From the Guidelines
The most effective approach to managing Interstitial Cystitis (IC) involves a multimodal treatment plan that prioritizes symptom control and quality of life, as outlined in the 2022 guideline for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome published in The Journal of Urology 1. When treating IC, it's essential to consider the patient's overall well-being and tailor the treatment plan to their specific needs.
- First-line treatments typically include lifestyle modifications, such as avoiding trigger foods and beverages, stress management, and bladder training techniques.
- Oral medications, including pentosan polysulfate sodium, antihistamines, tricyclic antidepressants, and pain medications, can be effective in managing symptoms.
- Bladder instillations with solutions like dimethyl sulfoxide, heparin, lidocaine, or sodium bicarbonate can provide direct relief.
- Physical therapy focusing on pelvic floor muscles can also help reduce symptoms. The goal of treatment is to maximize symptom control and patient quality of life while minimizing adverse events and patient burden, as emphasized in the guideline 1. Key considerations in treatment planning include:
- The chronic nature of IC, which requires ongoing management and adjustment of treatment plans over time.
- The importance of addressing the patient's physical and emotional well-being, as IC can have a significant impact on quality of life.
- The need for a multidisciplinary approach, incorporating urology, physical therapy, and pain management expertise, to provide comprehensive care.
From the Research
Definition and Symptoms of Interstitial Cystitis
- Interstitial cystitis (IC) is a heterogeneous chronic disease of unknown etiology that impacts a large number of women 2.
- Symptoms of IC are highly variable and may include pelvic pain exacerbated by bladder filling, frequency, and urgency 2.
- IC is also known as painful bladder syndrome, and its diagnosis is often one of exclusion 3.
Diagnosis and Treatment of Interstitial Cystitis
- Cystoscopy is the best way to confirm the diagnosis of IC, but treatment can be initiated based on symptoms alone 3.
- The American Urological Association (AUA) guidelines separate IC treatment recommendations into six tiers of increasing invasive therapies 2.
- Treatment options for IC include education, lifestyle modifications, physical therapy, pharmacological therapy, and surgical therapy 2.
- Medications such as pentosan polysulfate, amitriptyline, hydroxyzine, and cimetidine may be used to treat IC 3.
- Intravesical therapy with dimethyl sulfoxide, heparin, or an anesthetic therapeutic combination containing lidocaine may also be attempted 3.
Efficacy of Pentosan Polysulfate for IC Treatment
- Pentosan polysulfate sodium (PPS) has been shown to be safe and efficacious in the treatment of IC/bladder pain syndrome (IC/BPS) 4.
- A systematic review of randomized controlled trials found that PPS led to a statistically significant improvement in patient's overall response assessment, pain, and urgency 4.
Lifestyle and Behavioral Modifications for IC Management
- Patients with IC/BPS tend to make lifestyle behavioral changes to cope with their symptoms, including increased cranberry intake and decreased consumption of coffee and spicy food 5.
- Patients with IC/BPS may also wear less makeup or special work garments as part of their lifestyle modifications 5.
Note: The study 6 is not relevant to the topic of interstitial cystitis.