From the FDA Drug Label
Instillation of 50 mL of RIMSO-50® (dimethyl sulfoxide) directly into the bladder may be accomplished by catheter or asepto syringe and allow to remain for 15 minutes. The medication is expelled by spontaneous voiding It is recommended that the treatment be repeated every two weeks until maximum symptomatic relief is obtained. Administration of oral analgesic medication or suppositories containing belladonna and opium prior to the instillation of RIMSO-50® can reduce bladder spasm In patients with severe interstitial cystitis with very sensitive bladders, the initial treatment, and possibly the second and third (depending on patient response) should be done under anesthesia.
Treatment options for noninfectious cystitis include:
- Instillation of dimethyl sulfoxide (RIMSO-50®) into the bladder
- Administration of oral analgesic medication or suppositories containing belladonna and opium to reduce bladder spasm
- Use of anesthesia for initial treatment in patients with severe interstitial cystitis and very sensitive bladders The treatment should be repeated every two weeks until maximum symptomatic relief is obtained 1.
From the Research
Treatment for noninfectious cystitis should be patient-specific, focusing on multimodal regimens that include conservative options, oral treatments, intravesical options, or procedural management, as recommended by the most recent review of management strategies 2.
Overview of Treatment Options
Treatment options for noninfectious cystitis include both medication and lifestyle modifications tailored to the specific cause.
- For interstitial cystitis/bladder pain syndrome, oral medications like amitriptyline starting at 10-25mg at bedtime, or antihistamines such as hydroxyzine 25mg daily can help reduce symptoms.
- Bladder instillations with dimethyl sulfoxide (DMSO), heparin, or lidocaine may provide direct relief.
- For radiation or chemotherapy-induced cystitis, treatments focus on symptom management with phenazopyridine (Pyridium) 200mg three times daily for urinary pain, anticholinergics like oxybutynin 5mg twice daily for urgency, and adequate hydration.
- Anti-inflammatory medications such as ibuprofen 400-600mg every 6-8 hours can help reduce bladder inflammation regardless of cause.
Lifestyle Modifications
Lifestyle modifications are essential and include:
- Avoiding bladder irritants (caffeine, alcohol, spicy foods, acidic foods)
- Increasing water intake to 2-3 liters daily
- Applying heat to the lower abdomen
- Practicing pelvic floor relaxation techniques These treatments work by reducing inflammation, decreasing nerve sensitivity, strengthening the protective bladder lining, or blocking pain signals.
Recent Findings and Recommendations
Recent studies have shown that pentosan polysulfate sodium may have adverse ophthalmologic effects 2, and thus its use should be carefully considered. The most recent and highest quality study recommends a patient-specific approach, considering factors such as etiology and symptom profile, and starting with conservative options before escalating to more invasive treatments 2. In cases of ulcerative cystitis, fulguration with or without triamcinolone injections should not be delayed, as recommended by recent research 2. Overall, treatment for noninfectious cystitis requires a multimodal approach and may need adjustment over time based on symptom response.