Treating interstitial cystitis
Interstitial cystitis is a chronic inflammation of the bladder that
causes people to urinate -- sometimes painfully -- as often as 40,
50, or 60 times a day. Their quality of life, research suggests, resembles
that of a person on kidney dialysis or suffering from chronic cancer
pain. Not surprisingly, the condition is officially recognized as a
There's no cure for interstitial cystitis, but many treatments offer
some relief, either on their own or in combination.
Treatment (see chart) is aimed at relieving pain and reducing inflammation.
The two main approaches are oral medications and bladder instillations
-- drugs that are introduced into the bladder by catheter and held for
15 minutes. The procedure usually takes place in a physician's office,
but in some cases these drugs can be self-administered at home.
Common treatments for interstitial cystitis
Taken at low doses, tricyclic antidepressants relax
the bladder and interfere with the release of neurochemicals
that can cause bladder pain and inflammation. They may also improve
sleep. Amitriptyline is the medication most commonly prescribed
for interstitial cystitis.
Pentosan polysulfate sodium (Elmiron)
Elmiron is the only oral drug approved by the FDA
specifically for interstitial cystitis. It improves the bladder
lining, making it less leaky and therefore less inflamed and
painful. The full effect may take three to six months. Side effects,
which are rare, include reversible hair loss, diarrhea, nausea,
Antihistamines such as hydroxyzine (Atarax, Vistaril)
interfere with the mast cells' release of histamine, helping
to relieve bladder inflammation and pain, urinary frequency,
and nighttime voiding. Because antihistamines can cause drowsiness,
they are usually best taken at bedtime.
Nonsteroidal anti-inflammatory drugs (aspirin,
naproxen sodium, ibuprofen) and acetaminophen can help relieve
mild to moderate pain. Check with your clinician about possible
side effects of long-term use of these over-the-counter medications.
Opioid analgesics, such as oxycodone or hydrocodone combined
with acetaminophen, may be used to treat severe pain when other
forms of therapy have not worked. Because these medications can
be addictive, anyone taking them should be followed carefully,
for example, at a pain clinic.
Dimethyl sulfoxide (DMSO)
DMSO is the only FDA-approved bladder instillation
drug for interstitial cystitis. It helps relax the bladder and
alleviate pain and inflammation. Some research suggests that
more than half of patients improve after six weeks of once-a-week
treatments. It may cause a burning sensation during and after
instillation and can cause a garlicky odor on the skin and breath
for up to three days following treatment. DMSO is sometimes combined
with other medications.
. Bacillus Calmette-Guerin (BCG)
. Hyaluronic acid (Cystistat)
These instillation drugs are still under study
and not yet widely available. BCG is a bacterium that is thought
to block inflammation and stimulate a protective immune response.
Cystistat may help repair the bladder lining.
No single treatment alleviates all symptoms, and some may stop working
over time, so finding what works is often a matter of trial and error.
The good news is that in 50% of cases, the disease will disappear on
In a procedure called transcutaneous electrical nerve stimulation (TENS),
pain pathways are modified by a device worn on the body. The device produces
electrical impulses, which pass through electrodes that are attached
to the body with small adherent pads. Patients can adjust the level of
electrical stimulation themselves. Good results have been reported in
about one-quarter of those using TENS.
An implantable device called InterStim directly stimulates the sacral
nerve in the lower back. Already approved for treating bladder control
problems, it's now under study as a potential treatment for interstitial
Some people report that stress reduction, exercise, biofeedback, or
warm tub baths improve their symptoms, but no research has evaluated
the effectiveness of these strategies. Bladder training -- that is, learning
to urinate only at specific times (despite the urge to go) -- can help
reduce urinary frequency. There's no scientific evidence linking diet
to interstitial cystitis, but many people believe that their symptoms
are made worse by tomatoes, chocolate, caffeine, alcohol, and beverages
that acidify the urine, such as cranberry juice.
Surgery is usually a last resort and undertaken only when the pain is
crippling. The surgical procedure typically involves removal of the bladder
and the creation of a new one (a neobladder) using intestinal tissue.
Most people need to catheterize the neobladder themselves in order to
Scientists seeking a diagnostic test have begun to identify substances
unique to the urine of interstitial cystitis patients. They've also found
that certain factors required for healthy cell growth appear to be missing
from the urine, a discovery that could lead to a new therapy.
January 2004 Update
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