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 physical therapy, with the goal of achieving adequate symptom control and improving quality of life. According to the most recent and highest quality study 1, patients should be aware that IC/BPS is a chronic disorder requiring continual and dynamic management, with symptom exacerbations and remissions.

First-Line Treatments

• Lifestyle modifications, such as avoiding trigger foods and beverages (coffee, alcohol, spicy foods, citrus), stress management, and bladder training techniques, are essential in managing IC/BPS symptoms 1.
• Oral medications, including pentosan polysulfate sodium (Elmiron, 100 mg three times daily), have been shown to be effective in some patients, although results are contradictory, and benefits and risks should be discussed with the patient before initiating or continuing treatment 1.

Additional Treatment Options

• Bladder instillations, such as DMSO (50 ml of 50% solution held for 15 minutes), lidocaine, heparin, or sodium bicarbonate solutions, may be beneficial in reducing symptoms.
• Physical therapy focusing on pelvic floor relaxation can help patients with muscle tension or spasms.
• More invasive options, including hydrodistention during cystoscopy, Botox injections into the bladder wall, sacral neuromodulation, or rarely, surgical interventions, may be considered for refractory cases.

Patient Education and Management

• Patients should be informed about the chronic nature of IC/BPS and the importance of ongoing management and symptom control 1.
• A trial-and-error approach may be necessary to find the most effective treatment combination for each patient, and patients should be encouraged to work closely with their healthcare provider to develop a personalized treatment plan.

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 therapy: dimethyl sulfoxide (INTRAvesical), 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
  • Amitriptyline 7, 6
  • Hydroxyzine 8, 6
  • Antihistamines 4
  • Tricyclic antidepressants 4
  • Immune modulators 4
  • Cyclosporine A 6
  • Certolizumab pegol (currently in clinical development) 6
• Intravesical instillations:
  • Dimethyl sulfoxide 7, 8, 4, 5
  • Pentosan polysulfate sodium 4, 5
  • Heparin 8, 4, 5
  • Lidocaine 7, 8, 5
  • Sodium bicarbonate 5
  • Anesthetic therapeutic combination containing lidocaine 8
• Minimally invasive treatments:
  • Botulinum toxin 7
  • Chondroitin sulfate 7
  • Triamcinolone 7
  • Hyaluronic acid 7
  • Fulguration (if Hunner ulcers are found on cystoscopy) 8
  • Hydrodistention 8, 4
  • Sacral neuromodulation 8
  • Intradetrusor onabotulinumtoxinA 8
• Dietary changes and supplements:
  • No specific details provided in the studies, but mentioned as a treatment option 4
• Multimodal therapy:
  • Patient-tailored phenotype-directed multimodal therapy is the most promising treatment strategy 7
  • Combination of oral and intravesical medications, as well as behavioral techniques and lifestyle modifications 7, 8, 4