From the Guidelines
Interstitial cystitis (IC) is a chronic bladder condition characterized by bladder pain, pressure, and frequent urination, and its treatment typically involves a multimodal approach, including oral medications, bladder instillations, and lifestyle modifications, as recommended by the most recent guidelines 1. The signs and symptoms of IC include:
- Pelvic pain
- Persistent urge to urinate
- Frequent urination (often in small amounts)
- Pain or discomfort during sexual intercourse Treatment options may include:
- Oral medications, such as pentosan polysulfate sodium (Elmiron) at 100mg three times daily, antihistamines like hydroxyzine (25-50mg at bedtime), and tricyclic antidepressants such as amitriptyline (10-75mg at bedtime) 1
- Bladder instillations with dimethyl sulfoxide (DMSO), heparin, or lidocaine to provide direct relief 1
- Lifestyle modifications, including dietary changes (avoiding trigger foods like caffeine, alcohol, spicy foods, and acidic fruits), stress management techniques, pelvic floor physical therapy, and bladder training exercises 1 It is essential to maintain hydration but avoid excessive fluid intake that might worsen symptoms, and to identify and avoid specific behaviors that worsen symptoms, such as certain types of exercise, sexual intercourse, wearing tight-fitting clothing, and constipation 1. The condition is more common in women and often coexists with other chronic pain conditions like fibromyalgia or irritable bowel syndrome 1. IC is believed to result from a defect in the protective lining of the bladder, allowing irritating substances in urine to damage the bladder wall and trigger inflammation 1.
From the Research
Interstitial Cystitis Overview
- Interstitial cystitis/bladder pain syndrome (IC/BPS) is defined as persistent or chronic discomfort perceived to be related to the urinary bladder accompanied by urinary urgency or frequency 2.
- Symptoms of IC are highly variable and can include pelvic pain exacerbated by bladder filling, frequency, and urgency 3.
Treatment Options
- Pharmacotherapies used to treat IC/BPS include oral and intravesical agents, such as amitriptyline, hydroxyzine, cyclosporine A, and pentosan polysulfate sodium (PPS) 2.
- The American Urological Association (AUA) guidelines separate IC treatment recommendations into six tiers of increasing invasive therapies, starting with education and lifestyle modifications and progressing to physical, pharmacological, and surgical therapies 3.
- Pentosan polysulfate sodium is a heparin-like, sulfated polysaccharide used to manage bladder pain and discomfort in adults with IC, and is the only US FDA-approved oral treatment for the relief of bladder pain or discomfort associated with IC 4.
Efficacy of Pentosan Polysulfate Sodium
- Studies have shown that pentosan polysulfate sodium can provide beneficial effects in a proportion of patients with IC, including improvement of overall condition and relief of pain 4.
- A systematic review of randomized controlled trials found that treatment with pentosan polysulfate sodium led to a statistically significant improvement in patient's overall response assessment, pain, and urgency 5.
- However, another study found no statistically significant difference between pentosan polysulfate sodium and placebo in terms of treatment effect 6.
Safety and Side Effects
- Pentosan polysulfate sodium is generally well tolerated, with a similar percent of patients discontinuing due to adverse events across different treatment groups 6.
- However, recent findings of pigmented maculopathy with chronic use of pentosan polysulfate sodium are concerning and must be discussed with patients 2.