IC Flare Vs. A Bladder Infection?

When I first experienced bladder pain as an adult, I called my urologist dozens of times crying in pain because of a “possible bladder infection” and begged for antibiotics. He, in a desire to be helpful, usually filled those prescriptions EVEN when my urine cultures were negative. Even after I was diagnosed with IC/BPS, antibiotics were often prescribed for my urinary symptoms. Yet, in 33 years, I have only had TWO confirmed bladder infections. I now shudder when I think of all the antibiotics I consumed uselessly.

With the knowledge that IC flares, even those caused by the pelvic floor, often feel like a bladder infection, I now have a very specific routine before I would ever consider antibiotic use and it begins with a simple, home based, test. As soon as I feel a flare beginning, I test my urine with an AZO UTI Test Strip.

If it’s a double positive for leukocytes and nitrites, or just for nitrites, I call my doctor and request a urinalysis. I’ll even take a picture of the test strip with my phone and email it in. Why? Because nitrites are produced by infection.

If the test strip is only positive for leukocytes, I’ll usually wait 24 hours and then test again. Our body mobilizes leukocytes (white blood cells) when it senses a foreign invader in tissue which, in the case of IC, can be the result of urine leaking into the bladder wall through Hunner’s lesions or glomerulations.

Remember, as well, that any test strip test can generate false positives or negatives which is why many patients and their doctors turn to Next Generation DNA Urine tests (MicrogenDX.com) which will identify good bacteria, bad bacteria and fungal infections in your urine. In many states, you can request this without a referral.

UTI’s Are Becoming More Antibiotic Resistant

We have begun to see far more drug resistant infections in patients who contact our office. Antibiotic resistance in bladder infections is rising rapidly with more than half of infections showing signs of resistance. Kaiser Permanente Southern California recently reported that 57% of UTI’s weren’t susceptible to one or more antibiotics and 13% were resistant to at least three classes of medication. Subsequent infections increase the risk to 65% and 20%.(1)

A large study of over 500 patients is helping us to understand which bacteria are becoming the most drug resistant in a typical UTI.(2)

Escherichia coli was the most common pathogen found. Its highest resistance was to amoxicillin-clavulanic acid, followed by trimethoprim-sulfamethoxazole and levofloxacin. Fosfomycin and imipenem were the most successful treating these infections.
Enterococcus showed the highest resistance to levofloxacin, followed by penicillin. Fosfomycin, linezolid, and nitrofurantoin were the most effective treatments.
Klebsiella had the highest resistance to amoxicillin-clavulanic acid, followed by levofloxacin and trimethoprim-suflamethoxazole.

These results demonstrate the importance of comprehensive testing to determine which antibiotic would be the most effective at treating your unique infection, yet another advantage to Next Generation DNA Urine testing which identifies antibiotic resistance genes and provide more effective treatment suggestions.

Tracking Is Essential

Keep records! It is important to track the identity of the bacteria and the antibiotics used in your personal medical records file (free download) so that you can see if there are any trends. If you are getting the same infection over and over, that suggests that you could have a drug resistant infection. If it’s different bacteria each time, perhaps your immune system might be struggling to fight infection. Common variable immunodeficiency (CVID) is an immune deficiency disease characterized by low levels of protective antibodies and an increased risk of sinus and bladder infections.

Conclusion

IC flares suck. They come at the worst of times, prevent us from enjoying normal activities and, of course, can cause severe distress and pain. The challenge is that they almost always feel like a UTI but rarely are bacteria found. For most of us, IC flares are caused by foods irritating the bladder (i.e. coffee, teas, sodas, alcohol), activities that stress the pelvic floor (i.e. driving, sitting, running, sex), stress and hormones. Not UTI.

Infections, of course, can happen which is why we suggest you have UTI Test Kits on hand. If you have positive nitrite, then you certainly could have an infection. Other signs could be severe or increasing pain, blood in your urine, fever, dizziness or other unusual or frightening symptoms. If you have any doubts at all, please talk with your doctor.

The ICN has an extensive flare management guide here to help you prevent and manage flares you might have, including hour by hour rescue plans! Read it here!

References:

Jennifer H Ku, et al. Antibiotic Resistance of Urinary Tract Infection Recurrences in a Large Integrated US Healthcare System, The Journal of Infectious Diseases, Volume 230, Issue 6, 15 December 2024, Pages e1344–e1354,
Mareș C, et al. Update on Urinary Tract Infection Antibiotic Resistance-A Retrospective Study in Females in Conjunction with Clinical Data. Life (Basel). 2024 Jan 9;14(1):106.
Anger J, et al. Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline. J Urol. 2019 Aug;202(2):282-289

About the Author: Jill Osborne

My Google Profile+ Jill Heidi Osborne is the president and founder of the Interstitial Cystitis Network, a health education company dedicated to interstitial cystitis, bladder pain syndrome and other pelvic pain disorders. As the editor and lead author of the ICN and the IC Optimist magazine, Jill is proud of the academic recognition that her website has achieved. The University of London rated the ICN as the top IC website for accuracy, credibility, readability and quality. (Int Urogynecol J - April 2013). Harvard Medical School rated both Medscape and the ICN as the top two websites dedicated to IC. (Urology - Sept 11). For many years, Jill served on the Congressionally Directed Medical Research Panel (US Army) where she collaborated with researchers to evaluate new IC research studies for possible funding. Jill has conducted and/or collaborates on a variety of IC research studies on new therapeutics, pain care, sexuality, the use of medical marijuana, menopause and the cost of treatments, shining a light on issues that influence patient quality of life. An IC support group leader and national spokesperson for the past 20 years, she has represented the IC community on radio, TV shows, at medical conferences. She has written hundreds of articles on IC and its related conditions. Jill has a Bachelors Degree in Pharmacology and a Masters in Psychology, Jill was named Presidential Management Intern (aka Fellowship) while in graduate school. (She was unable to earn her PhD due to the onset of her IC.) She spends the majority of her time providing WELLNESS COACHING for patients in need and developing new, internet based educational and support tools for IC patients, including new live IC Support Group Meetings via Youtube and the “Living with IC” video series. Jill was diagnosed with IC at the age of 32 but first showed symptoms at the age of 12.

IC Flare Vs. A Bladder Infection?