Bowel and bladder issues - question about amitriptyline

[Simmi1]

Hello, wondering if someone can help. I gave birth to my second child 10 months ago just short of my 40th birthday. After the birth I developed IBS which got really bad around Christmas time and eventually started to get a bit better around may/June. I tried everything - herbal remedies, amitriptyline, acupuncture. I started off on 10mg of amitriptyline at night in April and then by end of May I moved up to 50mg. The IBS continued but started getting more bearable. Suddenly at the end of June I started getting bladder symptoms for the first time in my life (never even had a UTI). I get pain in my bladder and keep feeling like I need to go even to the loo even when I've just been. It's not like this all day - usually more in the afternoons. I try and hold out at least 2/3 hrs and take paracetamol for the pain. I still end up going 8-10 times a day but at night I'm usually fine and don't wake up to use the loo unless woken! I initially thought my symptoms could be urinary retention caused by the amitriptyline although I know this is very rare. However I never had any problems with my bladder before starting the amitriptyline. I have now reduced my dose to 25mg a night but no real improvement and my IBS is a little worse again. So now I'm thinking my body is in some sort of autoimmune state and the chronic IBS and now intertistial cystitis symptoms are all part of the same bigger problem. I should mention that I don't have a urinary tract infection (it has been checked). Any ideas? Suggestions? I went through all the usual investigations for my bowel problems (stool tests, blood tests, colonscopy) in January and am now terrified of having to go through it all again for my bladder. I'm also a bit horrified that I developed IC symptoms while taking amitriptyline which is a first line treatment for IC! I'm wondering if I'll ever be completely healthy again as I was up until 10 months ago

[Simmi1]

Sorry about length of post..,

[PollyPerky]

It may be what you are eating and drinking - food intolerances.

I'm a long term 'sufferer' of similar problems and for me, some improvement has come from following the 'IC' diet as well as some of the FODMAP diet for IBS.

I've never ever heard of using ami for iBS- how did you come to be prescribed this? Most GPs would suggest you used the FODMAP diet first and would refer you to a dietician to help with that.

Also- IBS is a disease by exclusion- so unless you've had investigations for other gut disorders, especially coeliac then it might be worth making sure you aren't low-level coeliac.

Ami is one of the 'classic' treatments for IC in small doses as a pain killer. Maybe it's not causing the issue - stop it and see what happens?

Have you tried cutting out gluten as well as caffeine , alcohol, fruit juices, acidic foods and drink, to see if that helps?

[Tanfastic]

I have had some UTI issues lately. I appeared on the other thread you contributed to but I'm not sure if you picked up on it.

Have you tried Uva Ursi drops? If not give them a try.

Also try cutting g out acidic food and drink, think of anything you wouldn't put on an open wound. I know you don't have pain but acidic stuff including caffeine won't help.

Pelvic floor exercises may help.

I think with bladder stuff it's a process of elimination. I can't help with your ibs.

[Tanfastic]

Also three hours is a long time to hold a wee in. I average three I'd I'm not drinking a lot (if I'm busy at work etc) but I couldn't go three if I'm drinking tea all day for eg.

When you are going to the loo are you going or just a dribble?

[Groovee]

Amitriptyline is often given for bed wetting. If you have a problem, I'd see your GP

[Simmi1]

Thanks for your help polly and tan. So the IBS has been a long (10 month) running issue whereas the IC symptoms are more recent (3 weeks). I've had all the bowel investigations done and it is IBS as I tested negative for everything else including coeliac. I've done low fod map and gluten free and everything in between for IBS. Nothing specifically helped but over time it has got better and my IBS symptoms are now relatively mild. My gastro is not a great believer in drugs for IBS so I got the ami off a psychiatrist who also thinks I'm depressed and has given me Valium too to take as and when (5mg).
As regards IC I haven't been investigated other than testing negative for a UTI so IC is just my guess. I've recently cut out caffeine, I don't drink fruit juices or eat much citrus fruits but I haven't managed to give up the wine. I know I need to do this but as yet my symptoms are relatively mild and I'm hoping it'll just clear itself. I'm working towards coming off the ami totally incase that is causing the bladder issue. I think the Valium actually helps my bladder issue but I don't think the psychiatrist will be forthcoming with any more prescriptions for that as its a short term med apparently.
So say most of the day when I have no discomfort I can go 3-4 hours between wees comfortably and then when I go it will be a normal amount. I'll then have a 2-3 hour window in the day when I get the bladder pain and want to keep going. That's when I'm conciously holding on but if I end up going after an hour or 90 mins I will pass a tiny amount - my bladder is not actually full but I'm in pain so want to go. Tan I do get pain in my bladder/pelvic region when flaring but no pain or burning when urinating ever.
Thanks for tips on the drops - will look them up.

[Simmi1]

Grovee - seems like amitriptyline is given for a lot but can't say it's been a wonder drug for me. I developed bladder issues while on it (never had any before) so all a bit of a mystery. No problem with bed wetting or incontinence in general. At night I can go quite comfortably for 9/10 hours without needing to get up for the loo which makes me think there's nothing wrong with my bladder capacity just something weird is going on in my afternoon flares

[PollyPerky]

PLEASE give up the alcohol! I've not had a drop for 20 years- not out of choice but because my bladder doesn't like it. It's hugely irritant, so do try!

The fact that your bladder symptoms start during the day suggests it's something you are eating or drinking that is making it worse. I know it's hard but you should try the IC diet which means cutting out all processed foods, fizzy drinks, sugar, chocolate (contains caffeine) and basically just live off fresh veg, 'allowed' fruit , meat and fish for a few weeks, and drink only water (boiled to get rid of the chlorine) or weak herbal teas. Tomatoes are a real no-no for example as are garlic and onions - pretty much the same as the FODMAP diet.

[PollyPerky]

Forgot- the Uva ursi drop are in a tincture of alcohol. I found even that tiny amount irritated me. They are for bladder infections really so I'd be careful ....

[HedgehogHedgehog]

Could it be anxiety related? I often get UTI like pain in my bladder when i am anxious. What you describe sounds exactly like what i experience in regards to my bladder. The fact that its not there all the time could be indicitave of this?
I am actually on amitriptyline for anxiety and it has improved my bladder symptoms. It is supposed to help muscular pain etc i think? Its also prescribed for that sometimes i hear so id be very surprised if it was the thing thats causing this pain in you? x

[Simmi1]

Thanks polly will give it a go! When my IBS was really bad (diarrhea 6-7 times a day) I was living off very little plain food but it didn't help me. my IBS continued. I know I've got to give the IC diet a real go. Just out of interest if you eat or drink something bad do you feel it right away? I love dark chocolate with coconut nectar but whenever I eat it I get IBS cramps .

[HedgehogHedgehog]

Id also say that anxiety, stress and depression can produce very real physical reactions in your body and that working to deal with the psychological aspects can make pain rapidly improve. So id suggest something like pain management counselling or CBT? The fact that vallium really helped you may be because stress is greatly contributing to your pain. xx

[Simmi1]

Thanks hedgehog - yes I do get anxious and have to a certain extent been all my life but it's only in the last 10 months I've suffered physical symptoms at all really. I've never had medication until now as I've never felt the need. My IBS symptoms and now IC symptoms seem to follow a pattern (eg better in morning, worse in afternoon etc) and then the pattern may change. I'm not worse when out socialising for example - if anything I'm maybe better as not thinking about it! So not sure if it's anxiety related. Agree on the ami - but I literally had no bladder/pelvic pain up until 3 weeks ago and the only drug I've recently started is the amitriptyline.

[HedgehogHedgehog]

That is strange, ive just been reading about it and its a sedative and muscle relaxant. Shouldnt really be giving you pain, if anything the opposite as apparently its used to treat urge incontinence in children!! It also says possible side effects are decreases in urination. But then i suppose you could be allergic to something in it? x

[PollyPerky]

If I eat something that doesn't agree with me, it doesn't usually affect me immediately UNLESS it's something acidic. Recently I had water with a slice of lemon it in (usually refuse!) and within 2 hours I was trotting to the loo every 30 mins. Ditto (too many) strawberries. Garlic just makes me feel ill - kind of hyper and weird - so eating out is an issue as it's in everything almost. Gluten is more of a slow burn- I can tolerate a little (not a portion of pasta but maybe 1 biscuit or half a scone) - and it affects me a day or so later.

[Groovee]

I can't drink on amitriptyline.

[Simmi1]

Thanks all. Yes hedgehog I know the ami should have an opposite effect and I think it did at first - I didn't really pay much attention as i had no bladder issue but I probably went from 5/6 times a day to 3/4 times a day but I had no pain or discomfort so just thought of it as a convenient side effect! My first theory then when the bladder problem started was that I had a UTI caused by not emptying frequently enough but my sample came back completely clear. I didn't think of the allergic reaction but I guess it could be.

When I first started the ami Grovee drinking wine and then taking the ami would give me a headache but it doesn't anymore - I guess I've become immune

I just feel like something really weird is going on with my body at the moment. I've gone from super healthy to this practically overnight. I saw various doctors and alternative practitioners over my IBS and everyone was stumped as to what was causing it as I have no history of bowel problems, didn't respond to dietary interventions, probiotics, supplements, mebeverine etc. The IC suddenly coming on now is probably even more weird and I wouldn't be surprised if it continued despite dietary changes like the IBS.

I just wish I could get to the bottom of it all and fix it but the body is a complex thing and is just behaving very badly for me at the moment .