What is interstitial cystitis?

From the Guidelines

Interstitial cystitis (IC), also known as bladder pain syndrome, is a chronic bladder condition characterized by recurring pain or discomfort in the bladder and surrounding pelvic region, along with urinary symptoms like frequency and urgency. The condition occurs when the protective lining of the bladder becomes damaged or irritated, allowing toxic substances in urine to irritate the bladder wall. According to the most recent study 1, treatment typically involves a multimodal approach including dietary modifications, oral medications, and bladder instillations.

Key Characteristics of Interstitial Cystitis

• Recurring pain or discomfort in the bladder and surrounding pelvic region
• Urinary symptoms like frequency and urgency
• Condition occurs when the protective lining of the bladder becomes damaged or irritated
• The exact cause remains unknown, though theories include autoimmune reactions, neurological dysfunction, or previous bladder infections

Treatment Approach

• Multimodal approach including dietary modifications (avoiding trigger foods like caffeine, alcohol, spicy foods, and acidic fruits)
• Oral medications such as amitriptyline (10-75 mg at bedtime), pentosan polysulfate sodium (Elmiron, 100 mg three times daily), or hydroxyzine (25-75 mg daily)
• Bladder instillations with dimethyl sulfoxide (DMSO) or a cocktail of medications
• Physical therapy for pelvic floor dysfunction, stress management techniques, and in severe cases, nerve stimulation therapy or surgery may be recommended

Impact on Quality of Life

• IC affects women more commonly than men and can significantly impact quality of life through chronic pain and frequent urination, including nighttime awakenings
• Patients with IC/BPS frequently exhibit mental health disorders, such as depression and anxiety, as noted in 1
• The condition can coexist with other unexplained medical conditions, such as fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome, suggesting a possible systemic dysregulation in some patients 1

From the FDA Drug Label

CLINICAL TRIALS ELMIRON® was evaluated in two clinical trials for the relief of pain in patients with chronic interstitial cystitis (IC). All patients met the NIH definition of IC based upon the results of cystoscopy, cytology, and biopsy.

Interstitial cystitis (IC) is a condition characterized by chronic pain in the bladder, as evidenced by the clinical trials evaluating the relief of pain in patients with IC 2.

• The condition is diagnosed based on the results of cystoscopy, cytology, and biopsy, according to the NIH definition of IC.
• Patients with IC may experience severe or unbearable pain, moderate pain, or mild or no pain 2.
• Treatment for IC may involve instillation of medication directly into the bladder, such as dimethyl sulfoxide (RIMSO-50®), which can provide symptomatic relief 3.

From the Research

Definition and Characteristics of Interstitial Cystitis

• Interstitial cystitis (IC), also known as interstitial cystitis/bladder pain syndrome (IC/BPS), is a chronic and debilitating condition characterized by symptoms such as bladder pain, frequent urination, and nocturia 4.
• The condition is often misdiagnosed due to the similarity of its symptoms with those of overactive bladder and acute bacterial cystitis 4.
• IC/BPS can be categorized into two main types: Hunner's (HIC) and non-Hunner's IC (NHIC), each with distinct clinical presentations and underlying pathophysiology 4.

Symptoms and Diagnosis

• Symptoms of IC include urinary frequency and urgency, severe suprapubic and/or pelvic pain, and nocturia 5.
• The condition is often characterized by a chronic inflammatory condition of the bladder wall, with standard urine cultures being negative and antibiotic therapy offering no relief 5.
• IC remains a diagnosis of exclusion, with no specific diagnostic test or marker available 6.

Treatment Options

• Treatment of IC/BPS should involve identifying the different clinical phenotypes and underlying pathophysiology causing clinical symptoms and developing strategies tailored to the patient's needs 4.
• Various treatment modalities are available, including oral and intravesical agents, such as amitriptyline, pentosan polysulfate sodium, and botulinum toxin A injection 7, 8.
• Multimodal behavioral techniques, alongside oral or minimally invasive treatments, are recommended by American and European Urological Association Guidelines 7.
• Patient-tailored phenotype-directed multimodal therapy is considered the most promising treatment strategy 7.