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Pepperoni pizza may trigger pelvic pain for a million Americans

by Laura Schocker
Oct 23, 2008


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 Laura Schocker/MEDILL

A new study from Northwestern University confirms that foods such as  pepperoni pizza may trigger symptoms in people who suffer from pelvic pain syndrome. But the study also paves the way for new treatment options.

Roenna Fulton has to clean her house in sections.

One day, the 42-year-old mother can manage cleaning the bathroom of her Hoffman Estates home and, the next, the living room. For the next few days she may be in so much pain, she can’t keep up with her housework at all.

Fulton suffers from interstitial cystitis (IC), which is a chronic disease that causes severe pelvic pain and the strong urge to urinate frequently, said David Klumpp, an assistant professor of urology at Northwestern University's  Feinberg School of Medicine. It affects as many as a million Americans, 90 percent of whom are women.

“Flare-ups feel like your insides are burning on top of labor pains,” Fulton said, explaining that she can spend hours in the bathroom suffering from spasms and contractions. “I feel like my body is on fire.”

While there’s no cure for IC, Fulton keeps a list of things that can trigger attacks and has learned that it’s best if she can eliminate stress, excitement and certain foods. She steers clear of foods such as green apples, oranges, beef, tomatoes, lemons, tuna and pizza.

And now scientists say they may understand the link. 

“The Pepperoni Pizza Hypothesis,” a new study from Northwestern University, found the pain that can be triggered by many foods or stress, may come from the colon, said Klumpp, principal investigator of the study. The bladder and the colon share the same part of the spinal cord, which registers pain, he explained.

“If you and I eat pepperoni pizza, that does nothing,” Klumpp said, except create a pleasant taste sensation. “Your spinal cord and brain are getting signals. But, unless the signals are very strong, your brain doesn’t perceive it as pain.”

But people with chronic bladder pain constantly send pain messages to the spine, Klumpp explained. The problem is that when IC patients eat spicy foods, the small pain messages are enough to cause painful attacks, like Fulton’s flare-ups.

“Patients have been (controlling their diets for) a long time, in consultation with their physicians,” Klumpp said. “But they really had no rationale for why they were doing it.”

And now that the colon connection has been established, the research may open up new treatment options.  Before this study, many researchers thought that something in the food was somehow getting into the urine and irritating the bladder, Klumpp said. As a result of the study, the focus on pain management can include the colon, as well as the bladder.

Patients are sometimes in so much pain, he explained, that they will insert a catheter into the urethra to deliver a numbing substance to the bladder.  But with the relationship to the colon, these people may have new options, such as putting a numbing gel or other substance directly into the rectum to cut back on pain.  Also, new research will look at applying anesthetic skin patches to turn down the severity of the pain signals.

For patients like Fulton, any help could be life changing.

Since being diagnosed with IC in 2004, she hasn’t taken a vacation or made any plans in advance—her attacks come five or six times a month and she never knows when one is going to hit.  Even when she’s not experiencing a flare up, she has to urinate frequently, including at least five times throughout the night.

“Any place that I go to, the first place I’m looking out for is the bathroom,” Fulton said. “The bathroom is like my second home.”

For now, while she’s waiting for more research, Fulton finds comfort in the little things, whether it’s eating out for breakfast or visiting a favorite thrift shop.

“There’s no cure for it, but there’s treatment options and there’s hope,” she said. “I live one day at a time. Tomorrow, I don’t know how I might feel.”