No single treatment works for all people. Treatment must be chosen and adjusted for everyone based on symptoms. The goal of treatment is to control your symptoms. A combination of lifestyle changes and medical options are tried until relief is found.
Most people can find ways to feel better, but it may take time. It can take weeks to months before symptoms improve.
IC/BPS treatment is often directed at the most bothersome symptoms and sometimes multiple treatments will need to be combined to get relief. It is of great value to talk with your doctor about how your treatment is working. Together, you’ll find your best options. Even with successful treatment, IC/BPS may not be cured but may be in remission. Sticking with your treatment plan (even without symptoms) is usually recommended.
Below are some treatment options that your doctor may discuss with you.
Lifestyle Changes
Lifestyle changes, known as "behavioral therapy," are tried first. In behavioral therapy, you change the way you live day-to-day. This may include things you eat or drink or practicing methods that may control symptoms. You may not get rid of all symptoms with lifestyle changes, but your symptoms may feel better after changing a few habits.
Limit Certain Foods and Drinks
Most (but not all) people with IC/BPS find that certain foods and drinks make symptoms worse:
- Citrus fruits
- Tomatoes
- Chocolate
- Coffee and caffeinated drinks
- Alcoholic drinks
- Spicy foods
- Some carbonated drinks
Elimination Diet
The list of foods that could aggravate symptoms is long, but not all foods affect all people. You should find out how foods affect you. The clearest way is to try an "elimination diet" for one to two weeks. For this, you start by not eating any foods that could irritate your bladder. (IC/BPS food lists are available from many sources. For more information on the elimination diet visit www.ichelp.org.)
If your symptoms improve with an IC/BPS elimination diet, this means at least one food on the list causes your IC/BPS symptoms to get worse. The next step is to find out exactly which foods cause problems for you. After one to two weeks on the elimination diet, try eating one food at a time from the IC/BPS food list. If this food does not bother your bladder, then this food is likely safe for you. In a few days you can try a second food from the list, and so on. In this way, you will add foods back into your diet one at a time. Your bladder symptoms will tell you what causes problems. Be sure to add only one new food at a time. If you eat a banana, strawberries and tomatoes in the same day, you won’t know which of the foods caused a symptom flare-up.
Self-Care and Limiting Stress
Emotional and mental stress can worsen IC/BPS symptoms. Patients are encouraged to learn coping skills to deal with family, work and/or past painful experiences. Professional counseling can be helpful to learn better strategies to cope with anxiety and pain.
Physical Therapy
Patients with IC/BPS often have tenderness and/or pain in the pelvic floor area, and sometimes manual physical therapy can reduce symptoms. There is evidence that physical therapy exercises to strengthen the pelvic floor muscles do not improve symptoms and often make them worse, so activities such as Kegel exercises are not recommended for patients with IC/BPS. However, physical therapists trained to help with pelvic floor tenderness may offer relief in the abdominal and pelvic areas, lengthen muscle contractures and release scarred or restricted tissue.
Medications
The two types of prescription drugs that may be recommended are oral and intravesical drugs. There are many types of oral drugs and the side effects range from drowsiness to upset stomach. Intravesical drugs are placed directly into the bladder with a catheter.
Oral Medications
Non-steroidal Anti-Inflammatory Drugs (NSAIDS)
NSAIDS and Acetaminophen can help relieve some of the discomfort and are available over-the-counter.
Amitriptyline
Amitriptyline is a type of antidepressant that is commonly used to improve IC/BPS symptoms. It has antihistamine effects, decreases bladder spasms and slows the nerves that carry pain messages. It also helps with sleep. This type of oral drug is often used for chronic pain, like with cancer and nerve damage. The most common side effects are drowsiness, constipation and increased appetite.
Oral Pentosan Polysulfate
Pentosan polysulfate is an oral drug used to relieve pain. It is not clear exactly how it works for IC/BPS. Many think it builds and restores the protective coating of the bladder tissue. It may also help decrease swelling. It often takes at least three to six months of treatment with this drug before you notice improvement. Possible side effects may include nausea, diarrhea and gastric distress and sometimes short-term hair loss. Routine eye examinations are needed while on this medication.
Hydroxyzine and Cimetidine
Hydroxyzine and Cimetidine are antihistamines. An antihistamine may help treat IC/BPS if an allergic reaction is thought to be the cause of pain and symptoms. The main side effect is drowsiness, which may be helpful since patients can sleep better at night and get up less often to pass urine.
Cyclosporine
Cyclosporine is a type of oral drug used when other options don’t help. It is an immune-suppressant. This means it slows down the body’s immune system. It is often used after an organ transplant. It can cause side effects that may be very serious, like kidney problems. It should only be considered when other safer options have failed to work.
Intravesical Instillations
Heparin
Heparin helps the bladder in similar ways as Pentosan polysulfate. It is placed in the bladder with a catheter. It may be used daily. Heparin stays in the bladder only and does not affect the rest of the body. It is usually given with an anesthetic agent, like lidocaine or bupivicaine.
Dimethyl Sulfoxide (DMSO)
Dimethyl sulfoxide (DMSO) is placed directly in the bladder through a catheter. This is usually done once each week for six weeks. Some people use it on and off for maintenance. It is not clear exactly how it helps. It may block swelling, decrease pain and remove "free radicals" that can damage tissue. Some doctors combine it with other drugs, such as heparin or steroids (to reduce inflammation). The main side effect of DMSO is a garlic-like odor that lasts for a few hours. For some patients, it hurts to place DMSO in the bladder, but a local anesthetic helps.
Supplements and Herbal Medications
You may or may not be using a supplement to help manage your IC/BPS. Knowing which supplement is best can be very confusing. There are a few that may help manage some of your symptoms. They include:
- Calcium glycerophosphate may help to neutralize the acidity in your body. Acidic foods and beverages can cause IC/BPS symptoms to get worse, so you should only use it when eating high acidic foods.
- Osteoarthritis supplements may help reduce the pain patients have; examples include glucosamine and chondroitin.
- Quercetin complex may help to reduce the inflammation caused by IC/BPS. It has also been found to reduce pain and other urinary symptoms.
- Aloe capsules are a relatively new supplement some IC/BPS patients use to manage their condition. It may help some patients, but more research is needed to find out its benefits.
If you have IC/BPS you SHOULD NOT take Vitamin C, L-arginine and L-citrulline. These drugs can actually make your symptoms worse.
Procedures
Cystoscopy with Hydrodistention
Cystoscopy with hydrodistention in the operating room (with anesthesia) fills the bladder with water to stretch it to full capacity. Many patients experience relief of bladder pain and frequency after the procedure. If ulcers are seen, the doctor can cauterize (burn) them with electricity or with a laser, or sometimes treat them with a direct injection of steroids into the ulcer.
Neuromodulation Therapy
If other treatments don’t help enough, more advanced therapies may help. You may be referred to a specialist/ urologist who is an expert in IC/BPS. The specialist may offer neuromodulation therapy. This is a group of treatments that deliver harmless electrical impulses to nerves going to and from the bladder to change how they work.
Botox® Injections
Injections of Botox® into bladder tissue are used to control symptoms. Small doses will paralyze muscles. When injected into the bladder muscle, it can relieve the pain of IC/BPS. Your doctor should follow you closely to ensure that your bladder is working well after injections. A side effect can be urinary retention (incomplete emptying of the bladder). Botox can wear off and you may need another treatment six to nine months after the first injection.
Major Surgery
Most patients do not require major surgery for this condition. Still, surgery can be an option when there are major bladder symptoms that haven’t responded to other treatments. Surgeries range from minimally invasive to very invasive. There are lifelong changes after surgery that must be considered.
