From the Guidelines
Managing interstitial cystitis (IC) with a negative urinalysis requires a multimodal approach focusing on symptom relief and quality of life improvement, with the primary consideration being to rule out other conditions that may mimic IC, such as bladder cancer, bladder stones, and intravesical foreign bodies, as indicated in the AUA guideline 1. When considering the management of IC with a negative urinalysis, it is essential to take a comprehensive approach that includes:
- Dietary modifications to eliminate bladder irritants such as caffeine, alcohol, acidic foods, artificial sweeteners, and spicy foods
- Oral medications, including amitriptyline, pentosan polysulfate sodium, hydroxyzine, or cimetidine
- Physical therapy targeting pelvic floor dysfunction
- Bladder instillations using dimethyl sulfoxide (DMSO), heparin, lidocaine, or sodium bicarbonate
- Hydrodistention during cystoscopy for temporary relief
- Stress management techniques and support groups as adjuncts to treatment As noted in the AUA guideline, 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. The clinical diagnosis of IC/BPS requires a careful history, physical examination, and laboratory examination to document basic symptoms and exclude infections or other confusable disorders, with symptoms present for at least six weeks and documented negative urine cultures 1. Behavioral modification strategies, such as altering the concentration and/or volume of urine, avoiding certain foods, and using an elimination diet, may also be beneficial in managing IC symptoms, as suggested by clinical experience and limited literature 1. Overall, treatment should be individualized and may require trial of multiple therapies before finding an effective regimen, as IC is a chronic condition requiring ongoing management, with the goal of improving quality of life and reducing morbidity and mortality.
From the Research
Primary Considerations for Managing Interstitial Cystitis with a Negative Urinalysis
- The management of interstitial cystitis (IC) with a negative urinalysis requires a comprehensive approach, including symptom-based diagnosis and treatment 2.
- A negative urinalysis does not rule out IC, as the condition is often characterized by chronic pelvic pain, urgency, and frequency, rather than a urinary tract infection 3.
- The use of oral and intravesical pharmacologic agents, such as pentosan polysulfate sodium, can provide symptom relief and improve quality of life for patients with IC 4, 3.
- Behavioral and dietary modifications, such as avoiding trigger foods and managing stress, may also be beneficial in managing IC symptoms 5.
- A multidisciplinary approach to care, including urology, physical therapy, and pain management, may be necessary to address the complex needs of patients with IC 2, 6.
Diagnostic Considerations
- IC is often misdiagnosed or underdiagnosed, and a thorough evaluation, including cystoscopy and hydrodistention of the bladder, may be necessary to confirm the diagnosis 3.
- The presence of glomerulations or Hunner's ulcers on cystoscopy can support the diagnosis of IC 3.
- A systematic review of the literature highlights the importance of a comprehensive diagnostic approach, including the use of symptom indices and quality of life assessments 6.
Treatment Options
- Oral pentosan polysulfate sodium and other pharmacologic agents may be effective in reducing IC symptoms and improving quality of life 4, 3.
- Intravesical therapies, such as hydrodistention and dimethyl sulfoxide, may also be beneficial in managing IC symptoms 3.
- Behavioral and dietary modifications, such as stress management and trigger food avoidance, may be used in conjunction with pharmacologic and intravesical therapies to optimize symptom management 5.