Interstitial Cystitis, also known as Bladder Pain Syndrome (IC/BPS), is a chronic condition defined by pain or discomfort related to the urinary bladder. It is accompanied by a frequent and urgent need to urinate that lasts for more than six weeks without an infection or other clear cause. Symptoms can fluctuate between periods of improvement and flare-ups, significantly affecting daily life.
Since the cause of IC/BPS is not well understood and it varies widely among individuals, there is no single treatment that works for everyone. The goal of treatment is to alleviate symptoms and improve quality of life through a personalized and layered approach. This process begins with conservative techniques and progresses to other interventions as needed, requiring collaboration between the patient and their healthcare provider.
Lifestyle Adjustments for Symptom Relief
Self-management begins with dietary changes, as certain foods and beverages can trigger symptoms. Following an “IC diet” involves systematically removing potential irritants and then gradually reintroducing them to pinpoint specific sensitivities. Keeping a food and symptom diary is a useful tool in this process. Common culprits include:
- Acidic foods like tomatoes and citrus fruits
- Caffeine
- Alcohol
- Artificial sweeteners
Fluid management is another component. The goal is to strike a balance by drinking enough water to maintain diluted urine, which is less irritating to the bladder lining, without overburdening the bladder. Spreading fluid intake evenly throughout the day helps prevent sudden, strong urges to urinate.
Bladder training is a behavioral therapy aimed at increasing the time between voids and improving bladder capacity. This involves urinating at scheduled intervals and using relaxation techniques to suppress urges, which helps individuals regain a sense of control. The interval is gradually lengthened to retrain the bladder to hold more urine for longer periods.
Managing stress is also recognized for controlling symptoms, as stress can exacerbate flare-ups. Techniques like mindfulness, deep breathing, and meditation can calm the nervous system, potentially reducing pain and urgency. Avoiding personal irritants like certain soaps or detergents can also prevent external factors from contributing to flare-ups.
Oral Medications for Interstitial Cystitis
When lifestyle changes do not provide enough relief, oral medications may be considered. Pentosan polysulfate sodium is one of the few drugs approved for IC/BPS, thought to work by restoring the bladder’s protective inner coating. It can take several months of use to see improvement and carries a rare risk of pigmentary maculopathy, a form of eye damage.
Antihistamines, such as hydroxyzine, are used based on the theory that mast cells contribute to bladder inflammation. By blocking histamine, these medications can reduce inflammation and provide a mild sedative effect, which may help with sleep disruption from nighttime urination.
Low doses of tricyclic antidepressants like amitriptyline are prescribed to treat the chronic pain associated with IC/BPS. They are used for their ability to block pain signals in the nerves and calm the bladder muscle. Their use requires careful management by a provider to find a dose that maximizes benefits while minimizing side effects.
Nonsteroidal anti-inflammatory drugs (NSAIDs) may be recommended for mild discomfort, but must be used with caution due to potential stomach and kidney issues with long-term use. Other medications that target nerve pain, like gabapentinoids, may also be employed. Stronger pain medications like opioids are generally avoided and reserved for severe, acute flare-ups due to the risks of dependence.
Bladder-Focused Medical Interventions
For individuals whose symptoms persist, treatments delivered directly to the bladder may be recommended. Bladder instillations, or intravesical therapy, involve placing a medicated solution into the bladder through a catheter. This procedure is performed in a doctor’s office in a series of treatments over several weeks or months. These “cocktails” often contain agents like the solvent dimethyl sulfoxide (DMSO), the anesthetic lidocaine, and heparin to help repair the bladder lining.
Cystoscopy with hydrodistention serves both diagnostic and therapeutic purposes. While under anesthesia, a surgeon uses a cystoscope to look inside the bladder and then gently stretches it with sterile fluid. This stretching can reveal pinpoint hemorrhages known as glomerulations and may provide some patients with a temporary reduction in pain and urgency, though the relief is often not permanent.
Botulinum toxin A (Botox) can also be injected into the bladder muscle during a cystoscopy. This treatment relaxes the bladder muscle and blocks pain signals from nerves, reducing urgency, frequency, and pain for several months. A potential side effect is urinary retention, which may require temporary self-catheterization.
These bladder-focused interventions are considered second- or third-line treatments, reserved for cases where more conservative approaches have been insufficient.
Nerve Stimulation and Physical Therapy Approaches
Targeting the nerves that control the bladder is another treatment avenue. Sacral nerve stimulation (SNS) involves surgically implanting a small device under the skin that sends mild electrical pulses to the sacral nerves. This device, similar to a pacemaker, influences bladder function to help reduce urinary urgency and frequency.
A less invasive method is percutaneous tibial nerve stimulation (PTNS). This office-based procedure involves inserting a fine needle near the ankle to stimulate the tibial nerve, which connects to the sacral nerves. Patients undergo weekly 30-minute sessions for about 12 weeks, followed by periodic maintenance treatments.
Pelvic floor physical therapy is a specialized approach that addresses muscles of the pelvic floor, which can become tight and tender. A trained physical therapist uses manual therapy, known as myofascial release, to relieve tension and trigger points in these muscles. Therapy also includes biofeedback and instruction on gentle stretching to help patients learn to relax their pelvic floor.
This therapy focuses on relaxation, not strengthening exercises like Kegels, which can often make symptoms worse.
Navigating Your Interstitial Cystitis Treatment Journey
Effectively managing IC/BPS requires recognizing that treatment is highly individualized and often multimodal, combining different therapies. A collaborative partnership with a knowledgeable healthcare provider is needed to navigate the complexities of treatment. The journey to finding an effective regimen is often a process of trial and error that requires patience from both the patient and the provider.
Learning to manage symptom flare-ups is a part of living with the condition. This involves having a plan that may include rest, applying heat or cold packs, using stress management techniques, and knowing which rescue medications are helpful for short-term relief.
For a very small number of individuals with severe symptoms that have not responded to any other therapies, surgery may be a last resort. Procedures like urinary diversion or cystectomy (complete bladder removal) are major operations with life-altering consequences. These are reserved for the most extreme and refractory cases.