Aug 10, 2010
Once the diagnosis of IC / PBS has been made, education of the patient is critical. Early diagnosis is especially important in patients. Those that have had IC for less than 2.5 years respond to treatment 75 to 80% of the time, and may be symptom free for years.
Most patients with IC report worsening of symptoms with certain foods or drinks, and diet modifications are necessary. Food know to cause irritation to the urinary tract include such items as, acidic foods, alcoholic beverages, and caffeine. For a more extensive list of foods, Click here. Prelief, (calcium glycerophosphate), a dietary supplement used to decrease the affect of acidic foods and beverages, has been shown to be beneficial in 70% of patients with IC.
Many different Oral Medications have been used to treat IC / PBS. The first oral drug to be FDA approved to treat IC was Elmiron. It is thought to have its effect by restoring the protective layer in the bladder. Elmiron is usually taken 3 times a day and usually must be taken for a minimum of 6 months to be considered an adequate trial. Unfortunately, only about 1/3 of patients respond to treatment with Elmiron in my experience.
Elavil, (Amitriptyline), an old antidepressant medication, has been used for chronic pain for many years with reasonable results. It is often used in the treatment of IC where its properties help reduce urinary frequency, improves sleep, reduces pain, and decrease nighttime voiding. Doses are usually lower (25 -100mg) than those used to treat depression and are generally well tolerated.
Most patients will be placed on some type of Urinary Analgesic, AZO, Pyridium, Urelle, to treat urinary urgency and frequency. These may be prescribed as daily use or to be used in cases of flares.
Antihistamines such as Atarax (hydroxyzine) may be beneficial in some patients especially if the patient has a history of significant allergies. A 6-month trial is often necessary to make a decision on the effectiveness of Atarax.
The use of anticonvulsants such as Neurontin (Gabapentin) is sometimes prescribed in an attempt to treat neurogenic (nerve) pain. These medications show some benefit in treating such pain in other conditions but they are not well studied in their use in treating IC.
Postmenopausal women or women whom have undergone surgical menopause (removal of ovaries) should be placed on intravaginal estrogen providing there is no contraindication. Estrogens affect on the bladder is well documented and estrogen should be included in a patients therapy.
Instillations of medications into the urinary bladder prove helpful in many patients. DMSO was the first drug to be FDA approved for the treatment of Interstitial Cystitis. Other medications used include Lidocaine, Heparin, Sodium Bicarbonate, and Elmiron. Instillations are often done weekly or every other week.
Treatment of spasm of the pelvic floor muscles should be considered in patients when present. The use of physical therapy can improve symptoms in many patients. Intravaginal Valium, which has potent muscle relaxing properties, may also be of benefit.
The use of Neuromodulation, stimulation of the nerves responsible for pain perception, to treat Interstitial Cystitis is showing great promise in those patients who fail to respond to other treatments. InterStim, Neuromodulation of the Sacral Nerves, has been used for the treatment of Over Active Bladder Symptoms for a number of years. Its use in IC is currently being investigated. My personal experience with treating IC patients with InterStim has been very favorable.
Treatment of Interstitial Cystitis often involves multiple therapies and care must be taken to rule out nonbladder sources of pain.
J. Kyle Mathews, MD
Plano Urogynecology Associates
Plano OBGyn Associates