ANY research on IC is being conducted!


                • #9
                  Makes sense in many cases, especially given how so many of us have IBS also.
                  Glad to see IC research going on & new ideas researched.
                  I'd love to be able to use a little external patch, rather than a catheter for my instillations!

                  I am not a medical authority nor do I offer medical advice. In all cases, I strongly encourage you to discuss your medical treatment with your personal medical care provider. Only they can, and should, give medical recommendations to you.

                  New favorite quote: "God gives us only what we can handle. Apparently God thinks I'm a bad-ass" ~Author Unknown
                  Source - Pinterest

                  Current treatments:
                  -IC diet
                  -Elavil 50mg at night
                  -Continuous use birth control pills (4-5 periods/year)
                  -Heparin/Marcaine/Sodium Bicarb home instills at night 3-4x per week, more often if needed
                  -Pyridium if needed,
                  -Pain medicine at bedtime daily, as needed during the day several times per week
                  -Antibiotic when doing an instillation to prevent UTI
                  -Colace & SmartFiber to treat chronic constipation from meds, Fleet enema as needed
                  -Dye Free Benadryl 50 mg at bedtime
                  -"Your Pace Yoga: Relieving Pelvic Pain" dvd, walking, treadmill at gym
                  -Managing stress= VERY important!
                  -Fur therapy: Hugging the cat!


                  • #10
                    I have inflammatory bowel disease and IC. I always have colon pain. I have noticed an increase in IC pain when my bowel pain is severe. Pepperoni pizza is out of the question for me.


                    • #11
                      Interesting article. Every bit a of research helps.
                      Jill, thanks for sharing.

                      Let's keep praying for a cure.
                      IC Symptoms began in early 2001
                      Divorced : Sept 2002 (Partly due to IC)
                      Diagnosed with IC in April 2004
                      Most recent injury - Rupurtured Left Achilles Tendon
                      Wed Jan 28 2009
                      (Ice Storm Accident)
                      2nd Achilles Tendon Surgery - May 28, 2009 after re-injury on May 17
                      Other Injuries
                      Broken Left Ankle - July 2004 ( fell off ladder)
                      Broken Left Ankle (Again) - May 2005 (car accident)
                      Sprained Left Ankle - November 2006 ( fell off my aunts porch on Thanksgiving Day)

                      CURRENT MEDS
                      Elmiron, Pyridium


                      • #12
                        I can literally feel my bladder cringe when I see pepperoni pizza...same with red wine and vinegar.


                        • #13
                          I am glad research is being done, but what they were doing to that poor mouse sounds brutal. You couldn't pay me to let them induce pelvic pain on me by putting something spicy in my colon! I am glad research is being conducted but it's too bad that mouse has to be in pain. I wouldn't wish bladder or pelvic pain on anyone.
                          my name is Katie, 22 yr old mother & nursing student. I want to be a writer and midwife.

                          I have severe IC w/ hunner ulcers and urethritis with lesions ENDO, chronic pelvic pain, PFD adhesions, scoliosis, arthritis,migraines,asthma chronic pain.

                          Mother to a beautiful little girl. She has my heart and she's everything to me. Thinking positive and consciously untensing tense muscles helps a ton!!!! physical therapy also helps a lot.


                          • #14
                            I have Ulcerative Colitis, and I notice that my IC will ALWAYS flare at least a little when my UC is flaring painfully. No exceptions. So, this does make a lot of sense for those occasions. I'm glad they're starting to examine ways that other body parts can feed in to some of our IC flares, because IC is definitely affected by our entire bodies, not just our bladder.

                            IC (diagnosed 2003), Ulcerative Colitis (protitis in 2008, now pancolitis :[), other assorted ailments. Wheeee~


                            • #15
                              Does anybody has tried Heparin rectally or any other(s) anesthetic patch?

                              Bentyl effects seems to wear out within weeks.

                              I'm not using it much anymore.