Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Diet (Please see the later discussion of
diet, "Are lifestyle modifications of value in managing interstitial cystitis?")
Oral medications
The principal type of oral medication is the heparinoid
(heparin-like) drug pentosan polysulfate sodium (PPS; brand name Elmiron). PPS
is chemically similar to the substance that lines the bladder, and it is
believed that PPS assists in the repair or restoration of the lining tissues in
the bladder. Even after therapy with PPS has begun, patients may still
experience symptoms for some time because the sensory nerves in the bladder have
been hyperactive, and it takes time for the nerves to return to their normal
state of activation. Therefore, doctors recommend giving up to one year of PPS
treatment in mild PBS/IC (and two years in severe PBS/IC) before deciding if the drug is
effective or not. Between one-third and two-thirds of patients will improve
after three months of treatment.
Other oral medications that may be used to treat
PBS/IC along with PPS include antidepressants of the tricyclic
group. This is not due to a belief that PBS/IC is a psychological
condition; rather, tricyclic
antidepressants can help reduce the hyperactivation of nerves within the
bladder wall. The antiseizure medication gabapentin (Neurontin, Gabarone) has also been used to treat nerve-related pain and has sometimes been used to treat the pain of IC/PBS. Oral antihistamines may also
be prescribed to help reduce allergy
symptoms that may be worsening the patient's PBS/IC.
Aspirin (Bayer) and ibuprofen
(Advil) are
sometimes used as a first line of defense against mild discomfort. However, they
may make symptoms worse in some patients. Over-the-counter forms of
phenazopyridine hydrochloride (Azo-Standard, Prodium, and Uristat) may provide
some relief from urinary pain, urgency, frequency, and burning. Higher doses of
the drug are available by prescription as Prodium and phenazopyridine (Pyridium).
Bladder distension
As mentioned previously, because some patients have noted an improvement in
symptoms after bladder distension done to diagnose PBS/IC, bladder distension
(termed hydrodistension) sometimes is used for therapy of PBS/IC. Bladder distension
helps reduce symptoms in approximately 20%-30% of people with interstitial
cystitis. When it is
effective, the relief of symptoms persists for three to six months after the
procedure.
Bladder instillation (intravesical therapy)
This procedure may also be called a bladder wash or bath. During a bladder
instillation, the bladder is filled with a solution that is held for varying
periods of time, from a few seconds to 15 minutes, before being drained through
a narrow tube called a catheter.
In severe cases of PBS/IC, intravesical solutions may be administered along
with oral PPS to provide relief until the oral medication has had time to take
effect.
Drugs that have been used for bladder
instillations include dimethyl sulfoxide (DMSO, RIMSO-50), heparin, sodium
bicarbonate, PPS, and
hydrocortisone (a steroid).
Other surgical therapies for interstitial
cystitis
In severe cases
of PBS/IC that do not respond well to oral medications or to bladder distension or
instillation, more invasive surgical procedures may be attempted. A procedure
known as sacral neuromodulation
has been shown to be effective in controlling symptoms in some people with
PBS/IC. The term "neuromodulation" refers to an alteration of the
nervous system. In sacral neuromodulation, a device is implanted that allows for
electrical impulses to stimulate the nerves in the sacral (lower back) area.
Sacral neuromodulation is believed to work by inhibiting the hyperactive signals
from the sensory nerves within the bladder wall. For sacral neuromodulation, a
wire from an electrical impulse generator is implanted in the sacral region of
the spinal column. If there is relief of symptoms, the impulse generator can be
implanted beneath the skin in the region of the buttocks. A remote control
programmer allows the patient to adjust the
impulse frequency and power to provide optimal relief of symptoms.
Therapies that also have been used include
transcutaneous electrical nerve stimulation (TENS), a form of neuromodulation
that does not involve surgical placement of wires or an impulse generator. With
TENS, mild electric pulses enter the body for minutes to hours two or more times
a day either through wires placed on the surface of the lower back or the
suprapubic region, between the navel and the pubic hair, or through special
devices inserted into the vagina in women or into the rectum in men. It is believed that the electric pulses may increase blood
flow to the bladder, strengthen pelvic muscles that help control the bladder,
and trigger the release of hormones that block pain. TENS is generally more
effective in reducing pain than in reducing urinary frequency.
Other surgical procedures that may rarely be performed
to treat severe PBS/IC include peripheral denervation (disrupting the nerves to the bladder wall), bladder augmentation to
increase bladder capacity, and cystectomy (bladder removal) with diversion, or
re-routing, of urine flow.
Urinary tract infection (UTI) is an infection of the kidney, ureter, bladder, and/or urethra. Not
everyone with a UTI has symptoms. Common symptoms include a frequent urge to
urinate and a painful, burning when urinating.
E. coli is the most common cause of bladder infections. Bladder infection symptoms and signs include frequent urination, burning urination, and foul smelling urine. Mild bladder infections may go away by increasing one's intake of fluid. More severe infections may be treated with a few days of antibiotics.
Urinary tract infections (UTIs) are very common in children. Symptoms and signs include fever and abdominal pain. Associated symptoms and signs include flank pain, vomiting, and blood in the urine. Treatment for a UTI involves antibiotic therapy.
Women's health is an important topic area to guide a woman through the stages of her life, as well as knowing the conditions and diseases that may occur. Educating yourself so that the transitions into different phases of life is key to a healthy, happy, and productive life.
People who have bladder spasms, the sensation occurs suddenly and often severely. A spasm itself is the sudden, involuntary squeezing of a muscle. A bladder spasm, or "detrusor contraction," occurs when the bladder muscle squeezes suddenly without warning, causing an urgent need to release urine. The spasm can force urine from the bladder, causing leakage. When this happens, the condition is called urge incontinence or overactive bladder.
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