What are the treatment options for Interstitial Cystitis (IC), also known as Bladder Pain Syndrome (BPS)?

From the Guidelines

Treatment for interstitial cystitis typically involves a multimodal approach, including lifestyle modifications, oral medications, bladder instillations, and procedures, with the goal of improving symptoms and quality of life, as recommended by the most recent guidelines 1. The treatment approach should be individualized, taking into account the unique characteristics of each patient, and may involve a combination of behavioral/non-pharmacologic, oral medicines, bladder instillations, procedures, and major surgery. Some key treatment options include:

• Lifestyle modifications, such as avoiding trigger foods and beverages, stress reduction techniques, and pelvic floor physical therapy, which can help improve symptoms and reduce pain 1
• Oral medications, such as pentosan polysulfate sodium (Elmiron), amitriptyline, and antihistamines, which can help repair the bladder lining, reduce pain and frequency, and alleviate symptoms 1
• Bladder instillations, which involve placing medications directly into the bladder to provide relief from symptoms, and can be used in combination with other treatments 1
• Procedures, such as hydrodistention during cystoscopy, which can temporarily relieve symptoms, and sacral neuromodulation or botulinum toxin injections, which may be considered for severe cases 1 It is essential to note that pain management alone is not sufficient treatment for interstitial cystitis, and patients should also be treated for underlying bladder-related symptoms 1. The benefits and risks of each treatment option should be discussed with the patient, and treatment should be tailored to the individual's needs and response to therapy, with the goal of improving morbidity, mortality, and quality of life.

From the FDA Drug Label

ELMIRON® is used to treat the pain or discomfort of interstitial cystitis (IC). 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.

The treatment options for Interstitial Cystitis (IC), also known as Bladder Pain Syndrome (BPS), include:

• Oral medication: pentosan polysulfate sodium (PO) capsules, such as ELMIRON® 2
• Intravesical instillation: dimethyl sulfoxide (INH), such as RIMSO-50® 3 Key points:
• ELMIRON® is taken continuously for relief as prescribed
• RIMSO-50® is instilled directly into the bladder and may be repeated every two weeks until maximum symptomatic relief is obtained

From the Research

Treatment Options for Interstitial Cystitis (IC)/Bladder Pain Syndrome (BPS)

• Oral medications:
  • Pentosan polysulfate sodium 4, 5, 6, 7
  • Amitriptyline 4, 8, 6
  • Antihistamines 5
  • Tricyclic antidepressants 5
  • Immune modulators 5
  • Hydroxyzine 8, 6
  • Cyclosporine A 6
  • Certolizumab pegol (currently in clinical development) 6
• Intravesical instillations:
  • Dimethyl sulfoxide 4, 5, 8
  • Pentosan polysulfate sodium 5
  • Heparin 5, 8
  • Lidocaine 4, 8
  • Hyaluronic acid 4
  • Chondroitin sulfate 4
  • Botulinum toxin 4
• Minimally invasive procedures:
  • Fulguration (if Hunner ulcers are found on cystoscopy) 8
  • Hydrodistention 8
  • Sacral neuromodulation 8
  • Intradetrusor onabotulinumtoxinA 8

Multimodal Therapy

• Patient-tailored phenotype-directed multimodal therapy is the most promising treatment strategy 4
• Combination of oral medications, intravesical instillations, and minimally invasive procedures may be effective in managing IC/BPS symptoms 4, 5, 8

Dietary Changes and Supplements

• Dietary changes and supplements may be recommended as part of the treatment plan 5