What are the initial management strategies for interstitial cystitis (IC) with urinary symptoms?

From the Guidelines

Initial management of interstitial cystitis (IC) should focus on conservative approaches, including behavioral modification strategies, such as altering urine concentration and volume, avoiding certain foods, and using over-the-counter products, as these have been shown to improve symptoms in some patients 1. The goal of these strategies is to reduce symptoms and improve quality of life.

• Behavioral modification strategies may include:
  • Altering the concentration and/or volume of urine, either by fluid restriction or additional hydration
  • Avoidance of certain foods known to be common bladder irritants
  • Use of an elimination diet to determine which foods or fluids may contribute to symptoms
  • Techniques applied to trigger points and areas of hypersensitivity, such as application of heat or cold over the bladder or perineum
  • Strategies to manage IC/BPS flare-ups, such as meditation and imagery
  • Pelvic floor muscle relaxation and bladder training with urge suppression Patients should be educated about normal bladder function, the benefits and risks of available treatment alternatives, and the fact that no single treatment has been found effective for the majority of patients 1. It is also important to rule out other conditions that may be causing the symptoms, such as bladder cancer, bladder stones, and intravesical foreign bodies, through a careful history, physical examination, and laboratory examination 1. By taking a conservative and multi-faceted approach to managing IC, patients can experience improved symptoms and quality of life. Key considerations include:
• Avoiding excessive fluid intake immediately before bedtime to minimize nighttime urination
• Using over-the-counter supplements like calcium glycerophosphate (Prelief) to reduce food-triggered symptoms
• Considering oral medications, such as amitriptyline, pentosan polysulfate sodium, hydroxyzine, or cimetidine, if symptoms persist
• Exploring bladder instillations, physical therapy, and stress management techniques as additional treatment options.

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. Application of an analgesic lubricant gel such as lidocaine jelly to the urethra is suggested prior to insertion of the catheter to avoid spasm. 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.

The initial management strategies for interstitial cystitis (IC) with urinary symptoms include:

• Instillation of dimethyl sulfoxide (DMSO) into the bladder, allowing it to remain for 15 minutes, and repeating every two weeks until maximum symptomatic relief is obtained 2
• Use of analgesic lubricant gel, such as lidocaine jelly, to avoid spasm during catheter insertion
• Administration of oral analgesic medication or suppositories containing belladonna and opium to reduce bladder spasm
• Anesthesia for initial treatment in patients with severe interstitial cystitis and very sensitive bladders 2

From the Research

Initial Management Strategies for Interstitial Cystitis (IC)

The initial management strategies for interstitial cystitis (IC) with urinary symptoms involve a multi-faceted approach.

• Education and lifestyle modifications are recommended as the first line of treatment, according to the American Urological Association (AUA) guidelines 3.
• Supportive therapies, including psychosocial, behavioral, and physical therapies, are also used to manage IC symptoms 4.
• Oral treatments, such as pentosan polysulfate sodium, have been shown to be effective in relieving bladder pain and discomfort in patients with IC 5, 6.
• Intravesical treatments may also be used to manage IC symptoms, although the evidence for these treatments is limited 4.

Pharmacological Treatments

Pentosan polysulfate sodium is a heparin-like, sulfated polysaccharide that has been shown to repair damaged glycosaminoglycan layers lining the urothelium and provide an anti-inflammatory effect in patients with IC 5.

• It is the only US FDA-approved oral treatment for the relief of bladder pain or discomfort associated with IC 5.
• Pentosan polysulfate sodium has also been shown to be effective in preventing recurrent urinary tract infections in women 7.

Considerations for Treatment

The treatment of IC should be tailored to each individual patient, taking into account the severity of their symptoms and the presence of any underlying conditions 3.

• Patients with IC should be monitored regularly to assess the effectiveness of their treatment and to adjust their treatment plan as needed 3, 6.
• Potential side effects of pentosan polysulfate sodium, such as mild haemodilution, nausea, and loss of hair, should be considered when prescribing this treatment 6.