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Treatment

There is no cure for interstitial cystitis (IC); however, there are various treatments, which can ease and alleviate the symptoms of this condition. No single therapy appears to be effective for all women, so you and your doctor will need to take a trial and error approach to treatment. A combination of treatments often proves most effective.

Several oral medications are used to treat IC. Other treatments are administered intravesically. This means that the medication is placed directly into the bladder, using a thin flexible tube, called a catheter, which is inserted through the urethra.

Surgery is a treatment of last resort and is appropriate only for women with the most severe symptoms, which do not respond to other treatments. It is estimated that less than 5 percent of women with IC fall into this category.

For women with IC who experience  chronic pain, treatments such as biofeedback and relaxation techniques may also be helpful.

Oral Medications | Intravesical TherapiesPelvic Floor Rehabilitation | Surgery

Oral Medications

The only oral drug approved specifically for interstitial cystitis (IC) in Canada is pentosan polysulphate sodium (trade name Elmiron®). Also known as PPS, this drug is very similar to the glycosaminoglycan layer that lines the interior of the bladder. PPS binds to the epithelial cells and helps prevent irritation of the bladder wall.

Studies show that 28 to 63 percent of people have a positive response to this medication, and 6 to 18 percent experience long-term relief of symptoms. It usually takes three to four weeks before the drug starts working. PPS has minimal side effects. These include short-term diarrhea, headache, nausea and possible hair loss, which reverses when you stop taking the medication. Pregnant women should not take PPS as it can cause bleeding and miscarriage.

Other oral medications used to treat IC include:

Antihistamines

Antihistamines can limit the amount of histamine produced in the bladder wall and relieve symptoms for some people. Many antihistamines are available over-the-counter or your doctor may prescribe one.

Antihistamines have few side effects but they may cause drowsiness. Newer antihistamines, such as Reactine, are less likely to cause drowsiness.

Tricyclic Antidepressants

Tricyclic antidepressants work by limiting the pain signals that damaged nerves send to the brain. They are an older class of antidepressants and have more side effects than newer antidepressants, like Prozac; however, they appear more effective for women with chronic pain. You are not being prescribed an antidepressant because the doctor thinks your condition is 'in your head.' These drugs are used to modify how signals from the nerves are received.

Tricyclic antidepressants may make you feel slower and drowsy. Like some of the other medications listed on this page, tricyclic antidepressants can also cause constipation. Many side effects go away or become less severe after the first few weeks; however, the side effects are the main reason people discontinue using these drugs.

Antispasmodics

Nerve damage and irritation may cause painful spasms of the bladder muscles, which also contribute to the feeling of needing to urinate urgently and frequently. Drugs called antispasmodics can relax the bladder and reduce these symptoms. Examples of antispasmodic drugs include oxybutynin (Ditropan®) and tolterodine (Detrol®).

Side effects include stomach cramps, gas and constipation, particularly when the body is first adjusting to the drugs. The drugs may also cause drowsiness and dry mouth.

Anticonvulsants

Formerly used to treat epilepsy, anticonvulsant drugs are now used to treat a variety of chronic pain conditions, which may be due to nerve damage, including chronic pelvic pain and IC. These drugs may make nerves less sensitive to stimulation, thus reducing pain as well as the symptoms of urinary frequency and urgency. Drugs in this group include gabapentin (Neurontin®) and carbamazepine (Tegretol®).

Side effects include dizziness, sleepiness, headache and nausea. Let your doctor know if you are pregnant or thinking of getting pregnant as some anticonvulsants may increase the chance of birth defects.

Analgesics

One of a variety of pain medications and sedatives may be prescribed to help control a woman's symptoms during flare-ups. Ideally, these drugs are used only as a temporary measure, until a more effective treatment can been found. Talk to your doctor about the side effects of any pain medication you are prescribed.

Intravesical Therapies

Intravesical therapies are treatments that are placed directly into the bladder, using a catheter – a thin flexible tube, which is inserted through the urethra.

Filling the bladder with water or gas and stretching it relieves the symptoms for 20 to 25 percent of people with interstitial cystitis (IC). The relief usually lasts for three to six months. This procedure, called bladder distention (or hydrodistention, when water is used) is performed while the patient is under general anesthetic.

Medications can also be administered directly into the bladder. After the bladder is filled with the medication, the medication is held in the bladder for anywhere from a few seconds to 15 minutes, and then drained or voided. Some doctors use a combination of ingredients, called a “bladder cocktail.” Drugs used intravesically include, but are not limited to, DMSO and hyaluronic acid.

DMSO

DMSO (or dimethyl sulfoxide) is a pain reliever that may also reduce inflammation and soften scar tissue. It is approved in Canada as a treatment for IC. It reduces the symptoms for about 50 to 60 percent of women with IC for up to 24 months. Unfortunately, about 10 to 15 percent of people experience more severe pain following DMSO treatments. This group is usually given opioid pain medications, either orally or in the form of suppositories.

To start, your doctor may give you DMSO treatments every week or two, for six to eight weeks. After this initial treatment, you may get maintenance treatments less frequently. The procedure can be performed in a doctor’s office.

For women who do not initially respond to this treatment, DMSO can also be combined with other drugs.

The most common side effect of DMSO is that it can cause you to have a strong garlic-like taste and body odour for up to 72 hours after treatment. It can also be hard on your liver, so your doctor may monitor your liver function with blood tests. Because research shows that DMSO can damage the bladder muscle, this treatment has declined in popularity and many doctors no longer use it.

Hyaluronic Acid

Hyaluronic acid (Cystistat®) is an alternative to DMSO treatment for women with IC. It is believed that IC may be caused by a damaged glycosaminoglycan (GAG) layer, which lines the bladder. Treatments with hyaluronic acid may improve the protective function of this layer and reduce damage to the bladder wall. It is usually administered weekly, for four weeks, followed by monthly doses to maintain the effect. People usually don’t experience relief until their fifth or sixth treatment.

Pelvic Floor Rehabilitation

The pelvic floor muscles are located at the bottom of the pelvis. They are shaped like a sling and attached to the pubic bone in the front, and the tailbone (sacrum and coccyx) in the back. These muscles support the bladder and form the sphincter, which surrounds the urethra and controls urination. Techniques that improve a woman's control of these muscles can help control bladder problems and decrease the symptoms of pain and overactivity in some women with interstitial cystitis (IC). Your doctor may refer you to a physiotherapist for these treatments.

Biofeedback
The biofeedback approach is based on the idea that much of the pain associated with IC is due to spasms in unstable muscles surrounding the bladder. This partly explains why many women with IC experience pain when the bladder is full and these muscles are working hardest. This muscle condition may have developed in response to nerve damage or physical damage and strain to the muscles themselves. Indiscriminate exercise of these muscles might make the problem worse. Some physiotherapists use a biofeedback machine to direct exercise and measure the response of specific muscles.

The machine measures the electrical impulses created by muscle contractions. The physiotherapist will teach you exercises that manipulate the muscles surrounding and supporting your bladder. Then electrodes attached to the biofeedback machine are placed on your body and used to monitor your success at controlling and exercising these muscles. When successful, this technique can make you more aware of these muscles and help you control spasms and pain. Studies have shown that biofeedback is useful for other chronic pain conditions, like vulvodynia, but research is still limited on its effects for women with IC.

TENS Units
TENS stands for transcutaneous electrical nerve stimulation. A TENS unit is a small electronic device that can be used to stimulate the nerves and exercise the muscles surrounding the bladder. Pads, placed on the lower back or the region between the navel and the pubic hair, emit a mild electrical impulse. Several small studies have shown that, when used over a period of time, this technique reduces pain and decreases urinary frequency for some women with IC. Although it is not entirely clear how a TENS unit produces these benefits, one theory is that consistent electrical stimulation helps to strengthen the muscles around the bladder.

Most women have a sense of tingling or numbness when the TENS unit is activated. Although your first treatments will likely last for only a few minutes, the length and intensity of your treatment can be extended. Some women with IC wear the device under their clothing and have several hours of treatment a day. Women who benefit from this treatment usually experience a benefit within three to four months.

Exercise
Exercises, including Kegel exercises, can help stretch and strengthen the pelvic floor muscles and control urinary problems. Your doctor may refer you to a physiotherapist, to help you learn exercises that strengthen these muscles. There are several ways to make exercising these muscles more effective:

  • Weights inserted in the vagina may be used to make the muscles work harder.
  • Electrical stimulation of the muscles with a low-grade electrical current may increase muscle contractions.
  • Biofeedback can be used to monitor your muscle contractions and tailor your exercise program to the muscles most in need.

For more information about using exercise, electrical stimulation and biofeedback to correct urinary problems, visit the Urinary Incontinence section.

Surgery

Surgery is generally used as a last resort for treating interstitial cystitis (IC) because it can lead to complications and is unpredictable. In many cases, surgery does not relieve pain. It should only be considered in cases where a patient has severe pain and all other treatments have failed.

Fulguration

For women with severe IC and painful ulcers, surgery may be used to burn the ulcers, seal the opening, and encourage the regrowth of healthy new tissue. This can be done using laser surgery or an electrical current. Either method uses an endoscope, a flexible fibreoptic device, which is passed into the bladder through the urethra. This procedure is often done as day surgery and requires less than a week recovery time.

Expanding or Removing the Bladder

A surgeon can enlarge the bladder with bowel tissue or remove it entirely; however, both these surgeries have serious limitations. They do not guarantee pain relief because a phantom pain, similar to that experienced by amputees, may continue. This is known as neuropathic pain, which is discussed in more detail in the chronic pelvic pain unit.

Surgery to expand the bladder, called a supratrigonal cystectomy, leaves only a small portion of the original bladder in place and replaces the rest of the bladder with bowel tissue. This increases the size of the bladder, allowing it to hold more urine, but it often impairs the ability of the bladder to empty properly. To compensate for this problem, many women who have this procedure must learn to insert a catheter once or twice a day to remove the remaining urine. This increases the risk of bladder infections. Also, bowel tissue naturally produces mucus that may block the flow of urine or make self-catheterization more difficult.

Urinary Diversion

One alternative to extending the bladder is a urinary diversion. A section of bowel is used to redirect the flow of urine to a hole in the abdominal wall, called a stoma. Urine from the stoma is collected in an external bag. The bladder may be left in place or removed entirely. This is a simpler procedure with a lower risk of complications, but an external bag is an unappealing option for many women.

Alternatively, an internal pouch may be created next to the abdominal wall. This is called an ileal reservoir. The pouch is made of bowel tissue and has a small stoma where a catheter can be inserted and used to drain the pouch. Although this is more discreet than an external bag, it also has a higher rate of complications, including infections and mucus blockages.

 

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