Ketamine and bladder problems

Ketamine has become more popular as a recreational drug in recent years. We also see this reflected in the figures in our annual report. With moderate use, you can experience a light, dreamy haze. At higher doses, your trip can be quite heavy, where for example it may become more difficult to move normally. Using ket is like balancing on a tight rope: a little too much and you’ll fall off  ;)

• Our peer coach Pieter noticed in his conversations with festivalgoers, that some users feel that ketamine is an innocent drug with few long-term effects. At the same time, he also knew that ketamine use can cause bladder problems. How does that work? Pieter dove into the literature to find the answer to this question!

What is the bladder made out of?

In this article we will focus on bladder problems related to ketamine use. Here we are talking about bladder inflammation and problems in the area around the bladder. A distinction is made between the upper urinary tract (kidneys and ureters) and the lower ureters (the bladder and urethra). To keep it simple, we are talking about bladder problems here, but that can also mean that you suffer from problems in other parts of this urinary tract.

An infection in this area is usually caused by a bacteria which can get into your bladder through your urethra and cause your bladder to become inflamed there, which is known as cystitis. Most people have experienced this at some point. If an infection goes up through your ureters and gets to the kidneys, it becomes more unpleasant. How this works in the body is explained further down.

Ketamine and bladder problems. How common is it?

The Global Drug Survey (GDS) is the largest annual online survey exploring themes around drugs and drug use. In 2012, the GDS highlighted ketamine and bladder problems. Participants who had used ketamine in the last 12 months (1285 in total) were given a specific questionnaire on bladder problems. Over a quarter of this group reported having problems in the lower urinary tract.

Image 1 shows the specific problems that users suffered from. With higher doses of ketamine, all problems occurred more frequently. When people used more often, it also meant that they had more often suffered from pain in the lower abdomen, having to go to the toilet more often, pain when urinating (but not with drops of blood) or unwanted leakage of urine.

Half of the users indicated that the problems reduced when they stopped using ketamine. So there seems to be a relationship between ketamine and these problems.

Image 1

A different study was conducted in Hong Kong. Of the participants who do not use drugs at all, 18.5% reported having bladder problems. With the participants who do use drugs, but no ketamine, it was almost half. And among the ketamine users over 60% (2)!

So bladder problems do sometimes occur. But the use of drugs does seem to certainly increase the risk, and ketamine in particular. The more often and more is used, the greater the risk of problems and complications.

How does that work in the body?

It is not entirely clear how it is possible that inflammation of the bladder sometimes has to do with ketamine use. There are various possibilities:

• Certain substances, that are released through the breakdown of ketamine appear to be harmful to the body. These substances leave your body through the urinary tract, and can thus damage those pathways.
• The protective layer of the urinary system is damaged. This makes the system less resistant to bacteria and harmful substances.
• Also there are changes to the nerves that ensure proper muscle tension around the bladder.
• Ultimately, all this can lead to ulcers, more inflammation, scar tissues and excessive bladder muscle activity. This causes you to need to urinate more often and the bladder to be able to store less urine, with the result that your bladder overflows, as it were. The urine then flows back to the kidneys. This backflow can cause the kidneys to swell up and become damaged. In the worst case, the kidneys will stop working entirely, with all consequences of that (5).

Treatment

Different treatments have been tested for ketamine users with bladder problems.

Up until now, there is only one truly effective treatment: to stop using ketamine. Additionally a patient can receive medication for the pain. Medicines that affect the muscles around your bladder are also sometimes used.

In a very small group of patients with serious kidney and bladder problems the damage is irreversible. In these cases surgery is the only treatment option (7). This usually involves people who for a longer time regularly use high doses of ketamine (3,4).

When may problems be related to ketamine?

If you use ketamine you may suffer from the symptoms mentioned in the first image. Think of pain in the lower abdomen, having to go to the toilet more often, pain when urinating, etc. In men erectile dysfunction may also occur.

In the case where it is a regular bladder infection, the problems should improve after a course of antibiotics.

Do the problems not improve? Then it may be that the bladder infection is related to your ketamine use or drug use generally. Always be honest with your doctor or GP about your use.

It may be that the problems develop when you first use ketamine, but it may also be that you only notice after years of use. If the problems increase when you use more often, or decrease when you stop using, there is a good chance that one has to do with the other (8).

Conclusion

Complaints in and around the bladder occur more often in people who use drugs. Ketamine further increases this risk. The bladder infection caused by this can lead to long-term complaints. This risk is greatest in people who for a longer period of time use (high doses) regularly.

Because in many studies research is conducted on patients who use very high doses, it is difficult to make a statement on the risk of bladder problems among the average recreational user we speak to at parties.

If we for now assume the Global Drug Survey participants correspond to the average visitor to the Unity-stand, a quarter of the ketamine users we speak with will develop symptoms. The likelihood that these will eventually lead to further complications is probably very small in most cases, but what this risk exactly is, we do not know.

Unity tip: Do not take ketamine if you have a bladder infection. And if you do have a sensitive bladder and notice that you have problems after ketamine use, stop using it immediately.

If you have problems from ketamine use, then please contact your doctor and be open about your use. If you want to use less, you may discover that this is quite tough. In that case, you can also anonymously call an addiction treatment facility near you.

Think for yourself, care about others <3 Unity 

Written by: Pieter Vis. Translated by: Sammy of The Loop UK

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Sources

1. Winstock et al. The prevalence and natural history of urinary symptoms among recreational ketamine users
2. Tam et al. Population-based survey of the prevalence of lower urinary tract symptoms in adolescents with and without psychotropic substance abuse.
3. Mak et al. Lower Urinary Tract Changes in Young Adults Using Ketamine
4. Yee et al. The Risk of Upper Urinary Tract Involvement in Patients With Ketamine-Associated Uropathy
5. Chen et al. Risk Factors of Lower Urinary Tract Syndrome among Ketamine Users
6. Jhang et al. Elevated  serumimmunoglobulin E may be associated to the development of ketamine cystitis
7. Jhang et al. Possible pathophysiology of ketamine-related cystitis and associated treatment strategies
8. Middela et al. Ketamine-induced vesicopathy: a literature review