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The IC Flare Cycle

Natural Approach to IC Flares

Flares are Real and Not in Your Head

IC/BPS patients often struggle with “IC flares,” a sudden or dramatic worsening of their bladder symptoms. Flares can last from hours to months. IC flares can be unpredictable, disruptive, and challenging for newly diagnosed and veteran IC patients.


IC flares can be specifically triggered or sporadically appear in many ways that can irritate the bladder wall, tighten pelvic floor muscles, and sensitize nerves. 

It’s still not entirely known what causes most cases of IC. But several factors have been identified that seem to contribute to the development of the condition.

These factors include:

  • Any health condition or event that damages the bladder or bladder lining. For example, “bladder trauma” may be caused by bladder infections, pelvic infections, or pelvic surgery.

  • Bladder overdistention caused by holding urination in for long periods of time.

  • Pelvic floor muscle dysfunction.

  • Autoimmune disorders.

  • Pelvic inflammatory disease can be linked to bacterial infections, including sexually transmitted infections like chlamydia.

  • Primary neurogenic inflammation (hypersensitivity or inflammation of pelvic nerves)

  • Spinal cord trauma.

  • Biofilms (Hypothesis not enough research). 

IC is an inflammatory condition of the bladder that experts believe is caused by the dysfunction of protein membranes found in the bladder lining. There's evidence that damage to the bladder wall can allow particles in the urine, such as potassium, to leak into the bladder lining, causing an inflammatory response. Usually, the bladder's lining should be able to repair itself, but this process doesn't seem to happen in people with IC.


Some studies suggest that proteins, which include the sub-type called antiproliferative factor (APF), may interfere with the regular activity of bladder cells, causing ongoing damage and irritation. The immune system may start to attack the bladder (an autoimmune response), and nerve signaling in the bladder may also become impaired. When someone with IC's bladder fills up with urine after being filtered by the kidneys, the stretching sensation causes lots of pressure and discomfort that can sometimes be intolerable.


Based on its postulated underlying causes, is interstitial cystitis a disease or a manifestation of symptoms based on various etiologies?  Most likely, IC results from many uncomfortable symptoms derived from various etiologies (origins).


The two commonly most recognized subtypes of IC are:

  1. Non-ulcerative IC

  2. Ulcerative IC

  3. Bladder Centric

  4. Non-Bladder Centric

  • Non-ulcerative interstitial cystitis accounts for the vast majority, about 90 percent, of all IC cases. People with this type of IC develop inflammation and hemorrhages in the bladder wall, contributing to pain.

  • Ulcerative interstitial cystitis is much less common, accounting for about 5 percent to 10 percent of all IC cases. People with this type of IC may develop ulcers or patches on their bladder walls.

  • Another rare but severe type of IC is called end-stage interstitial cystitis. This type accounts for approximately 5 percent of all IC cases. Diagnoses are when a patient has chronic and severe IC symptoms that last more than two years. End-stage IC causes the bladder to harden, develop ulcers and become very painful.

Negative Shift in Body's Microbiome 

Initial Injury to Bladder Wall

Hypersensitized Pelvic Muscles 

Pain, Urgency, Frequency, Noctura

Increased Cortisol Pro-Inflammatory

Phase 1: Inflammatory Cycle 

Stress, Anxiety, Acute Depression 

Hypersensitized Pelvic Nerves / Tissues

Recurring Bladder Pain & Aches

Phase 2: Pain Cycle 

Lower Back Pain

Food Sensitivities / Mast Cell 

Pain on Bladder Fill / Suprapubic

Migratrory Pelvic Pain

Pain from Intercourse

Feeling of Loneliness / Sadness 

Phase 3: Established IC / BPS  

Symptoms Unique in Every Patient  

Recurring Flares / Cyclical Signature  

Types of Flares:


Pain BEFORE urination (that gets worse as you bladder FILLS with urine and feels better once you have emptied your bladder) points to your bladder wall (Bladder-Centric).


Pain AFTER urination points to your pelvic floor as the probable source of your flare.

If pain is intense before and after urination, you may have a combination flare that is involving the bladder, muscles and nerves (Non-Bladder-Centric).

NAN Goals from 0-3 Weeks of NAN Supplementation

Flare Intensity

Most flares that the patient usually are severe.

Flare Frequency

Flares can occur every day to every couple of days.

Flare to Non-Flared Ratio

Patient usually is in a perpetual flared state.

Interstitial Cystitis Flare Goals 0-2 Weeks of NAN Supplementation

NAN Goals from 3-10 Weeks of NAN Supplementation

Flare Intensity

Flares move from severe to moderate.

Flare Frequency

Flares moves from daily to every few days.

Flare to Non-Flared Ratio

Patient has less flares and intensity.


NAN Goals from 10-26 Weeks of NAN Supplementation

Flare Intensity

Flares become less often, quality of life improvement.


Flare Frequency

Less than three times per month or none at all.

Flare to Non-Flared Ratio

Patient may reach positive degrees of homeostasis.

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