From the Guidelines
The current treatment approach for interstitial cystitis/bladder pain syndrome (IC/BPS) should be individualized and categorized into behavioral/non-pharmacologic, oral medicines, bladder instillations, procedures, and major surgery, as outlined in the 2022 updated Guideline 1. When managing IC/BPS, it's essential to consider the unique characteristics of each patient.
- Behavioral and non-pharmacologic interventions may include lifestyle modifications such as dietary changes, stress management, and pelvic floor physical therapy.
- Oral medications may be prescribed, such as pentosan polysulfate sodium, with consideration of potential adverse events 1.
- Bladder instillations, procedures, and major surgery are also options, with cystoscopy for patients with Hunner lesions and shared decision-making being important considerations 1. Key treatment options include:
- Oral medications like amitriptyline, pentosan polysulfate sodium, and hydroxyzine
- Bladder instillations with solutions containing dimethyl sulfoxide (DMSO), lidocaine, heparin, or sodium bicarbonate
- Procedures like cystoscopy with hydrodistention under anesthesia, Botox injections into the bladder wall, and sacral neuromodulation
- Major surgery, such as urinary diversion or cystectomy, may be considered in severe cases unresponsive to other treatments. It's crucial to work closely with healthcare providers specializing in IC management to find the right combination of treatments, as effectiveness can vary significantly between patients 1.
From the FDA Drug Label
RIMSO-50® is a sterile solution of 50% dimethyl sulfoxide (DMSO) and 50% water that has been approved by the U. S. Food and Drug Administration for use in the symptomatic relief of patients with interstitial cystitis. The current treatment option for interstitial cystitis mentioned in the drug label is dimethyl sulfoxide (DMSO), specifically RIMSO-50®, which is used for symptomatic relief.
- The treatment involves instillation of the solution into the bladder, either on an inpatient or outpatient basis, as determined by a physician.
- Patients should inform their physician of all medications they are currently taking, as dimethyl sulfoxide may interact with other medications 2.
From the Research
Current Treatment Options for Interstitial Cystitis
The current treatment options for interstitial cystitis include:
- Conservative supportive therapy, such as diet modification 3
- Oral treatment with pentosan polysulfate sodium, amitriptyline, hydroxyzine, or cimetidine 3
- Intravesical treatments with heparinoids, dimethyl sulfoxide, alkalized lidocaine, or bacille Calmette-Guérin 3
Oral Therapy for Interstitial Cystitis
Pentosan polysulfate sodium is an oral therapy that has been shown to be effective in repairing the damaged glycosaminoglycane layer on the urothelium of the urinary bladder, which is thought to be a cause of interstitial cystitis/bladder pain syndrome 4.
- The efficacy of pentosan polysulfate sodium has been proven in randomized trials 4, 5
- It is recommended as a basic pharmaceutical therapy, in addition to behavioral intervention, dietary therapy, or other drug treatments such as pain therapy 4
- Side effects of pentosan polysulfate sodium include mild haemodilution, nausea, and loss of hair 4
Other Treatment Options
Amitriptyline, a tricyclic antidepressant, has also been shown to be effective in treating interstitial cystitis, with significant improvement in pain and daytime frequency 6.