Going With The Flow: Water and IC Symptoms – Fresh Tastes by Bev

By Bev Laumann, Author of A Taste of The Good Life: A Cookbook for IC & OAB

Like most people, I just took for granted the water I consumed every day. What could be less painful for an IC bladder than just plain water? Then I noticed a curious thing: My husband Charlie and I were on vacation when suddenly my bladder began feeling better. What a welcome relief from the months-long rampage it had been on! But was the bladder pain just coincidentally taking a vacation too, was it lack of stress? or was it something else?

At home I had been in the habit of drinking store-bought bottled water. But on vacation, I was drinking the local tap water. Each morning of our vacation I would fill several small bottles with water from our hotel. I took this water with me as something safe to drink on the day’s excursion. Once the vacation was over and I got back home, I discovered that I had a couple bottles of “hotel water” left. On a lark, I popped them in the fridge. There they sat, next to some brands of bottled water I had purchased from the store. When I ran out of the store-bought bottled water, I began using the leftover hotel water. Much to my amazement my bladder felt better again. Hmm. That got me to thinking.

I took a good hard look at the bottled water I had been drinking at home and, sure enough, the pH listed on the label indicated it was on the acid side. Could that slight, undetectable-to-the- taste-buds acidity be enough to set my overly-sensitive bladder on a rampage? As it turned out, apparently it could. I quit drinking that brand of bottled water, went back to my household tap water (which is slightly alkaline) and sure enough, my bladder felt better. But my story isn’t the only one. There are as many variations as there are people.

Some IC sufferers carry water wherever they go, sipping constantly. They’ll tell you that drinking a lot seems to dilute their urine and lessen their pain. Then there are others who limit their intake. Those people say that cutting down on fluids reduces their urinary frequency. And so it seems that many of us who suffer from both pain and frequency do a balancing act: if we drink too much we’ll run to the bathroom even more, but if we drink too little our bladder pain is worse. Those of us who take Elmiron may worry about something else: are we drinking so much water that the drug washes out before it can coat our bladders? (A good topic to discuss with your doctor.)

Most IC patients find their optimum level of water intake fairly quickly through trial and error. Physician and IC researcher Dr. Lowell Parsons recommends that IC patients “try to balance fluid intake with fluid output” but observes that other than reducing either frequency or pain, the amount of fluid intake plays no role in the disease itself (ICA Update, Vol. 8, #4, 1993.) Doctors do however, recommend that everyone be sure to get enough water for good health.

Water For the Body’s Needs

For basic life-sustaining functions, the amount of water you need depends on the calories you burn. Pregnancy or increased body weight will increase your need for water.

Nationwide surveys indicate that a portion of the U.S. population may be chronically dehydrated, and even mild dehydration of only 2% loss of body weight can result in impaired bodily functions. Some people become dehydrated because they have a poor thirst mechanism, a function of an autonomic nervous system abnormality.

We all know that hot weather increases our bodies’ need for water, but did you know that cold weather does too? Recirculated air in our homes can be as drying as a desert wind. And when we go out in the cold, our bodies rely on water to facilitate the chemical processes that warm us.

Winter colds and flu can increase the body’s need for water and so do some drugs IC patients commonly take. Antihistamines like Atarax, Allegra, or Benadryl are drying to the system. Elavil, Ultram or Vicodin (to name a few) can easily cause constipation if you don’t drink enough. And if you eat a high-fiber diet for your constipation-predominant irritable bowel syndrome (IBS), you will need more water to process the additional roughage. If you take guaifenisin, an expectorant in cough syrups, it may make you drink (and urinate) more.

Most healthy adults need to take in enough water to replace the eight to twelve cups of water lost each day through urination, bowel movements, perspiration and breathing. Getting that much water is not as difficult as it may seem because many foods are mostly water and contribute significantly to our intake. Even a slice of whole wheat bread is about 38% water.

A small number IC patients seem to have thirst regulation problems. Some of us simply don’t get thirsty and have trouble remembering to drink enough. Others are always thirsty and have a hard time reducing their fluid intake. (While this may be just an annoying part of life with IC, if it gets to be a real problem it’s worth seeing your doctor to rule out a more serious condition).

Chlorinated Drinking Water

Those of us with very sensitive bladders may question whether the chlorine in tap water is irritating. So far, there are no scientific answers to that, and many IC sufferers have no problem with tap water. But a few of us do claim our bladders are happier when we drink only bottled water. One IC patient I know has installed a home water filtration system that she says not only reduces the chlorine in her water, but has reduced her bladder symptoms too. (Some women with IC, and many with vulvodynia, avoid swimming in chlorinated pool water because they say it provokes already-inflamed urethral or vulvar areas.)

Doctors too have their stories. A physician in the Midwest noticed that every year the number of IBS and IC patients in his waiting room dramatically increased shortly after the week in which the local water district increased the chlorine in the water. Is chlorination in water a problem, or are these just coincidences??? Who knows, but it may be worth checking out if you have an extremely sensitive bladder.

Tap Water

We don’t normally think of water as an acid, but some drinking water can be quite acidic. If your tap water comes from a local water district, you can call and ask about the relative acidity or alkalinity of your water. They may give you the information in terms of “pH”. A pH value of 7.0 is neutral. Numbers smaller than 7.0 are acid, and numbers larger than 7.0 are alkaline.

Most municipal water used to be treated with chlorine, but concerns were raised at the Environmental Protection Agency about a by-product that was created when chlorine interacted with organic matter in water. Now many places treat their water with a similar chemical, chloramine. (Chloramine is ammonia and chlorine bonded together). Both chlorine and chloramine are reputed to alter the flavor of soups and stews a bit and because of that, some professional chefs prefer to cook with unchlorinated bottled water.

If you get your water from a well, you can have it tested for various factors including acidity. Well water tends to be more mineralized, so many people use water softeners. As minerals are removed from the softened water, sodium is added. Fully softened water can contain up to 39 milligrams of sodium per cup.

Some IC patients take a half-teaspoon or so of baking soda in a glass of water to help with food-induced bladder pain. If your softened water is already high in sodium and you frequently use baking soda to combat food-induced IC flare-ups, you may want to ask your doctor about your sodium intake.

Bottled Waters

There is a wide selection of bottled waters on the market. (And one quarter of them are actually just processed municipal water). Luckily for us, many aspects of the safety, quality and labeling of bottled waters are FDA regulated. If you’re trying to figure out which bottled waters are safe for your bladder, it’s helpful to know that some of the words on the labels are legally defined. Here’s what some of those words mean:

Sparkling water

Sparkling water is any water that “fizzes” due to the carbon dioxide gas dissolved in it. The water is under pressure and once released (as in opening the bottle), gas begins to come out of solution as bubbles. The fizz can be there naturally as a result of water flowing over certain kinds of rocks, or it can be added. For people with IC, the big problem with carbonation is that carbonic acid forms in the water when carbon dioxide is dissolved in it. This acid may bother an IC bladder. Sometimes a pinch of salt or baking soda in the water can “flatten” it. Taking Tums or Prelief may help too.

Seltzer and club soda

Because they can have added sugar or salt, the FDA considers seltzer and club soda “soft drinks”, not bottled water. They are also carbonated (thus acid) and so may cause bladder symptom flare-ups.

Tonic water

This is a carbonated water to which quinine has been added. Quinine is a substance which in large doses is used to treat malaria, and in small amounts is an appetite stimulant.

Flavored water

These are waters with a hint of flavor, usually from fruit. Unfortunately, they’re usually carbonated and therefore acidic. (Flavored waters are not the same as clear soft drinks. Clear soft drinks have sweeteners added. Clear soft drinks may also contain just as much bladder-irritating caffeine as colas).

Mineral water

Mineral water is simply very “hard” water. In order to be called mineral water, a bottled water has to have at least 250 parts per million dissolved solids (minerals) and they have to be there naturally, not added. The term “mineral water” implies nothing about carbonation. If the label doesn’t say “carbonated” or “sparkling” it may be worth a try.

Artesian water

This term merely means that the water contained in an underground rock strata is trapped between impermeable rock layers and is under pressure. When a well is drilled the water comes out of the ground naturally without pumping. The term “artesian water” implies nothing about the acidity, taste, carbonation, or overall quality of the water.

Spring water

Spring water is just water that comes from a natural spring in the ground. The term implies nothing about the quality or taste of the water. Spring waters may or may not be naturally carbonated due to interactions with rock formations.

Purified water

To be called purified water the bottled water must have had the minerals removed by one of several processes: deionization, reverse osmosis, or distillation. The label will indicate which method was used. If your tap water seems to bother your bladder, you can try purified water. (Some questions have been raised though about the wisdom of drinking and cooking with purified water exclusively. Tap water contains some trace minerals necessary to human nutrition).

Finding Bladder-friendly Bottled Water

There are so many bottled waters on the market (many are only available locally) that it would be impossible to evaluate them all for IC “bladder safety” and even so, the evaluators’ experience may not be the same as yours.

There is however, one nationally distributed brand that most of us have no problem with: Evian. Imported from France and slightly alkaline, it’s a favorite with IC patients all across America. Two other brands are worth a remark: In New York, Deer Park may be worth a try. Arrowhead, available in Southern California (and less expensive than Evian) seems fairly safe and bladder friendly. Naya, also available on the West Coast, is one brand I steer clear of though. It’s comparatively acid. Another note: in general, water in the northeastern United States is more acid than water from the southwestern United States. Any area that is subject to acid rain will probably have acid tap water.

Check labels when you shop. Some brands will identify the water’s acidity in terms of pH right on the label. If they don’t, try calling the distributor. Once you find a good brand, you can save money by buying large bottles and “repackaging” it into a few small ones kept in the fridge.

References:

Parsons, Lowell, M.D. Doctor’s Forum, ICA Update, Vol. 8, #4. Interstitial Cystitis Association. New York, NY. 1993.
Food Values of Portions Commonly Used, 16th Ed., Jean A. T. Pennington. J.B. Lippincott Co., Philadelphia. 1994.
Physicians Desk Reference, 53rd edition. Medical Economics Company, Inc., Montvale, NJ. 1999
The American Dietetic Association’s Complete Food and Nutrition Guide. Roberta Larson Duyff. Chronimed Publishing. Minneapolis, MN. 1998
The Wellness Encyclopedia of Food and Nutrition, Sheldon Margen & editors of University of California Berkeley Wellness Letter. Rebus, NY. 1992.
The Merck Manual of Medical information. Robert Berkow, ed. Merck Research Laboratories. Whitehouse Station, NY. 1997.
Susan M. Kleiner, PhD, R.D. Water: An essential but overlooked nutrient. Journal of the American Dietetic Assn., Vol. 99, #2, pp. 200-206. American Dietetic Assn. 1999.

This article originally published August 1999, revised and updated by the author Jan 2004.