From the Guidelines
Treatment options for interstitial cystitis should prioritize a stepwise approach, starting with conservative measures such as lifestyle modifications and oral medications, and progressing to more invasive options if symptoms persist, as recommended by the most recent guideline from 2022 1. The goal of treatment is to maximize symptom control and patient quality of life while minimizing adverse events and patient burden.
First-line Treatments
- Lifestyle modifications: dietary changes (avoiding trigger foods like caffeine, alcohol, spicy foods, and acidic fruits), stress management, and bladder training techniques.
- Oral medications:
- Pentosan polysulfate sodium (Elmiron) at 100mg three times daily, which may take 3-6 months to show benefit by helping repair the bladder lining.
- Antihistamines like hydroxyzine (25-50mg at bedtime) to reduce mast cell activity and inflammation.
- Amitriptyline (10-75mg at bedtime) to help with pain and urinary frequency by blocking nerve signals.
Second-line Treatments
- Bladder instillations: medications like dimethyl sulfoxide (DMSO), heparin, or lidocaine are directly placed into the bladder for 15-20 minutes, can provide relief for 3-6 months.
- Pain management: nonsteroidal anti-inflammatory drugs or gabapentin (300-900mg daily) may be prescribed.
Invasive Options
- Hydrodistention (stretching the bladder under anesthesia).
- Botox injections to relax bladder muscles.
- Sacral neuromodulation for severe cases. It is essential to note that interstitial cystitis is a chronic condition requiring ongoing management rather than a one-time cure, and treatment should be tailored to the individual patient's needs and symptom severity, as suggested by the guideline 1.
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. 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.
The treatment options for interstitial cystitis include:
- Dimethyl sulfoxide (DMSO) instillation: directly into the bladder, repeated every two weeks until maximum symptomatic relief is obtained 2
- Oral analgesic medication: to reduce bladder spasm before instillation of DMSO
- Suppositories containing belladonna and opium: to reduce bladder spasm before instillation of DMSO
- Anesthesia: for initial treatment in patients with severe interstitial cystitis and very sensitive bladders 2
From the Research
Treatment Options for Interstitial Cystitis
The treatment of interstitial cystitis (IC) involves a multi-disciplinary and multi-modal approach, including lifestyle and behavioural modifications, physical therapy, oral medications, and intravesical treatments 3. The goal of treatment is to alleviate symptoms such as urinary frequency, urgency, and pain or discomfort.
Oral Medications
Oral medications that have been used to treat IC include:
- Pentosanpolysulfate
- Amitriptyline
- Hydroxyzine
- Quercetin 4
Intravesical Treatments
Intravesical treatments involve the direct introduction of medication into the bladder and can provide relief for patients who have failed conservative and oral therapies. Options for intravesical treatments include:
- Heparin/bicarbonate/lidocaine solutions 4
- Dimethyl sulfoxide
- Heparin
- Lidocaine 5
- Sodium hyaluronate, chondroitin sulfate, and quercetin to reduce bladder inflammation and replenish the glycosaminoglycan layer 4
- Pentosan polysulfate or heparin with lidocaine and sodium bicarbonate 6
Other Treatment Approaches
Other forms of care that may be used to manage IC symptoms include: