A Comprehensive Treatment Plan
First Steps
Oral Medications
Bladder Instillations
Other Treatments
Experimental Treatments
Research Advances
Treatments NOT Effective for IC
Non-invasive techniques, such as diet modification and self-help measures, may be used in combination with other, more traditional medical therapies, and are considered a first step in relieving IC symptoms. Response to treatment is individual.
Diet & Self-Help: A diet low in acidic foods and beverages, such as coffee and most teas, and avoiding carbonated and alcoholic drinks, may be helpful in reducing IC symptoms. Read more about diet, some of the over-the-counter products and medications, and other self-help strategies that may be helpful to people with IC.
Physical Therapy: The goal of physical therapy for IC patients is to relax the pelvic floor muscles and avoid overly stressing them. Many people with IC have problems with this group of muscles and develop a condition called pelvic floor dysfunction (PFD). Treatment usually combines physical therapy, home exercise, medication, and self-care.
The following oral medications may be added if more relief is needed:
Tricyclic Antidepressants: : Used for their anti-pain properties, and prescribed in low dosages. Benefits include:
- Anticholinergic effects that help decrease urinary frequency
- Sedative effects
- Blockage or reuptake of certain neurotransmitters that cause the brain to misinterpret or ignore pain impulses
The most common tricyclic antidepressants used to treat IC are:
- Amitriptyline (formerly Elavil, now generic)
- Desipramine (Norpramin)
- Nortriptyline (Pamelor)
- Doxepin (Sinequan)
- Imipramine (Tofranil)
Also, selective serotonin reuptake inhibitors (SSRIs), such as paroxetine (Paxil), or selective serotonin and norepinephrine reuptake inhibitors (SSNRIs), such as duloxetine (Cymbalta), may be helpful.
Antihistamines: Especially useful for IC patients with allergies. The most widely used antihistamine to treat IC is hydroxyzine, which affects mast cell degranulation (thought to play a part in causing some IC symptoms). It also has sedative and anxiety reducing effects.
Hydroxyzine is available in two oral forms:
- Hydroxyzine pamoate
- Hydroxyzine hydrochloride.
Pentosan Polysulfate Sodium (Elmiron): Elmiron is the only oral medication FDA-approved specifically for use in IC, and is thought to work by restoring a damaged, thin, or "leaky" bladder surface. Elmiron eases the pain and discomfort of IC in many patients.
Pain Medications: Anticonvulsants such as gabapentin (Neurontin) and clonazepam (Klonopin) are being used to treat chronic pain, as are muscle relaxants such as Valium and Flexeril. Short-acting opioid analgesics such as Vicodin and Percocet may be used to treat moderate, intermittent IC pain. OxyContin, MS-Contin, and Duragesic are long-acting analgesics that are useful in treating chronic, severe IC pain.
Other Oral Medications: Given the range of IC symptoms, additional medications may include:
- Anticholinergics (Detrol, Ditropan XL, and Levsin)
- H2 blockers (Tagamet and Zantac)
- Urinary alkalinizing agents (Bicitra and Polycitra-K)
- Adrenergic blockers (Cardura, Flomax, and Hytrin)
- Leukotriene inhibitors such as (montelukast, Singulair)
- Combination urinary tract medications such as those that contain an antispasmodic, analgesic, and anti-infective.
The following bladder instillations may be added to the treatment protocol, as necessary:
DMSO (dimethyl sulfoxide), Rimso-50: Instilled directly into the bladder. Believed to work as an anti-inflammatory agent. DMSO can be combined with steroids, heparin, and/or local anesthetics to form a bladder “cocktail.”
Heparin: Has both anti-inflammatory and surface protective actions. Heparin may mimic the activity of the bladder's mucous lining, temporarily "repairing" the glycosaminoglycan (GAG) layer. Heparin is also a commonly used component of bladder “cocktails.”
Cystistat: This medication is approved for use in Canada and Europe. It is not FDA-approved for use in IC in the US. It is thought to work by replacing the defective lining of the bladder.
Other bladder instillations include:
- Clorpactin WCS-90 (oxychlorosene sodium), which can be very painful and usually requires general anesthesia. It has been used in a diluted form in an office setting.
- Silver nitrate, which also requires general anesthesia, is used infrequently and is considered an outdated therapy.
ICA Medical Advisory Board Bladder Cocktails. Review bladder cocktail recipes used by IC experts, who are also members of the ICA Medical Advisory Board.
A combination of these treatments may be needed. An example of an individualized treatment plan might include diet modification, combined with the regular use of a low-dose tricyclic antidepressant; Elmiron; and an opioid analgesic for breakthrough pain.
Laser Surgery: Has been successfully used to treat Hunner's ulcers (or patches), present in 5 to 10 percent of IC patients. No other uses for treating IC with lasers have been clinically proven, therefore laser surgery should be reserved for the ulcerative form of IC only.
Neuromodulation Devices: Products approved for the treatment of urgency, frequency, urge incontinence, and retention may be considered as a potential IC treatment when other more conservative therapies have failed.
Small, surgically implanted neuromodulation devices send mild electrical pulses to nerves located in the lower back (just above the tailbone). By influencing the bladder and surrounding muscles that manage urinary function, neuromodulation devices can help relieve symptoms. Nonsurgical devices are also available. Worn externally, these devices use electrical current to treat symptoms of IC, PFD, vulvodynia, etc.
Surgery: Considered only as a last resort. Several types of surgeries have been used to treat IC, including bladder augmentation, urinary diversion, and construction of an internal pouch. Serious complications can result from surgery, and pain may persist after the procedure.
The following treatments are not approved by the US Food & Drug Administration for use in IC.
Currently under investigation for the treatment of IC:
- Physical Therapy
- Acupuncture
- Botulinum Toxin (Botox)
- Uracyst (chondroitin sulfate)
- URG-101 (bladder instillation)
For more information on these and other IC research studies, visit Current Clinical Trials.
Markers: Of particular importance is the work on IC urinary markers spearheaded by Susan Keay, MD, PhD, at the University of Maryland. A unique protein in the urine of IC patients has been isolated.
This protein, called APF (antiproliferative factor), prevents the growth of new, healthy bladder cells in IC patients. APF was not found in the urine of patients with acute urinary tract infection or other urologic conditions. It was also not found in the urine of people with healthy urologic systems.
This protein may be directly responsible for preventing repair of the damaged epithelial lining in IC patients. In addition, studies have found that heparin-binding epidermal growth factor-like growth factor (HB-EGF), important for epithelial cell proliferation and wound healing, is significantly decreased in IC patient urine specimens. The results of further research could lead to identification of agents that will suppress the production of APF, or enhance the production of HB-EGF, both resulting in the formation of a healthy bladder lining. APF may ultimately provide a noninvasive clinical test for IC. This would have a major impact on early diagnosis and treatment.
Genetics: Studies indicate a higher-than-expected prevalence of IC among first degree relatives, concordance among monozygotic twins for IC, and several families with IC in multiple generations. These findings are consistent with an inherited susceptibility to IC. Linkage analysis and positional cloning can be used to identify the location of susceptibility gene(s) to IC. The rapid progress being made in sequencing the human genome will facilitate identification of such genes.
Related Conditions: The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), along with several other NIH institutes and offices, has committed up to $7.5 million per year starting in 2008 for a five-year project to study IC and related conditions. Related chronic pain syndromes of primary interest to the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) project are fibromyalgia, irritable bowel syndrome (IBS), and chronic fatigue syndrome, as well as additional conditions if adequate scientific justification is provided.
- Urethral dilatation/dilation
- Urethrotomy
More research is needed to understand all aspects of IC, including variations in treatment response
Last modified: July 24, 2008