Cystitis is the inflammation of the urinary bladder and the ureters. The Symptoms are frequent and urgent urination, lower abdominal pressure and pain, and sometimes pain in the vagina area, which can range from a mild burning or discomfort to severe pain.

Mechanism of Cystitis: The protective mucous membrane inside the bladder is damaged, so urine can irritate and inflame the bladder lining. If the concentration or the acidity of urine is too high, the mucous membrane can be damaged and will no longer be able to protect the bladder especially when the bladder lining is inflamed due to systematic inflammation.

What can cause inflammation of the bladder?

1. Hormone imbalance before, during, and after menopause: When estrogen is not balanced with progesterone, mast cells in bladder tissue are easily activated to release many kinds of chemicals that cause inflammation in those tissues, as discovered by researchers from Tufts Medical School in 1998. This is one of the reasons why women between 35 and 55 are prone to developing cystitis if they do not eat a balanced diet.

2. Imbalanced nervous system: When you get nervous, you tend to use the bathroom more often than you normally will. In addition, the nervous system regulates immune cell activities and the magnitude of the immune response. The newest research verified that when we use electro-acupuncture stimulation to activated the vagus nerves with low intensity, the body can modulate the inflammation to the right level to avoid damaging its own tissues (Ma, Q.F. et. al Neurons, 2020). Dr. Ma in Harvard Medical School explains two mechanisms that acupuncture can help modulate the inflammation. One is through vagus-adrenal axis by modulating the production of norepinephine in the adrenal gland. The other is through modulating the special group of cells in Spleen. Furthermore, the intensity ,frequency and when electro-acupuncture can be used to modulate the inflammation is critical in order to prevent cytokine storm.

3. If immune function is hyperactive from the overstimulation of the sympathetic nervous system, then inflammation of the bladder will become chronic.

4. Chronic stress: Stress depletes our anti-inflammatory hormones such as cortisol. When I was supervising the Chinese Herbal Clinic at the New England School of Medicine, I saw a young lady with interstitial cystitis. She felt constant lower abdominal pressure, urgency to urinate, and burning in the urethra that significantly interfered with her life. Even though she visited many doctors and went through extensive tests, no one could determine what caused her problems. She tried many kinds of medications, but nothing worked. I discussed with her about factors that might trigger this disease under certain conditions. She said that at the time, she had tremendous stress and drank 10 cups of coffee a day to keep her alert in her long work time. A few weeks later, she developed cystitis. In this case, stress initially stimulated her adrenal gland to produce more endogenous cortisol. Then, too much caffeine stimulated her sympathetic nervous system to produce more adrenaline. Finally, the adrenal gland, depleted by the great amount of caffeine she took in short period of time, could no longer protect her from inflammation. Although our bodies have a tremendous ability to compensate, if abused for too long, it will eventually fail us.

5. Feminine hygiene sprays and spermicidal jellies: These products can cause inflammation when your immune system is already out of balance, which is why not every woman will develop cystitis from using the same product for the same period of the time. If you currently have bladder inflammation, try to avoid these products until your symptoms are gone.

6. Carbonated beverages: Carbonated beverages create an acidic environment in the body, which facilitates inflammation. If the inflammation occurs in the bladder, then you may develop cystitis.

7. Caffeine: Caffeine aggravates the symptoms of cystitis according to a 2005 article from the Journal of the British Menopause Society. Caffeine not only creates an acidic environment in the body, but also causes imbalance of the immune and nervous systems.

8. Citrus products: Most articles blame citrus products for causing inflammation of the bladder, but I think that the vitamin C in citrus actually helps our body build stronger connective tissues. I used to have canker sores regularly a week before my period started and they would last for two weeks, causing me severe pain. Since I began eating one orange or tangerine a day, I have not had this problem for a long time. Moreover, oranges help our digestion, so that our body can absorb other nutrients more efficiently. If people eat citrus while drinking soda or coffee, however, their bodies cannot buffer the acidity then inflammation occurs. I do not think that orange juice provides the same benefits as actual oranges though.

9. Alcohol: Alcohol inflames the inner membranes of your digestive system, causing vitamin and mineral deficiency. Your body, including the bladder, cannot repair itself without sufficient vitamins and minerals even if you take multi-vitamins every day. Alcohol can also cause urine retention, which leads to damage of the bladder lining.

10. Spicy food: Spicy food can cause acute urine retention and inflammation because it irritates the bladder lining especially if you eat too much of it, too frequently, and without drinking enough water.

11. Artificial sweetener: The Mayo Clinic recommends that women who have cystitis avoid artificial sweeteners. Artificial sweeteners can inflame the small nerves of the bladder, making your bladder hypersensitive.

12. Radiation: Radiation therapy can cause inflammation of the bladder and its controlling nerves.

13. Catheters: Long-term use of a catheter can cause inflammation and even infection of bladder and urethra linings.

14. Autoimmune reaction: If a person has an autoimmune disease, such as lupus, MS, or colitis, his/her immune system produces different kinds of antibodies that attack the tissues and lead to chronic inflammation.

15. Allergies: When you have allergies, your mast cells produce more chemicals associated with chronic inflammation, including histamine. In this case, using herbs to resolve your allergies as soon as you can will help relieve your cystitis.

16. Bacteria: Bacterial infection can cause chronic inflammation of the bladder.

17. Certain drugs: Ryanodine, heparin, 2-aminoethoxydiphenyl, atropin, belladonna, efedrin, aminasin, tizercin, phenobarbital, imisin, promedol, and lazix can cause urine retention. Because the urine becomes more concentrated, the bladder is more prone to inflammation.

18. Avoid eating too much canned meat, aged cheese, and shell fish to avoid too much histamine.

19. Onions, fava beans, and spinach can irritate the bladder lining.

20. Avoid most nuts, especially peanuts because they can induce the release of histamine.

What should we do to make our bladders healthy?

1. Quite smoking: nicotine can irritate your stomach, intestine, bronchi and bladder lining.

2. Cut down or stop drinking alcohol during flare ups of cystitis. Once the symptoms are gone, you may try drinking moderately once or twice a week.

3. Wear loose cotton underwear. Synthetic materials usually cause irritation and cannot absorb sweat as easily. The resulting damp environment helps bacteria and fungi grow.

4. Bladder training: You should go to the bathroom at regular intervals instead of waiting until you feel really uncomfortable. If you hold your urine too long, it becomes more concentrated and the harmful materials in it may be more likely to irritate your bladder lining.

5. Reduce your stress level with acupuncture, yoga, tai chi, and meditation: Less stress means that you will have more anti-inflammatory hormones to protect your bladder lining.

6. The Kegel Exercise for bladder control: Tighten your pelvic muscles by stopping urine flow. Count to 10 and then, relax those muscles by restarting urine flow. Practice this exercise 2 to 3 times a day.

7. Eat wheat grass, green barley, alfalfa, kelp, and seaweed. These foods will create an alkaline condition in your body, thus reducing bladder inflammation.

8. Eat cantaloupe, melons, and pears. These fruits can help clear internal heat and reduce inflammation according to Chinese medical theory.

9. Avoid onions, tofu, soybeans, lima beans, fava beans, yogurt, sour cream, nuts and foods containing nitrates and preservatives when you have interstitial cystitis because they can modify your immune function and estrogen activity. You may resume eating small amounts of these foods after your cystitis heals.

10. Drink enough water to flush out your urethra and bladder. Water also helps lower your histamine level, thus reducing inflammation. Do not be afraid of frequent urination. The less water you drink, the more irritation your bladder feels. The toxins in your urine are more concentrated if you do not drink sufficient water. If you make a chart of how many times you urinate each day compared to your water intake, you may find that your urination frequency is almost the same regardless of how much water you drink. However, it is a good idea to avoid drinking water after 7 PM to prevent urination from disrupting your sleep only if you drink enough water during the day time.

11. Food supplements: Calcium glycerophosphate, L-arginine, mucopolysaccharides, and bioflavinoids can help repair damaged tissues in the bladder. Co-enzyme Q (1030-60 mg) and vitamin E (400 IU) have strong antioxidant effects, thus helping reduce tissue damage.

Foods for treating and preventing interstitial cystitis:

Many very safe Chinese herbs, which can help your body balance the immune and nervous systems to reduce chronic inflammation, are also edible as food.

1. Wild yam (Shan Yao): Helps balance estrogen and progesterone, optimize the digestive function, and reduce the frequency of urination. Steam wild yam and eat about 30 g per day.

2. Dandelions greens: Helps clear internal heat to reduce inflammation. Stir fry them with olive oil.

3. Bitter melon: Helps clear internal heat. Stir-fry it with olive oil.

4. Honeysuckle flowers: Has anti-inflammatory effects. Soak the flowers in hot water for 5 to 10 minutes and drink as tea. It also has anti-virus and anti-bacteria effect.

5. Parsley: Helps buffer your body fluids so that they are neither too acidic nor too basic. Put parsley into your soup.

Why acupuncture helps relieve the symptoms of cystitis:

1. Acupuncture can relax your bladder and pelvic floor muscles so that they do not contract constantly when the bladder is not yet full.

2. Acupuncture can desensitize the nerves controlling the bladder so that it does not leak small amounts of urine or become so sensitized to the irritating chemicals in the urine.

3. Acupuncture can relieve pelvic pain by stimulating your body to produce its own painkillers: endorphin, serotonin, and dopamine.

4. Acupuncture can change your perception of pain so that you focus less on when and how you can get to the bathroom. Furthermore, it reduces the pain signal in the pain processing center of your brain.

5. Acupuncture can strengthen your adrenal gland and balance your immune function, so you are less prone to developing inflammation.

Questions for acupuncturist and herbalist:

1. What is cystitis?
a. Inflammation of kidney
b. Inflammation of the bladder lining
c. Infection of kidney
d. None of the above.

2. What causes cystitis?
a. Hormone imbalance: estrogen dominance condition during the menopause
b. Too much coffee or alcohol
c. Too much stress
d. All of the above.

3. Why does alcohol make people prone to cystitis?
a. Alcohol can produce more heat, leading to inflammation
b. Alcohol dehydrates the body, inducing more histamine
c. Alcohol can interrupt hormone balance
d. All of the above.

4. How can acupuncture help relieve the pressure sensation of people with cystitis?
a. Acupuncture can relax the pelvic muscles instantly
b. Acupuncture can calm down the nervous system so people can feel less pressure sensation
c. None of the above
d. A and B.

5. How can acupuncture help reduce the pain and burning sensation in people with cystitis?
a. Acupuncture can induce the fight or flight hormones
b. Acupuncture can stimulate the body produce more natural pain killer such as serotonin, endorphin, and dopamine.
c. Acupuncture increase the pain threshold by balancing the nervous system
d. B and C

6. True or false statement: Wild yam (Shan Yao) help improve hormone balance and digestion and hence reducing inflammation in the bladder.
a. True
b. False

7. Which herbs can help reduce the inflammation in the bladder or other parts of the body
a. Dandelion green
b. Honey suckle
c. Wild yam (Shan Yao)
d. All of the above

8. What are the main symptoms of cystitis?
a. Lower abdominal pressure sensation
b. Burning sensation upon urination.
c. Increased frequency and urgency of urination
d. All of the above.

9. Why does adrenal gland play important roles in preventing cystitis?
a. Adrenal gland produce adrenaline to fight the inflammation
b. Adrenal gland can produce more cortisol to reduce the inflammation
c. Adrenal gland can produce GABA to calm down the nerves
d. None of the above.

10. Parsley helps prevent cystitis because it can help keep the PH value of the body within normal range.
a. True
b. False

11. Why is it beneficial for people with cystitis to urinate regularly?
a. It can reduce the pressure sensation
b. It can reduce the concentration of the minerals in the urine, thus less stimulation to the bladder lining
c. It can empty bladder more
d. None of the above.

12. What food supplements can help reduce the frequency of urination for patients with cystitis?
a. L-arginine
b. Co-enzyme Q
c. Vitamin E
d. All of the above.

13. When you have cystitis, why do you need to avoid Tofu, soybeans, and fava beans?
a. They will modify your immune function
b. They can change the estrogen activity, thus change the nerve sensitivity
c. A and b
d. None of the above

14. According to Chinese medical theory, which food can help clear internal heat and reduce the inflammation?
a. Melons
b. Pears
c. Cantaloupe
d. All of the above.

15. How can wheat grass, green barley, kelp and seaweed reduce inflammations?
a. They create acidic condition in your body
b. They create alkaline condition
c. They induce histamine release
d. None of the above.

16. How can stress make cystitis worse?
a. Stress makes people lose weight
b. Stress makes people gain weight
c. Stress can weaken the adrenal gland and cause more inflammation
d. None of the above.

17. Is the following statement true of false? Wearing cotton underwear will reduce the bacterial or fungi growth because the synthetic material cannot absorb sweat easily and create a damp environment.
a. False
b. True.

18. Why do people need to avid aged cheese, shell fish and too much canned meat when they have cystitis.
a. Those food make them nervous
b. Those food tends to induce histamine release
c. A and B
d. None of the above

19. Why certain medications should be avoided when people have cystitis, such as atropine, efedrin and heparin?
a. Those medications can cause contraction of the bladders
b. Those medications may change the hormone balance
c. Those medications can cause urine retention, thus more irritation to the bladder lining.
d. None of the above

20. Why can allergies make cystitis worse?
a. Allergies can cause contraction of bladder muscles
b. Allergies can cause relaxation of the bladder muscles
c. A, B and D
d. Allergies cause more histamine to be released, and thus more inflammation in the bladder lining.