From the Guidelines
The patient's worsening interstitial cystitis symptoms should be treated with pentosan polysulfate sodium (Elmiron) 100 mg orally three times daily. This medication works by coating and protecting the bladder lining, reducing inflammation and pain. Given her negative urine culture despite pyuria, this represents a flare of her interstitial cystitis rather than a urinary tract infection 1. In addition to medication, the patient should avoid bladder irritants such as caffeine, alcohol, spicy foods, and acidic beverages.
Some key points to consider in the management of this patient's condition include:
- Pelvic floor physical therapy would also be beneficial to address muscle tension that may be contributing to her pain.
- Hydrodistention during cystoscopy could be considered if symptoms persist despite these measures.
- Her recent sexual activity may be triggering symptoms, so using lubricants and emptying the bladder before and after intercourse is recommended.
- Stress management techniques like meditation or yoga may help, as stress can worsen interstitial cystitis symptoms.
- The patient should follow up in 4-6 weeks to assess treatment response, with the understanding that symptom improvement may take several months.
It's worth noting that the provided evidence on urological infections 1 does not directly apply to this patient's condition, as her symptoms and negative urine culture suggest a flare of interstitial cystitis rather than a urinary tract infection. Therefore, the focus should be on managing her interstitial cystitis symptoms and improving her quality of life.
From the Research
Patient's Condition
The patient is a 29-year-old woman with interstitial cystitis (IC) experiencing worsening urinary urgency and pain with voiding. She was initially prescribed amitriptyline, which improved her symptoms, but they have recently deteriorated.
Diagnostic Findings
- Clean-catch urinalysis shows:
- Leukocyte esterase: positive
- Nitrites: negative
- Bacteria: none
- White blood cells: 40/hpf
- Red blood cells: none
- Urine culture and pregnancy testing are negative
Treatment Options
- According to 2, oral treatments such as nonsteroidal anti-inflammatory drugs, tricyclic antidepressants, gabapentin, and pentosan polysulfate have shown varying degrees of efficacy in treating IC.
- 3 suggests that pentosan polysulfate sodium is efficacious in treating bladder pain, urinary urgency, and frequency of micturition in patients with IC/BPS.
- 4 reviews the use of pentosan polysulfate in relieving bladder pain or discomfort in IC, suggesting it repairs damaged glycosaminoglycan layers and provides an anti-inflammatory effect.
- 5 evaluates the efficacy of pharmacologic approaches to PBS/IC, suggesting pentosan polysulfate may be modestly beneficial for symptoms of PBS/IC.
Considerations for Reevaluation
- 6 highlights the importance of reevaluating patients with IC who do not respond to standard treatments, as many may have other underlying causes contributing to their symptoms.
- The study suggests that urodynamic studies can be crucial in excluding the diagnosis of IC and identifying other potential causes of urinary symptoms.