Interstitial Cystitis (cont.)
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD
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.
In this Article
What is the treatment of interstitial cystitis?
Diet (Please see the later discussion of diet, "Are lifestyle modifications of value in managing interstitial cystitis?")
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).
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.
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