The Ultimate Guide to IC Flare Management
By Callie Krajcir
Registered Dietititan, IC Warrior
If you’re not, we’ll talk about that too in this post. I’m first going to define what a “flare” is, then I will reveal the two major types of IC flares, and finally I’ll dive into the various causes of flares and how to identify what caused your flare. You’ll gain the knoweldge you need to prevent flares and manage the next flare (they are sometimes inevitable) that pops up.
Let’s dive in!
What is an interstitial cystitis “flare”?
In the simplest definition possible, a flare-up is an increase in your symptoms. For example, if your main symptom is pain, and your daily pain is a 5/10 on average, then a flare could be a week of 9/10 pain. If you typically urinated 16-20 times per day, a flare-up could look like 30-40 trips to the bathroom each day. The duration of a flare can be unpredictable. I’ve even heard stories of people getting stuck in month-long flares. Brutal, I know.
Is it a UTI?
Before you assume what you’re experiencing is a flare, you’re going to want to make sure it is not a urinary tract infection (UTI). The symptoms of a UTI and those of an IC flare are annoyingly similiar. If you’re new to IC, call your doctor and ask if you can get a urine culture done. Some doctors will even write you an ongoing script for a urine culture so you can avoid unnecessary visits to the doctor, saving you both time and money (also sanity).
Types of Flares
Once a UTI has been ruled out and you determine what you’re facing is a flare, you need to determine what type of flare you are experiencing. To make things easy, I’ll break flares down into two different categories: bladder wall and pelvic floor. Let’s dive into each of these.
Bladder Wall Flare
- Typically caused by an dietary source irritating the wall of your bladder. Think of it like pouring acid on an open wound (especially if you have Hunner’s lesions)
- Foods and beverages that turn your urine too acidic or alkaline can irritate the nerves in the bladder wall. This creates a very, very angry bladder that can feel like it has razor blades in it or is just uncomfortable
- The onset time of this type of flare can range from 30 minutes to 3 days
Pelvic Floor Flare
- Typically caused by an irritating activity such as sitting in a car, sexual intercourse, or muscle trauma such as riding a bike or horse
- You may experience pelvic floor muscle spasms during this type of flare
- You also could have vaginal burning or feel like something is falling out of your vagina
- Can have a bit more of a delay than Bladder Wall flares and can present 24-48 hours after the triggering event or action
Determining What Type Of Flare You’re Experiencing
To figure out what type of flare you’re enduring, it’s helpful to determine WHEN you are having pain. Per the IC-Network, “pain BEFORE urination (that gets worse as your bladder FILLS with urine and feels better once you have emptied your bladder) points to your bladder wall. Pain AFTER urination points to your pelvic floor as the probable source of your flare. If pain is intense before and after urination, you may have a combination flare that is involving the bladder, muscles and nerves.”
Causes of IC Flares
Now that we’ve defined the types of flares and discussed how to identify which type you’re experiencing, let’s dive deeper into the causes for each type of flare.
Bladder Wall Flare Causes
Diet Irritant
- Did you consume a food or a beverage that is on the “try it” or “caution” lists of the IC diet? Maybe there was citric acid in something you ate or a restaurant seasoned your food with pepper or lemon
- The best way to identify if food caused your flare is to keep detailed records of what you eat and drink. That way if you flare, you can go back a few days in your logs and see if you consumed something that could’ve been triggering
- To learn exactly what your dietary triggers are, conduct an elimination diet. If you’re looking for guidance in this process, check out the Road To Remission program
- To manage a flare caused by a diet irritant, you’ll want to try flushing the irritant out of your body with water. Some people even utilize Prelief, TUMS, or ½ tsp baking soda in 8 oz water to help manage a bladder wall flare (consult your doctor before trying this)
Dehydration
- Have you been consistently drinking water today? What about yesterday? I don’t know about you, but if I don’t drink enough water in a day, my bladder lets me know
- If your urine is too concentrated (color of apple juice), it can be more acidic and thus irritating to the bladder wall
- You want your urine to be a pale yellow (like lemonade), but not completely clear – that is a sign of over-hydration
You may also want to utilize analgesic medications like Azo, Uribel, or pain medications during this type of flare to help with the pain. Ask your doctor what option is best for you.
Pelvic Floor Flare Causes
Invasive procedures/treatments
- Having a doctor poking around your pelvic floor during an exam or getting instillations can be quite irritating to your pelvic floor muscles and your urethra. For some people, invasive procedures do more harm than good.
Exercise
- Anything past light exercise can be irritating to your pelvic floor, especially if you suffer from pelvic floor dysfunction
- Instead of high intensity exercise like going for a long run, Crossfit or heavy lifting, try yoga, a light walk, or pilates
- Such activities can be a lot easier on your pelvic floor and you still get those “feel good” endorphins
Stress
- The most common trigger
- Can cause your pelvic floor muscles to tense up and cause a flare that could happen immediately or the next day
- If you’re a highly anxious person, your nervous system is likely stuck in an up-regulated state, meaning it believes there is a constant threat to your body. If this is you, start working on minimizing your stress and down-regulating your nervous system through meditation, guided breathing, yoga, journaling, or a program like Pelvic Sense. A book I recommend to all my clients is Why Pelvic Pain Hurts.
Chemical Irritants
- If you have sensitive skin, you are going to want to make sure you are not using scented detergent, dryer sheets, body wash, or perfumes and other fragrances. This can be irritating to your skin and can cause a flare
- Switch to a scent-free version and be sure to rinse your vulvar area with water – it doesn’t actually need soap per my urogynecologist.
Sexual Intercourse
This is another pretty common trigger. Here are some things you can try:
- Limit thrusting time to 5-10 minutes
- Utilize hypoallergenic, non-irritating lubrication (try coconut oil, Aloe Glide)
- Try different positions such as angled missionary, side lying or “spoon” position, or rear entry with forward lean
- Keep your mind as clear as possible. Push any negative thoughts out as best you can
- If it hurts, tell your partner and STOP. Do not continue and cause yourself pain just to help them get an orgasm
Or, explore alternatives to intercouse, such as “outercourse”, oral or manual pleasuring, mutual masturbation, cuddling, a sensual massage, or sex talk.
Things you can do after sexual activity to prevent a flare include
- Urinating ASAP
- Take any “as needed” medications
- Drink water
- Take D-Mannose* and/or Phenazopyridine (Azo, Pyridium)
- Apply ice or heat to the pelvic floor
- Stretch the pelvic floor
- Take a valium suppository overnight*
*Only after discussing with your physician
Hormone Fluctuations
Unfortunately, there isn’t a whole lot that can be done about hormone flares, but on the bright side, this type of flare doesn’t typically last too long (1-3 days)
Try using ice or heat on your pelvic floor or abdomen and use any other methods that typically work for you. To identify if hormones are causing your flare, keep track of your menstrual cycle. Bring your records into your IC doctor at your next visit to discuss if there is any type of treatment you can try.
Standing/Sitting
If you suffer from pudendal neuralgia (or not), your pelvic floor can be affected by standing or sitting for too long. Consider purchasing a cushion to sit on or take breaks to stand up every 20-30 minutes at work.
Tight Clothing
Leggings or jeans can be constrictive and uncomfortable for the pelvic floor. Swap them for sweatpants, joggers, skirts or dresses. If you’re feeling daring, try on some mom (or dad) jeans and even size up for extra room.
Extreme temperatures
I typically flare if I’m in a place that has extreme heat or cold. I believe there are multiple factors at play, like I can be more dehydrated in hot temperatures or I may need to wear multiple layers of clothes in cold temperatures, which could irritate my pelvic floor. I prepare for situations like this by hydrating before the event, dressing as comfortably as I can, having my Peppermint Cooling Balm with me as well as Azo just in case I need it.
Medications
Check the label or do a quick internet search of the medications you take to make sure there aren’t any side effects that could trigger a flare. You could always ask your pharmacist for help.
Conclusion
Now that you know the various causes of flares and the different types of flares, you now have the base knowledge you need to prevent flares and manage your next flare! If you need additional help with flares, I created an entire Masterclass about Flare Management inside The IC Collective. If you want more personalized guidance and support in investigating your IC triggers, apply for my Road To Remission program.