Interstitial Cystitis (cont.)
What is the treatment of interstitial cystitis?
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 interstitial cystitis (and two years in severe interstitial
cystitis) 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
interstitial cystitis along with PPS include antidepressants of the tricyclic
group. This is not due to a belief that interstitial cystitis is a psychological
condition; rather, tricyclic
antidepressants can help reduce the hyper-activation of nerves within the
bladder wall. Oral antihistamines may also
be prescribed to help reduce allergy
symptoms that may be worsening the patient's interstitial cystitis.
Aspirin and ibuprofen 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 Pyridium.
Bladder Distension
As mentioned previously, because some patients have noted an improvement in
symptoms after bladder distension done to diagnose interstitial cystitis, bladder distension
(termed hydrodistension) sometimes is used for therapy of interstitial cystitis. 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 interstitial cystitis, intravesical solutions
may be administered along with oral PPS to provide relief until the oral
medication has had time to take effect. Both PPS and heparin may be used in the
treatment solution, and both have been shown to be effective in relieving
symptoms. It is possible for patients to learn how to do bladder instillations
at home.
Other drugs that have been used for bladder
instillations include dimethyl sulfoxide (DMSO, RIMSO-50), heparin, sodium
bicarbonate, and
hydrocortisone (a steroid). Treatments are given every week or two for 6 to 8
weeks, and repeated as needed depending on symptoms. Most people with
interstitial cystitis who
respond to DMSO notice an improvement in symptoms 3 or 4 weeks after the first 6
to 8-week cycle of treatments.
Other Surgical Therapies for interstitial
cystitis
In severe cases
of interstitial cystitis 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
interstitial cystitis. 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 interstitial cystitis 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.
Next: Are lifestyle modifications of value in managing interstitial cystitis? »
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