In my last post I looked at the GAG layer in the bladder and how damage to it can cause problems for the bladder lining, a.k.a the bladder urothelium.

When the bladder urothelium gets damaged it can lose its integrity and become ‘leaky’ or ‘hyper-permeable’. Molecules that shouldn’t normally leave the bladder can get into the space (‘interstitium’ – hence interstitial cystitis) between the layers of the tissue and into the blood.

If you’re reading about health you may have heard of a ‘leaky gut’ syndrome, where the gut becomes hyper-permeable and things that shouldn’t get into the blood suddenly do. The concept of ‘leaky bladder’ is very similar.

How a healthy bladder wall works

The bladder wall consists of several layers. The innermost layer is the mucus-like GAG layer that protects the urothelium from irritating and electrically charged molecules in the urine.

The urothelium is also known as the transitional epithelium. It is a layer made up of cells that are sealed together with ‘tight junctions’ that have a low permeability, meaning only selected very small molecules can pass through this space. Because of its structure, this layer is able to stretch.

Behind the urothelium is the submucosa, a tissue with blood vessels and nerves that are connected to the sympathetic nervous system.

Behind that, we can find the muscle layer, which controls bladder movement.

The bladder has a capacity of 300-800 ml urine. Once capacity is nearly reached, the urothelium is stretched. Small ions can now pass through the tight junctions and excite the nerves in the submucosa to let the brain know that it’s time to go to the toilet.

The mechanism behind a ‘leaky bladder’

The first step in the bladder becoming ‘leaky’ is a damaged GAG layer. Once the GAG layer loses its integrity, the urothelium is exposed to irritation from urine and the molecules contained in it.

Toxic factors in urine can damage the tight junctions of the urothelium, essentially making them wider. This allows molecules in the urine to pass through the barrier and stimulate the underlying nerves.

Potassium, which is secreted in urine as part of the body’s water regulation, plays a major role in the resulting symptoms of frequency, urgency, pain and incontinence. Potassium has the ability to depolarize nerves and in the long-term this may cause cell death.

The urethra is also normally protected by a GAG layer. Therefore, when the GAG layer is damaged the lining of the urethra can also be subject to irritation, which may explain why sufferers often experience symptoms in both the bladder and the urethra.

How to test for a ‘leaky bladder’

There are a few ways this could be tested, mainly by measuring potassium levels.

Potassium sensitivity test (PST): Patients are briefly exposed to water and then a potassium solution directly into the bladder. The reaction is measured on a 6-point scale, with everything above 2 being regarded as ‘positive’.

Creatinine: the concentration of potassium in the urine can be measured as creatinine. In a patient with a ‘leaky’ urothelium the concentration would be expected to be low, as potassium is lost across the bladder wall. A result of around 0.51 mEq/mg creatinine or lower may indicate that potassium is being lost (data on this is quite scarce, however).

All the same disease?

There are several conditions relating to the bladder, prostate, vagina and pelvic region. Pain can be perceived differently and in different areas of the pelvic region. Therefore, a diagnosis made according to where the patient feels the pain may be misleading.

Interstitial cystitis is often only diagnosed as such when damage to the bladder is already visible. But by this time, the syndrome has progressed quite far.

The early stages of interstitial cystitis may look different and a connection might never be made until a lot of damage has been done.

A study from a few years back looked at different conditions related to the pelvic region: Interstitial cystitis, overactive bladder, chronic pelvic pain, vulvadynia, vaginitis, emdometriosis, urethral syndrome and prostatitis. What do they all have in common? Shared symptoms often include at least one of frequency, urgency, pain and incontinence.

But what is more interesting is that when populations suffering from any of these conditions were tested with the Potassium sensitivity test (PST), a lot of them tested positive.

Therefore the author argued that the common denominator for all of these conditions may be a ‘leaky’ urothelium.

He argues that these conditions should be united as ‘one disease’: Lower Urinary Dysfunction Epithelium, or LUDE.

Things that may contribute to a ‘leaky bladder’

• Chemicals in the diet, cosmetics, environment
• Certain medications such as antibiotics and NSAIDs
• Stress
• Standard American/Western Diet
• Infection
• Mould toxicity

What to do if you expect your bladder to be ‘leaky’

The most important step when trying to ‘heal’ the urothelium would be to treat the GAG layer, as I have outlined in my last post.

Moreover, the following steps could help:

• Remove anything that can cause further damage: chemicals (often found in foods, drinks and beauty products), irritating foods, unnecessary medication (such as NSAIDs or antibiotics – unless there is a good reason to take them)
• Follow a healing and nutrient-dense diet such as outlined in the interstitial cystitis diet (this provides the raw materials needed for the body to repair itself)
• Manage stress (stress can increase hyper-permeability in the gut, so it may do so in the bladder too)
• Get good sleep and rest (these are the times the body repairs itself)

 

Let me know in the comments if you struggle from any of the conditions I mentioned above and if you suspect your urothelium may be damaged. What have you done about it? What does it feel like?

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Sources

Slobodov, G. et al Abnormal expression of molecular markers for bladder impermeability and differentiation in the urothelium of patients with interstitial cystitis. J Urol. 2004 [Apr;171(4):1554-8] available at: https://www.ncbi.nlm.nih.gov/pubmed/15017219

Hurst, RE. et al Bladder defense molecules, urothelial differentiation, urinary biomarkers, and interstitial cystitis. Urology. 2007 [Apr;69(4 Suppl):17-23.] available at: https://www.ncbi.nlm.nih.gov/pubmed/17462475

Parsons, C. Lowell The role of a leaky epithelium and potassium in the generation of bladder symptoms in interstitial cystitis/overactive bladder, urethral syndrome, prostatitis and gynaecological chronic pelvic pain BJUI [Volume 107, Issue 3, February 2011, Pages 370–375] available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2010.09843.x/full

Parsons, C. et al Epithelial dysfunction in nonbacterial cystitis (interstitial cystitis). The Journal of Urology [1991, 145(4):732-735] available at: http://europepmc.org/abstract/med/2005689

ELDRUP, J. et al Permeability and Ultrastructure of Human Bladder Epithelium BJUI [Volume 55, Issue 5, October 1983, Pages 488–492] available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.1983.tb03354.x/abstract

Rajasekaran, M. et al Toxic factors in human urine that injure urothelium. Int J Urol. 2006 [Apr;13(4):409-14.] available at: https://www.ncbi.nlm.nih.gov/pubmed/16734860