Treatment Options

There is no single approach to the successful treatment of IC. The treatment must involve a combination of various therapies and will differ for each patient. The current treatments goal is symptom relief in IC.

Diet Modifications

You may have experienced that certain food and drinks tend to aggravate IC. You should identify foods and beverages that will irritate the bladder and avoid taking them. This diet modification will regulate the IC flare-ups and help in controlling it.

Firstly, the patient has to identify the foods that worsen the IC [Table 2] and avoid its intake. This can be done by using the ‘elimination method’ that is, by beginning with different foods and excluding those with which the patient has experienced symptoms.

Multivitamins such as B-complex and vitamin C are known to trigger IC. Constipation has to be avoided to reduce exacerbations of IC symptoms. Ensure intake of fibre-rich diet and optimum amount of fluid.

Oral Medications

Oral treatment is mostly preferred, as it is easy to administer.

Pentosan Polysulphate Sodium

This is an FDA-approved drug for the treatment of IC. It is still uncertain how the drug works. However, it is believed that pentosan polysulphate sodium (PPS) repairs the defects in the bladder wall by preventing irritants from urine that attack the bladder. Pain due to IC will not be relieved until first 2 to 4 months after initiating therapy with PPS, and urinary frequency will require a span of 6 months to reduce. Therefore, the treatment has to be continued for an adequate period of time to relieve the symptoms.

Antihistamines

It is believed that patients with IC have significant amount of histamine present in the bladder, which results in pain. Hydroxyzine is used as an antihistamine to decrease pain. This has been proved beneficial in inducing better sleep at night.

Antidepressants

Amitryptiline may help reduce the pain and increase the bladder capacity. The relaxation effects on the bladder will reduce the urinary frequency. However, this drug is not preferred because of its common side effects such as sedation and constipation.

Bladder Instillations

Bladder instillations or intravesical therapies introduce the drug directly to the bladder. This would help the drug reach the bladder at a higher dosage and a faster pace. As the drug is not absorbed into the body, it has minimal side effects. However, the drawback of this therapy is that the patient has to be catheterised, which may lead to infection.

Dimethyl Sulphoxide (DMSO)

This is most common FDA-approved drug used for bladder instillation. With the help of a catheter the drug is retained for about 15 minutes inside the bladder before expelling out. This procedure is repeated once in a week, for a period of 6 weeks. DMSO helps in decreasing pain and inflammation. Its main drawback is the garlic-like odour of the breath and skin, which lasts for several hours.

Bladder Injections

Botulinum Toxin A

Botulinum toxin A (Botox) is injected intramurally into the detrusor muscle of the bladder. This helps in reducing the pain sensations and also improves bladder muscle strengths. Its temporary side effects such as urinary retention last till the drug effect wears off.

Neuromodulation Devices

Small surgical implanted devices send electrical signals to the nerves surrounding the bladder and bladder muscles. Nonsurgical devices are also available, which can be worn externally. These devices manage urinary functions and provide pain relief.¹

Alternative Treatments

The optimum pain control can be achieved only through a combination of relaxation and medical therapies.

Voiding Diaries

This can be of immense help to both the doctor and the patient, as it may help in monitoring the success of the treatment. The number of voids (= number of times you urinate) in a day, with the volume of urine, is noted. Factors such as excessive water intake (>2 L/d), perspiration and climate will affect the reliability of the voiding diary.

Bladder Training

Pain control is essential, as it limits the bladder from filling up. Under medical supervision, the bladder can be retrained in pain control. This can help in increasing the time of urine hold; however, it will be slow and short lasting.

Biofeedback

Patients tend to gain significant awareness and control over the bladder muscles. Hypnotherapy, pelvic floor reeducation, acupuncture and herbal supplements can be useful in pain control.

Relaxation Techniques

Yoga, meditation, exercise, swimming and warm baths help in relaxation and reduction of stress.^{1, 2}