The inspiration for this article arises from a question in our Facebook group that has not yet found a clear answer on this blog:
“Is constipation a factor that may be partly the cause of recurrent cystitis and overactive bladder syndrome? I would like to know your opinions”.
Thank you very much for this question that opens a great “chapter” on the association between cystitis and the gut.
To answer your question, YES, constipation is clearly a risk factor for bacterial and abacterial cystitis for several reasons:
1) stasis of feces in the colon induces various effects that promote cystitis
-> modification of the microbiota in favor of the growth of potentially uropathogenic germs (such as E. coli) which, becoming dominant, colonize the perineum more easily to successively ascend towards the urinary tract
-> this dysbiosis also causes a (negative) alteration of immunity with the consequence of a greater susceptibility to infections, in particular those of the urinary and genital tracts
-> in addition, the increase in volume in the colon (always linked to the accumulation of matter) causes distension of its walls, leading to an increase in pelvic inflammation (and associated pain)
2) when constipation becomes chronic, inflammatory processes may appear as:
-> the intestinal mucosa suffers repeated attacks/irritations that cause inflammation of the wall
-> the inflammatory response induces modifications (alterations) of the intercellular connections which ends up creating intestinal permeability = that is, the loss of the filtration capacity of the intestinal wall
3) intestinal hyper permeability therefore allows the passage of substances from the intestinal lumen to the internal environment (sublayer of the mucosa, blood and nearby organs):
-> bacteria from the gut microbiota can therefore migrate to the bladder
-> the “toxins” (product of digestion or metabolites) that must be eliminated with the feces give rise to an inflammatory response (allergic type most of the time) local but also systemic (there are manifestations of all kinds in case of intestinal porosity: dermatological, respiratory, nervous, etc.)
In such a context, cystitis is often the visible manifestation of a much more complex problem (in short, the tip of the iceberg).
Therefore, consistent and resolute management should focus not only on the urinary tract and on preventing the arrival of bacteria in the bladder, but also on the cascade of events that allows these colonizations, infections, and inflammations.
In particular, we should:
– regularize transit
– restore the eubiosis (= balance) of the microbiota
– support the “repair” of the intestinal wall
– block the various inflammatory responses
– reduce the allergic response and its manifestations
– disrupt and eliminate pathogenic biofilms that favor the recurrence of bladder infections
– manage other risk factors that may have been identified