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Interstitial cystitis (IC)
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Interstitial cystitis (IC)

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No simple treatment exists to eliminate the 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.

  • Medications. Your doctor may prescribe an oral medication, pentosan (Elmiron), the only oral drug approved by the Food and Drug Administration specifically for interstitial cystitis. How it works is unknown, but Elmiron may restore the inner surface of the bladder, which protects the bladder wall from substances in urine that could irritate it. It may take 3 to 6 months before you begin to feel pain relief and up to 9 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. Not for use by pregnant women, Elmiron may cause bleeding and loss of pregnancy. Make sure your doctor knows if you're pregnant.

  • Other oral medications that may improve the symptoms of interstitial cystitis include aspirin and ibuprofen (Advil, Motrin, others) to relieve mild discomfort. Tricyclic antidepressants, such as amitriptyline (Elavil) or imipramine (Tofranil), may help relax your bladder and block pain. Hydroxyzine pamoate (Vistaril) and hydroxyzine hydrochloride (Atarax) are antihistamines that may provide symptom relief for some people, especially people who have allergies, migraines and irritable bowel syndrome in addition to interstitial cystitis.

  • Nerve stimulation. This therapy uses electrical currents. A method called transcutaneous electrical nerve stimulation (TENS) can relieve pain and decrease urinary frequency, particularly in people with Hunner's ulcers. TENS delivers a relatively painless electric current through wires placed on your lower back or below your navel. In some cases, the current is delivered through a special device inserted into the vagina in women or anus in men. Although no one knows exactly how TENS works, it may be that the current increases blood flow to the bladder, that it triggers the release of substances that block pain or that it strengthens pelvic muscles that help control the bladder.

  • Researchers are testing sacral nerve stimulators, currently used for urinary incontinence, for treatment of interstitial cystitis. This small device, which resembles a pacemaker, is surgically implanted in your abdomen and acts on nerves to control bladder contractions. A wire from the device is connected to a sacral nerve — an important nerve in bladder control that runs from your lower spinal cord to your bladder. Through the wire, the device emits electrical impulses that stimulate the nerve.

  • Bladder distention. A small percentage of people notice a temporary improvement in symptoms after undergoing cystoscopy with bladder distention, the stretching of the bladder with water or gas. For them, the procedure may be repeated as a treatment. Symptom relief may last for several months.

  • Medications instilled into the bladder. Another treatment is bladder instillation, in which the prescription medication dimethyl sulfoxide, or DMSO (Rimso-50), flows into the bladder through a thin, flexible tube (catheter) or syringe you insert through the urethra. The solution sometimes is mixed with other medications, such as local anesthetic.

  • After remaining in the bladder for 15 minutes, the solution is expelled through urination. Because DMSO is delivered directly to the bladder, it may effectively reduce inflammation and possibly prevent muscle contractions that cause frequency, urgency and pain. A garlic-like taste and odor may last up to 72 hours after treatment, an annoying but not dangerous side effect. DMSO can affect your liver, so your doctor will monitor your liver function. Other instilled medications, such as bacillus Calmette-Guerin, or BCG (Tice BCG, Pacis, TheraCys), currently used to treat bladder cancer are being studied in clinical trials for treatment of interstitial cystitis.

  • Surgery. Doctors rarely use surgery to treat interstitial cystitis because surgery may not relieve symptoms and can lead to other complications. Only people with severe pain for whom other treatments have failed are possible candidates for surgery.

One surgical option, bladder removal (cystectomy), requires reconstructing your bladder and rerouting urine. If your doctor recommends surgery, discuss your options for reconstruction. Two types of surgery that involve instruments inserted through the urethra remove Hunner's ulcers. Fulguration involves burning them off with a laser or electricity and resection involves cutting around them. However, the effectiveness of these procedures has not been proved.


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