treatment for interstitial cystitis

by Diane K. Newman, RNC, MSN, CRNP, FAAN

Treatment for interstitial cystitis includes pharmacologic (drug) therapy, bladder stretching and behavioral training—bladder retraining and biofeedback may be especially helpful to decrease symptoms of urinary urgency and frequency. The goal of therapy is to reduce or eliminate bladder pain.

Drug Therapy for Interstitial Cystitis

First line treatment is usually oral drug therapy such as antihistamines, tricyclic antidepressants or PPS (Pentosan polysulfate sodium, Elmiron). Some experts in the field feel that interstitial cystitis is a chronic bladder infection problem caused by unusual forms of bacteria. Treatment requires several weeks of antibiotic therapy with Macrodantin and Augmentin.

Medications such as analgesics and Anti-inflammatory agents may be prescribed to decrease interstitial cystitis pain. Antidepressants in low doses may relieve interstitial cystitis symptoms by blocking pain receptors and relaxing the bladder muscle.

Another medication used is DMSO that is placed in the bladder using a catheter. The DMSO is retained in the bladder for at least 15 minutes until the person voids. Four to eight treatments are given at 1 to 2 week intervals. At least 10 to 15% of people will have a decrease in symptoms after DMSO.

Behavioral Therapy for Interstitial Cystitis

In many IC individuals, pain and burning on urination occurs because the pubococcygeus or pelvic floor muscle group is in spasm. Biofeedback therapy is especially helpful in relieving interstitial cystitis flare-ups as it teaches relaxation of the pelvic muscles. Electrical stimulation may help relieve symptoms by blocking the painful nerve signals to and from the bladder. It may also improve blood flow to the areas and strengthen pelvic muscles. Bladder retraining is also successful in decreasing voiding frequency and urgency. It is important to keep accurate bladder records so tracking of patterns and improvements can be done.

Dietary Modifications for Interstitial Cystitis

Dietary Modifications significantly help to relieve and control symptoms and avoid flare-ups in the majority of interstitial cystitis cases. The idea behind controlling the diet is to avoid foods that irritate the bladder. Following are dietary suggestions to help control interstitial cystitis.

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Dietary Suggestions for Controlling Interstitial Cystitis Symptoms

Don’ts		Do’s
Milk/Diary Products
aged cheeses, sour cream, yogurt and chocolate		white chocolate, non-aged cheeses such as cottage or American, frozen yogurt and milk
Vegetables
fava beans, lima beans, onions, tofu, spinach and tomatoes		All other vegetables and home grown tomatoes
Fruits
apples, apricots, avocados, bananas, cantaloupes, citrus fruits, cranberries, grapes, nectarines, peaches, pineapples, plums, pomegranates, rhubarb, strawberries and juices made from these fruits		melons and pears
Carbohydrates and Grains
rye and sourdough bread		other breads, pasta, potatoes and rice
Meats and Fish
aged canned, cured, processed smoked meats and fish, anchovies, caviar, chicken livers, corned beef, and meats which contain nitrates or nitrites		other poultry, fish and meat
Nuts
most nuts		almonds, cashews and pine nuts
Beverages
alcoholic beverages, beer, carbonated, regular acid-free coffee and tea, and some herbal teas		bottled or spring water, decaffeinated acid-free coffee and tea, and some herbal teas
Seasonings
mayonnaise, miso, spicy foods )especially ethnic foods as Chinese, Indian, Mexican and Thai..), soy sauce, salad dressing and vinegar		garlic and other seasonings
*Preservatives and Additives*
benzol alcohol, citric acid, monosodium glutamate, aspartame (Nutrasweet), saccharine, foods containing preservatives and artificial ingredients and colors.
*Misc*
tobacco, caffeine, diet pills, junk foods, recreational drugs, cold and allergy medications containing ephedrine or pseudoephedrine and certain vitamins, B complex, which may contain fillers

As this list of forbidden foods may initially appear daunting, use substitutions by:

Adding a pinch of salt to carbonated beverages to make them flat.
Using reduced acid orange juice now available in supermarkets.
Boiling down all sauces containing alcohol.

Many interstitial cystitis patients also have food allergies. The most common are wheat, corn, rye, oats and barley.

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More Treatments for Interstitial Cystitis

Manage Your Stress

Stress exacerbates interstitial cystitis symptoms or causes flare-ups. IC patients are advised to learn and practice basic relaxation techniques. Pain relief need not be provided solely by medication. Simple strategies that can be tried at home include:

Placing a cold pack, heating pad or hot water directly on the perineum (area between the anus and vagina in women, and anus and base of penis in men.) Experiment to determine if hot or cold works best for you.
Taking a warm “sitz” bath with or without Epsom salts. A “sitz” bath is a small plastic container that fits over the toilet and is available in drug stores.
Placing your knees against your chest, recline with spread legs, or adopt a squatting position.

Alleviating Painful Sex

Sex can be a painful activity for women and men with interstitial cystitis. They will avoid sex because they are afraid of urinary frequency, pain and discomfort. Others put up with painful sex because they worry that a partner would reject them if the problem becomes an issue. Women report pain occurs because of lack of vaginal lubrication, direct stimulation to the clitoris, and during orgasm. Using any lubricants, i.e. Vitamin E oil, water-based gels, aloe vera gel, can ease pain during penetration. Having intercourse in other positions such as with the woman on top or on her hands and knees will decrease clitoral stimulation and pain. Men with interstitial cystitis may have difficulty with sex because of genital pain at time of erection, and frequent needs to void during sex. In these cases good communication with your partner is imperative. Avoid the use of latex condoms and the contraceptive diaphragm as these can cause or worsen interstitial cystitis symptoms.

Bladder Stretching & Instillation to Alleviate Bladder Pain

In persons who have a low capacity bladder, stretching the bladder (referred to as bladder hydrodistension) with fluid may bring temporary relief from symptoms. Sometimes filling the bladder with medications helps to relieve inflammation and repair the bladder’s irritated muscle.

Therapeutic Massage

Certain women, especially during an acute episode of interstitial cystitis, experience significant benefit from applying ice and stretching the “trigger points” in the pelvic muscle. Trigger points are areas of hypersensitivity, and in people with interstitial cystitis, trigger points can be found in areas such as the vagina, belly button, or upper thighs. That is why some women with interstitial cystitis will not wear belts or clothing with waistbands because they press on the trigger point in the belly button. Locating the trigger points along the piriformis muscle can assist in directing massage therapy. This muscle is found in the pelvis and upper thigh. The sacral nerves and pudendal nerves exit the pelvis through the piriformis muscle. Another muscle that responds to ice massage is the abdominal muscle. Stroking the abdomen in overlapping vertical strokes from the rib cage to the pelvic bones will relieve the women’s bladder pain. The goal with therapeutic massage is to reduce trigger points and reeducate muscles to regain their normal motion and function.

Bowel & Fluid Management in Interstitial Cystitis

Many individuals with IC are constipated due to pelvic muscle spasm and decreased fluid intake. Increasing fluids is an important part of IC management. Follow the table of best fluids to be used.

While there is still no cure, there are many treatments for interstitial cystitis available. No single remedy works for every person, but the vast majority of interstitial cystitis problems can be brought under control by following the above recommendations.

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References

Erickson, DR. Interstitial Cystitis: Update on Etiologies and Therapeutic Options. Journal of Women’s Health & Gender Based Medicine 1996; 8(6):745-758.

Sant, GR. Interstitial Cystitis a urogynecologic perspective Contemporary Ob/Gyn. 1998:2-7.

Webster, DC; Brennan, T. Self-care Strategies Used for Acute Attack of Interstitial Cystitis. Urologic Nursing 1995; 15(3):86-93.

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Posted: October 2007
Updated: May 2009

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