Chronic UTI And Interstitial Cystitis Testing With Ruth Kriz

Ruth Kriz, Nurse Practitioner, became interested in and dedicated to exploring underlying causes of chronic UTI and interstitial cystitis (IC) during her own decade-long experience with a diagnosis of IC. 

In part one of our interview with Ruth Kriz, she shares the history behind how she became involved in treating IC patients. Also discussed are alternatives to standard urine culture and how these advanced tests have helped Ruth successfully diagnose and treat patients with IC.

Watch the video or read the full transcript below to learn more about Ruth’s background and her approach to interstitial cystitis.

Jump To Section:

• Ruth Kriz Video 1 Transcript: UTI and Interstitial Cystitis Testing Methods  >>>>
• Ruth Kriz on How Chronic UTI and Interstitial Cystitis Differ >>>>
• How Standard Urine Culture can be Misleading  >>>>
• Ruth Kriz on More Accurate Diagnostics for UTI  >>>>
• How Advanced Diagnostics are Helping UTI Interstitial Cystitis Patients >>>>

Melissa: Today we’re talking with Ruth Kriz, a chronic UTI and interstitial cystitis specialist, and we’re really happy to have you on board Ruth. We received hundreds of questions from our audience for you, so I’m hoping you can shed some light on some of these topics. But maybe first you can just tell us a little bit more about your background and your work in this field?  

Ruth: Certainly. I’m a Nurse Practitioner. When I was in my early 30s I was diagnosed with interstitial cystitis. I had symptoms for about 11 years, six of which were chronic pain. And basically I was told to go learn to live with it and that interstitial cystitis was chronic, degenerative and incurable.

And that set me on a path for the past 40 years of trying to sort out the root causes and how to treat it, and I think I’ve come up with some answers that can maybe help some of your audience.  

Melissa: Great, we’re looking forward to hearing them. First maybe you can tell us a little bit more about interstitial cystitis. So what is IC and how do chronic UTI and interstitial cystitis differ?  

Ruth: That’s a very important question because I think that there’s a lot of confusion concerning the terminology. When people get urinary tract infections they have pain, burning, frequency, urgency and they go to their practitioner. A dipstick is done looking for leukocytes and nitrites and those can be highly inaccurate. And then based on that they are often given an antibiotic and sometimes a culture is sent and sometimes a culture is not. 

The problem we have here diagnostically is that if the culture is positive, and by the way, culture plates only favor the growth of fast-growing bacteria that like the culture media, so it misses a lot of infection. Then they’re given an antibiotic and if it doesn’t grow anything they’re told it’s culture negative and they don’t need an antibiotic, and they don’t have an infection, even if they’re still symptomatic. 

Ruth: When cultures come back repeatedly that are negative, oftentimes the IC diagnosis is given at that point. A more thorough diagnosis would involve looking at the bladder through a cystoscope and somehow there’s this magic point in time when if the urologist with the naked eye using the cystoscope can now see damage to the bladder wall then the IC label is applied. Otherwise, there are a lot of other labels that are given, such as urethritis, trigonitis. I’ve heard pre-IC. 

There’s a lot of terminology that’s being thrown out there and yet I think all of this is really on a continuum. The bladder wall damage from infection can take place years before the bladder wall is sufficiently damaged that the IC label is now applied. 

Oftentimes it says that it’s a diagnosis of exclusion, so if you go through your logical testing they’ve ruled out bladder cancer, which by the way is painless blood in the urine, they’ve ruled out some other conditions with bladder stones and oxalate crystals, and some other things that can give people urinary symptoms.

If they’ve ruled those things out and excluded them they therefore say well since we can’t find that it’s any of these things we will now call it IC and people now have that label.   

Melissa: So basically they just figured out what it’s not but they’re not sure what it is? 

Ruth:  Exactly and it still doesn’t tell you what the cause is. I mean I believe things have causes.  

Melissa:  That makes sense. Are there more accurate tests that you feel can help clear up the uncertainty around these different levels of diagnosis? 

Ruth: Well I am delighted to tell you that now we do have those other tests. Years ago when I was first diagnosed all we had was a standard urine culture. I worked with Dr. Paul Fugazzotto, a PhD microbiologist who was in the 1980s and 90s using a broth culturing technique that is somewhat better than standard culture plates. But it has its own set of biases. 

Once again we have a culture media that some bacteria like and others do not. He was culturing for a week which will help to find the slow growing bacteria, but once again there are some bacteria that are not hydrophilic – water loving – that can still be found in the urine and those might grow differently on another culture media. 

So about eight years ago I started using MicrogenDX, which is a company using DNA testing. There are several other companies also out there doing DNA testing and one of two techniques are used most popularly. 

The first is PCR (polymerase chain reaction). PCR can be done on a limited number of organisms but it requires a special primer for each one. It’s highly accurate, it has a fast turnaround, but it is limited by how many organisms you can test for at one time. 

The other technique is called next generation sequencing and that one is not quite as high in accuracy. It takes much longer to do. But MicrogenDX that does PCR for the most common pathogens reported as level one, uses next generation sequencing for level two, which will look for over 50 000 different bacteria and fungi. And so these are able to find things that typically wouldn’t be identified on a culture plate. 

When you’re doing a culture, the lab technician has to look at the culture plate and pick out which colonies are then going to be identified. If you have a slower growing one you might have fewer on the culture plate and that one will be assumed to not be a contributor to your symptoms. 

The ones that are most frequently picked out are the fast growing ones which typically is E. coli. And the slower growing ones get missed.  

Melissa: Have you had a lot of chronic UTI and interstitial cystitis patients that have used this different type of testing and have had positive results after negative cultures?  

Ruth:  Oh, hundreds of them. There are several reasons why culture might be negative. One of the reasons is that it doesn’t pick up the slower growing bacteria or that bacteria doesn’t like that culture medium, but another huge reason is that bacteria can live in different forms. 

Most bacteria have a cell wall, however, when they’re exposed to certain antibiotics it drives them into a cell wall deficient form, or an L-form, and those cell wall deficient forms won’t grow on a standard urine culture plate but absolutely are detected by DNA testing.

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Acknowledgements

We receive many questions around interstitial cystitis and UTI, as many patients believe there is a connection. With the help of advanced diagnostic methods, researchers and clinicians are getting closer to answering these questions. We want to thank Ruth Kriz for generously donating her time to speak with us and share her knowledge with the UTI community. 

Watch the rest of our video series with Ruth Kriz, APRN, or subscribe to Live UTI Free on YouTube.

1. Biofilms and Antibiotic Resistant UTI
2. Antibiotic Bladder Instillations And Other Chronic UTI Treatment Methods
3. How To Prevent Recurrent UTI

To get answers to commonly asked questions about chronic and recurrent UTI, visit our FAQ page. Share your questions in the comments below, or reach out to our team directly.