Interstitial Cystitis Treatments

Oct 20, 2018

There is currently no cure for interstitial cystitis and the aim of treatment is to relieve symptoms, with varying degrees of success depending on the individual patient.

Diet and Lifestyle

Simple changes to diet and lifestyle activities can lead to a significant improvement in symptoms for many patients with interstitial cystitis. It is often beneficial to keep a food and activities diary to help establish a connection between trigger foods or activities that tend to worsen symptoms.

Common foods that may be associated with the condition include:

Alcohol
Artificial sweeteners
Caffeine
Chocolate
Citrus and other fruits
Cured meats
Onions

Physical Therapy

A physical therapist can be helpful in the management plan for interstitial cystitis and can help to relieve the associated pain with various physical exercises.

The exercises are usually designed to improve muscle tenderness, restrictive tissues or muscle abnormalities in the pelvic floor.

Pharmacological Options

There are several oral medications that some patients find to be beneficial, including:

Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, aspirin or naproxen. These help by reducing associated inflammation.
Tricyclic antidepressants such as amitriptyline or imipramine. These help by relaxing the muscles of the bladder and reducing reported pain.
Antihistamines such as loratadine. This helps to reduce urinary urgency and frequency.
Pentosan may help to restore epithelial cells of the bladder and protect the surrounding tissues from irritation and inflammation.

Medication may also be administered directly into the bladder by way of a catheter that is inserted through the urethra. Dimethyl sulfoxide (DMSO) is commonly given in this way with regular treatments for six to eight weeks, followed by maintenance doses as needed. Other medication can also be administered in the same way, such as lignocaine, sodium bicarbonate, pentosan or heparin.

Complementary Therapies

Many patients have found successful relief of symptoms with the use of complementary therapies such as:

Acupuncture
Hypnosis
Thiele (pelvic floor) massage

It is prudent to note that these complementary therapies do not have proven efficacy and any side effects that may result from their use are not known.

Electrical Nerve Stimulation

There are several techniques that may be used to stimulate the nerves and treat interstitial cystitis.

Transcutaneous electrical nerve stimulation (TENS) involves mild electric pulses to the pelvic area, serving to relieve pain and reduce the frequency of urination by increasing muscular control.

Stimulation of the sacral nerves on the pathway between the spinal cord and bladder may help to reduce urinary urgency that is commonly associated with the condition.

Bladder Distention

Distention of the bladder involves the stretching or expansion of the bladder with a medium such as water or gas. This procedure tends to precipitate a temporary improvement in symptoms, which can be useful in certain situations such as after a cystoscopy. If the results are successful, repeat treatments can be used to continue the effect.

Surgery

Surgery is typically reserved as a last-line therapy when other treatment options have not been successful, due to the low rates of efficacy and high risk of complications.

Patients that may benefit from surgery include those with very high frequency or urination due to small volume of capacity in the bladder, and those with severe pain.

Fulguration is one surgical procedure, which is used to burn ulcers that are causing severe pain in the bladder.
Resection is a minimally invasive procedure that cuts around any ulcers for their removal.
Bladder augmentation is used to replace the damaged section of the bladder with connective tissue from the colon. However, associated pain usually remains and a catheter is still needed to empty the bladder frequently.