Magazine 13 May 2024

Cystitis, bowel and nutrition: what are the correlations?


by now we know how ano-urethra proximity in women can facilitate fecal bacteria to ascend into the bladder.
But that’s not all there is to it: are we sure that the transit of bacteria within our bladder does not also pass through other pathways?

That’s why today we want to clarify once and for all the correlation between cystitis, bowels and nutrition. We will do this in a special way, enlisting the help of a professional in the field of nutrition: Dr. Alessio Fabbricatore, a nutrition biologist specializing in functional nutrition.

Let’s get started!

Bowel problems and cystitis: is there a link? And what is the role of nutrition when suffering from cystitis?

Most cystitis is caused by bacterial infections, and the bacteria responsible come right from our intestines. One example is E. coli, responsible for 80-90% of bacterial cystitis.
How is it possible for these bacteria to go unnoticed inside our bladder (which is certainly not made to house these evil little critters)?

We asked Dr. Fabricator this and other questions to clarify the cystitis-gut connection once and for all.

Bacterial cystitis is more common in women because of the passage of pathogenic bacteria by the fecal-perineal-urethral route, which is more favored by the female anatomy. Less awareness, however, is had about the possibility that the passage of intestinal bacteria into the bladder can occur from within: how is this possible and what are the causes of this phenomenon?

We evaluate the anatomy. The bowel, occupying the entire abdomen, is in close proximity to the bladder and cannot help but influence its environment, especially in conditions where the bowel is inflamed, malfunctioning, or constipated.
It is obvious that, under normal conditions, this should not happen, but who among us can say that we have a perfectly healthy microbiota and, consequently, a gut that is, even slightly, not inflamed?

Returning to constipation, I try to explain why it is so critical, especially in patients with recurrent UTI histories, to have regular (but also satisfactory) evacuations every day. During constipated conditions, the intestines are unable to regularly shed their fecal contents, and because feces are for most of their dry weight made up of bacteria, this large mass of normal bacteria in the intestines is not excreted.
Moreover, constipation still results in inflammation, and this is where a phenomenon happens that is now much more common than we think: the wall of our intestines becomes permeable(Leaky Gut, from English). Normally, the intestine has a layer of cells so tightly packed together that they form a selective palisade that allows the passage of only the “building blocks necessary for life” but does not allow the passage of “foreign molecules” (allergens, bacteria, etc.). However, it can become much more permeable due to inflammation and allow free passage of food allergens and pathogenic germs from the intestinal lumen to the blood and lymphatic circulation or directly to nearby organs (such as the bladder).

It goes without saying that a constipated gut with a large bacterial mass stagnating and not well protected by an inflamed and therefore more permeable mucosa leads to inflammation and penetration of bacteria at the urological level.
Numerous studies have now established that it is the intestine that is the reservoir of bacteria that normally result in cystitis, but it is also now certain that recurrent UTIs are routinely preceded by a so-called “intestinal bloom of uropathogens.” Basically, our microbiota becomes altered, goes out of balance, and certain pro-inflammatory bacterial species take over, resulting in what is called gut dysbiosis.

Are there any symptoms/signs that a woman with recurrent cystitis can look out for to see if the cystitis may result from leaky gut and dysbiosis?

Definitely intestinal symptomatology, so alternate alvus, abdominal bloating, digestive difficulties, gastroesophageal reflux. However, since the gut is the most important immunocompetent organ in our body and contains a huge slice of our immune system, a condition of intestinal permeability puts a strain on our entire body. Indeed, one can develop many food sensitivities, intolerances, as well as skin problems (dermatitis, rosacea, skin rashes and sudden papules), migraines, arthritis and, unfortunately, even autoimmune diseases.

Who should one turn to for clarification, diagnosis, and possible initiation of ad hoc treatment? Can it be cured?

Definitely to the specialist in gynecology and gastroenterology.

Hopefully, we will be able to break out of the highly restrictive view in my opinion of seeing the organism as compartmentalized. This practice results in focusing only on the symptoms and thus on the sick part, but that is nothing more than the tip of the ‘iceberg of the problem you want to try to address. We need to return, in other words, to a comprehensive and integrated view of the patient.

What is the role of nutrition and a nutritionist in these cases?

diet has the most powerful influence on gut microbial communities in healthy human subjects. About 75 percent of the foods in the Western diet have little or no benefit to the lower gut microbiota. Most of it, consisting mainly of refined carbohydrates, is already absorbed in the upper part of the gastrointestinal tract, and what reaches the large intestine is of limited value, as it contains only small amounts of minerals, vitamins, and other nutrients necessary for maintaining the microbiota.

Nutrition is therefore a key driver in reducing intestinal inflammation.


We thank Dr. Fabricator for his time and valuable input.
Dr. Alessio Fabbricatore receives in Salerno and Nocera Inferiore. Follow his Instagram profile for more insights (@dr.alexiofabbricatore).

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