While smoking is well known to be a cause of bladder cancer, its relationship with urinary symptoms has remained somewhat unclear. Researchers at the University of Pennsylvania studied 1720 women to determine if smoking could be an underlying cause of urinary symptoms, including those found in some IC patients.(1)  They found a consistent and strong association.

The more cigarettes smoked, the greater the risk. Women who smoked more than 20 packs per year had the highest risk of urinary symptoms, including moderate to severe urinary urgency AND incontinence. Women who smoked between 5 and 19 packs per year were strongly associated with more moderate urgency.

Notably, the study found that women who were no longer smoking experienced far fewer symptoms. The authors said “This suggests that the urgency symptoms caused by smoking may be reversible.” Women who had quit smoking five or six years previously showed lower rates of urinary symptoms when compared to those who had quit more recently, suggesting that the “harms of smoking on the bladder improved over time…” 

Smoking In The Home Affects Children

Not only does smoking affect adults in the home, it can also affect children. Cancer causing chemicals from tobacco smoke have been found in the urine of infants.(2) A 2012 research study showed the children of smokers were at high risk of developing severe urinary disorders including the symptom of ICs (3). Researchers found that the greater their exposure to second hand smoke, the worse the children’s bladder symptoms. 

What’s the Harm of Smoking?

It is an undeniable fact that the toxins found in cigarette smoke (tobacco) can be lethal. It contains more than 7,000 chemicals, including 69 known cancer-causing compounds, such as formaldehye, ammonia, cyanide, arsenic,  acetone, lead, methanol, DDT (4) and several pesticides (5). These chemicals pass through the lungs, into the bloodstream and to the kidneys where they are collected in the urine. It comes as no surprise that tobacco use is the number one cause of bladder cancer.

Patients with Hunner’s lesions or chemo cystitis have open wounds on their bladder wall which allow the carcinogens and toxins to travel more deeply into the tissue, resulting in severe inflammation and more frequency, urgency and pain.  Patients with Genitourinary Syndrome of Menopause have a thinner protective mucosal layer on the inside of their bladder which could allow toxins to reach the skin more easily, again triggering urinary symptoms.

Is Vaping Safer?

E-cigarette manufacturers may proclaim that they just produce “water vapor” and are less harmful than tobacco, but this is deceptive advertising. Studies have found that vapor from e-cigarettes may contain a variety of toxins, including 20 potential cancer causing chemicals, including: acetone, benzene, toluene, acrolein and several  heavy metals, (5)

The big draw of vaping, though, are the thousands of flavors available. Unregulated and lacking basic safety studies, these flavors are often made with a focus on market appeal and profit rather than safety. And, unfortunately, some of these flavors can damage cells. Vapes that use a “butter” flavoring use a chemical that has been linked to “popcorn lung” though some dispute this finding. (6) Cherry, chocolate, candy, coffee, tea and tobacco flavors have been found to contain high levels of benzaldehydes. (7)

Vaping advocates argue that vaping is safer than cigarette smoking yet studies have still found an increased risk of bladder cancer, increased exposure to carcinogenic compounds, mixed evidence on chronic kidney disease, increased risk of reproductive disorders and burns to the GU system.(8)

Conclusion

One of the most frequent questions we receive from patients with IC is “Can I smoke or vape with IC?” Our answer is an unequivocal NO.

Some patients with IC have a bladder that is structurally compromised with Hunner’s lesions, GSM and inflammation. As a result, toxins in urine penetrate more deeply into the bladder wall where they can cause IC flares, interfere with healing, destroy healthy cells and an increased risk of cancer?

One study has found that some e-cigs reduce cell growth in the lungs.(9) What happens when this chemical reaches the bladder wall?? Could it interfere with bladder healing? We simply don’t know. Are you willing to risk it?

Your goal is to create an environment that supports bladder healing and to avoid substances which can irritate the bladder wall. We strongly encourage you to stop smoking and/or vaping.

References

  1. Michel K, et al. Association of Smoking Status and Pack Year History with Urinary Urgency Symptoms.  Neurouology and Urodynamics, 2024;44:14-21
  2. Than K. Tobacco Smoke Found in Baby Urine. Live Science – May 2006
  3. Robert Wood Johnson Medical School. “Second-hand smoke affects bladder function in children, study suggests.” ScienceDaily. ScienceDaily, 7 June 2012.
  4. What’s In A Cigarette. American Lung Association
  5. Harmful Chemicals In Electronic Cigarettes. Group to Alleviate Smoking Pollution. 2013
  6. Hall N. Chemicals in Flavored E-Cigarettes Tied to ‘Popcorn Lung’ Disease. Newsweek. Dec. 8, 2015
  7. Kosmider L, et al. Cherry-Flavored E-Cigarettes Expose Users to the Inhalation Irritant, Benzaldehyde Thorax. Jan. 16, 2016
  8. Bandara NA, et al. The genitourinary impacts of electronic cigarette use: a systematic review of the literature. World J Urol. 2023 Oct;41(10):2637-2646.
  9. Makris, N. E-Cigarette Flavorings Can Be Toxic to Lung Cells. Healthline. May 18, 2015
  10. Pesticides Found in Cigarette Smoke. Live Science – April 2006