IC Treatment Guideline
The need for standardized guidelines for diagnosing and treating interstitial cystitis (IC) has become very apparent over the past few years—and has generated many heated debates. The good news is that several countries and professional medical associations are now in the process of developing their own IC Guideline.
In March 2011, the American Urological Association (AUA) released clinical guideline including:
- A paper describing consensus from an expert panel on the recommended diagnosis and treatment approaches for IC.
- An algorithm providing a snapshot of the clinical treatment approach.
The ICA encourages patients to print copies of these documents and to give them to ALL of the members of their healthcare teams:
- Print a 2-page, easy-to-read summary of the AUA IC guideline.
- Or download the full guideline from the AUA website.
The AUA initially announced the release of preliminary IC guideline at the AUA 2010 annual meeting. On behalf of the AUA’s IC guidelines committee, Phil Hanno, MD, presented the first-ever guidelines for diagnosis and treatment from the association. This guideline does not support using the potassium sensitivity test as a valid one for IC, nor do they support cystoscopy with hydrodistention for “uncomplicated” cases, that is, cases that are not severe and don’t have many accompanying conditions. The guideline emphasizes conservative, noninvasive approaches to start, for example, an IC-friendly diet, physical therapy aimed at pelvic floor dysfunction, and stress management. Therapies called first-line treatments include the oral medicines amitriptyline, histamine blockers such as hydroxyzine (Atarax, Vistaril) or cimetidine (Tagamet), pentosan polysulfate (Elmiron) and bladder instillation therapy. Treatment recommends then step up through five levels-no matter what level, the guideline emphasizes the importance of pain management.
Dr. Hanno emphasized that this guideline is a work in progress and far from the final word on IC diagnosis and treatment. Furthermore, the guideline reflects what’s been published so far in controlled trials or other trustworthy studies and sometimes on expert opinion, so they don’t necessarily include helpful treatments that IC experts are just starting to use and research.
East Asian: An East Asian Committee, with representatives from Japan, Korea, and Taiwan, published (on the website of the International Journal of Urology) a sneak preview of Clinical Guideline for Interstitial Cystitis and Hypersensitive Bladder Syndrome.
Indian: The launch of the Indian IC/PBS Society and intent to develop Indian Clinical Guideline was announced at a meeting of leading IC/PBS experts in Goa, India (June 20 to 21, 2009). Under the direction of Dr. Nagendra Mishra, the Society plans to spend a year researching treatment protocols in hopes of validating country-wide treatment guideline.
Japanese: The Japanese Urological Association’s new IC Guideline was recently published in the International Journal of Urology. Japanese Guideline for Diagnosis and Treatment of Interstitial Cystitis by Homma, Ueda, Ito, Takei, and Tomoe is a very detailed, comprehensive document that you can access for free online.
Revised Wednesday, October 29th, 2014