Treatments and drugsBy Mayo Clinic staff
CLICK TO ENLARGE
|Sacral nerve stimulation|
No simple treatment exists to eliminate the signs and symptoms of interstitial cystitis, and no one treatment works for everyone. You may need to try various treatments or combinations of treatments before you find an approach that relieves your symptoms.
Oral medications that may improve the signs and symptoms of interstitial cystitis include:
- Ibuprofen (Advil, Motrin, others), naproxen (Aleve, Anaprox) and other nonsteroidal anti-inflammatory drugs, to relieve pain.
- Tricyclic antidepressants, such as amitriptyline or imipramine (Tofranil), to help relax your bladder and block pain.
- Antihistamines, such as diphenhydramine (Benadryl, others) and loratadine (Claritin, others), which may reduce urinary urgency and frequency and relieve other symptoms.
- Pentosan (Elmiron), is the only oral drug approved by the Food and Drug Administration specifically for interstitial cystitis. How it works is unknown, but it may restore the inner surface of the bladder, which protects the bladder wall from substances in urine that could irritate it. It may take two to four months before you begin to feel pain relief and up to six months to experience a decrease in urinary frequency. Side effects include minor gastrointestinal disturbances and possible hair loss, which reverses when you stop taking the drug. Make sure your doctor knows if you're pregnant or planning to become pregnant before taking pentosan, because this medication hasn't been studied in pregnant women. You may also need to have your liver function tested while you're taking this medication.
Transcutaneous electrical nerve stimulation (TENS) uses mild electrical pulses to relieve pelvic pain and, in some cases, reduce urinary frequency. Electrical wires are placed on your lower back or just above your pubic area, and pulses are administered for minutes or hours, two or more times a day, depending on the length and frequency of therapy that works best for you. In some cases a TENS device may be inserted into a woman's vagina or a man's rectum.
Scientists believe that TENS may relieve pain and urinary frequency associated with interstitial cystitis by increasing blood flow to the bladder, strengthening the muscles that help control the bladder or triggering the release of substances that block pain.
Another possible nerve stimulation treatment is sacral nerve stimulation. Modulation of your sacral nerves — a primary link between the spinal cord and nerves in your bladder — may reduce feelings of urinary urgency that accompany interstitial cystitis. With sacral nerve stimulation, a thin wire placed near the sacral nerves delivers electrical impulses to your bladder, similar to what a pacemaker does for the heart. If the procedure successfully lessens your symptoms, a permanent device may be surgically implanted.
Some people notice a temporary improvement in symptoms after undergoing cystoscopy with bladder distention. Bladder distention is the stretching of the bladder with water or gas. The procedure may be repeated as a treatment if the response is long lasting.
Medications instilled into the bladder
In bladder instillation, the prescription medication dimethyl sulfoxide, or DMSO, (Rimso-50) is placed into your bladder through a thin, flexible tube (catheter) inserted through the urethra. The solution sometimes is mixed with other medications, such as a local anesthetic. After remaining in your bladder for 15 minutes, the solution is expelled through urination. Delivering DMSO directly to your bladder may reduce inflammation and possibly prevent muscle contractions that cause frequency, urgency and pain.
Your doctor may initially perform DMSO treatment weekly for six to eight weeks, and then perform maintenance treatments as needed — often, every couple of weeks — for up to one year.
A garlic-like taste and odor may last up to 7 hours after treatment. DMSO can affect your liver, so your doctor may monitor your liver function with blood tests. For some people, this procedure may be painful or it may worsen symptoms. Talk with your doctor about other treatment options if this happens to you.
A newer approach to bladder instillation includes using a solution that contains a trio of medications: lidocaine, sodium bicarbonate and either pentosan or heparin to relieve urinary pain and urgency. Researchers are also testing a number of other solutions that may help relieve the symptoms of interstitial cystitis, including hyaluronan, chondroitin sulfate and oxybutynin.
Doctors rarely use surgery as interstitial cystitis treatment because removal of part or all of the bladder doesn't relieve pain and can lead to other complications. People with severe pain and people whose bladders can hold only very small volumes of urine are possible candidates for surgery, but even then surgery is usually considered only after other treatments have failed. Surgical options include:
- Bladder augmentation. In this procedure, surgeons remove the damaged portion of the bladder and replace it with a piece of the colon, but the pain still remains and some people need to empty their bladders with a catheter multiple times a day.
- Fulguration. This minimally invasive method involves insertion of instruments through the urethra to burn off ulcers that may be present with interstitial cystitis.
- Resection. This is another minimally invasive method that involves insertion of instruments through the urethra to cut around any ulcers.
- Interstitial cystitis/painful bladder syndrome. National Institute of Diabetes and Digestive and Kidney Diseases. http://kidney.niddk.nih.gov/kudiseases/pubs/interstitialcystitis/. Accessed Nov. 23, 2010.
- Fitzgerald MP. Clinical features and diagnosis of painful bladder syndrome/interstitial cystitis. http://www.uptodate.com/home/index.html. Accessed Nov. 23, 2010.
- Interstitial cystitis. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/print/sec17/ch228/ch228e.html. Accessed Nov. 23, 2010.
- Hanno PM, et al. Bladder pain syndrome. Medical Clinics of North America. 2011;95:55.
- Hanno PM. Painful bladder syndrome/interstitial cystitis and related disorders. In: Wein AJ, et al. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/113536197-2/0/1445/13.html?tocnode=54300277&fromURL=13.html#4-u1.0-B978-0-7216-0798-6..50012-1_840. Accessed Nov. 23, 2010.
- Engelhardt PF, et al. Long-term results of intravesical hyaluronan therapy in bladder pain syndrome/interstitial cystitis. International Urogynecology Journal. In Press. Accessed Nov. 23, 2010.
- Homma Y, et al. Clinical guidelines for interstitial cystitis and hypersensitive bladder syndrome. International Journal of Urology. 2009;16:597.
- Fitzgerald MP. Treatment of painful bladder syndrome/interstitial cystitis. http://www.uptodate.com/home/index.html. Accessed Nov. 23, 2010.