I’ve been meaning to write this post for a long time because it is sooo important. Hopefully by now, many of you will have heard of ‘embedded’ or ‘intracelullar’ bladder infections but if not, please read on.
Recent research suggests, that many cases of chronic UTIs and in fact ‘interstitial cystitis’ may be down to infections having taken hold in the bladder by entering the bladder wall cells and/or hiding under biofilm structures. This allows the pathogens to evade antibiotics and indeed testing.
The great news is that it is treatable!
Could your problems be due to a chronic imbedded infection?
The common scenario seems to be this: a history of urinary tract infections that would occur periodically, perhaps after intercourse but not in every case.
Then at some point, the symptoms would persist and potentially get worse after each course of antibiotics. Some people would then experience frequent flares or constant 24/7 symptoms. Testing would usually come back negative.
Some people may receive a diagnosis of interstitial cystitis. No dietary change or medication would make a real difference.
But what if the inflammation and pain experience in so-called ‘interstitial cystitis’ was actually due to a chronic infection that was evading testing?
What if the flares of chronic UTIs were not new infections, but a chronic infection instead?
We now know, thanks to the great research of one professor Malone-Lee, that this is entirely plausible.
How a chronic UTI develops
- If an acute UTI is not completely cleared withing 14 days, pathogens can change their shape and penetrate into the cells of the bladder wall (called ‘urothelium’ and consisting of transitional epithelium), which is around 5 cells deep. This is called ‘intracellular colonisation’.
- Once in the cell, microbes go into a dormant state (hibernation) and stop dividing. Only dividing microbes are affected by antibiotics, and thus they can survive short courses. Even just one dormant microbe can, when it wakes up again, divide into a million others.
- A cell that has been colonized will now be transmitting distress signals to the immune system, which results in an inflammatory response (the immune response is inflammatory) – blood vessels dilate and the bladder may look red and inflamed (the typical picture of ‘interstitial cystitis’). They may also burst and leak blood into the urine, which may be picked up on testing.
- As part of the immune response, white blood cells are sent into the bladder, but detect no problem as the microbes are hiding in the cells. The bladder wall cells disagree, which leads to a ‘standoff’ that causes chronic low-grade inflammation. This is responsible for chronic low-grade symptoms that may persist despite negative test results.
- As a protective mechanism for cells, the bladder wall and the wall in the urethra may thicken, causing a degree of obstruction that can cause symptoms such as:
• reduced stream
• terminal dribbling
• double voiding
• Reduced bladder capacity
- Pro-inflammatory chemicals may also cause the bladder muscles to contract, leading to symptoms such as:
• urge incontinence
• And generally inflammation causes pain, burning and stinging.
- One of the ways the immune system tries to clear the intracellular infection is by shedding cells. This causes the dormant microbes to wake up and start dividing again, causing an acute infection (in which healthy cells can become colonized again). This is responsible for periodic flares.
- Another problem can be the formation of biofilms by bacteria (this could be in addition to intracellular bacteria): these are protective structures under which microbes can ‘hide’. Once under a biofilm, microbes cease to divide and become dormant (thus unsusceptible to antibiotics) and can stay attached to cells. They can then break out, divide and cause fresh infections.
Why does my doctor not know about this?
The research around this is fairly new and unfortunately, new research seems to take a while to actually be incorporated into standard healthcare. We’ve only known for a relatively short while that the bladder is not sterile, as previously believed, and that gold standard urine testing is not very accurate as it’s based on outdated science.
But gold standard testing is the main means by which many doctors for assess the bladder and diagnose interstitial cystitis and this is probably the main problem.
How to treat embedded infections
Both long-term antibiotics and more natural approaches can be used to support recovery.
Please stay tuned for my next few blog posts in which I will look at both approaches in detail.
Do you think you might be suffering from chronic embedded infections? Let me know in the comments!
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