The key to pain relief from a severe bladder disease may lie in “the pepperoni hypothesis.”

Provoked by spicier foods such as pepperoni, a flare-up of interstitial cystitis can cause intense pain and the need to urinate up to 50 times a day. The disease, also known as “painful bladder syndrome,” affects up to a million women and a smaller fraction of men in the U.S. Many believed the bladder to be the culprit, but Feinberg Professor David Klumpp has found reason to think otherwise.

In a paper published in the September issue of Nature Clinical Practice Urology, Klumpp speculated that pain from the disease may actually originate in the colon. Nerves from the colon and bladder both connect to the same part of the spinal cord, so distinguishing between them can be difficult, he said. His hypothesis is based off of a study he conducted last year, where mice exposed to the disease responded to pain relief applied to the colon. Klumpp is now working with urologists to see if these results translate to humans and how they can better define and treat the largely unexplored disease.

“Twenty years ago these patients would go to see their physician, and they would be told they were crazy,” he said. “Now there’s a greater appreciation amongst clinicians and also in the press of this disease.”

Klumpp worked on the paper with Charles Rudick, a postdoctoral fellow at Feinberg. As for the name of hypothesis, Klumpp said he had asked someone who had the disease how she felt about pepperoni pizza.

“She avoids it like the plague,” he said.

– Steven Berger