Is low dose naltrexone used to treat IC?

LDN stands for low dose naltrexone. Naltrexone is an opioid blocker used in treated opioid dependence, but in very low doses, the blocker seems to encourage the body to produce its own painkilling endorphins and enkephalins. A pilot trial of low-dose naltrexone in fibromyalgia showed positive effects. Some research also indicates that it may be useful in autoimmune conditions and inflammatory disease. The science isn’t there yet on whether it is a useful treatment for IC. Some pain management doctors are having IC patients try the therapy; naltrexone has to be compounded to get the low dose.

Is Normast used to treat IC?

Normast (generic: palmitoylethanolamide) is a marijuana-like compound that our bodies make internally. There is a lot of hopeful research. Some pelvic pain specialist may be trying it with IC patients. Please check with your doctor and ask if this medication might be a good option for you. Before your doctor’s appointment, take some time to pull together information for your doctor. Go to www.pubmed.gov and search the medical literature for palmitoylethanolamide.

What are the best treatments for IC?

Because IC symptoms vary from patient to patient, there is no single “best” treatment that will work for everyone. IC patients respond to various treatments differently. It sometimes takes a period of “trial and error” before just the right treatment or combination of treatments is found. The best treatment strategies use a combination of therapies. It is also extremely important to recognize that medicines may take time to work.

Read an overview of treatment options and review the AUA Diagnosis and Treatment Guidelines for IC. Learn about self-help (diet, bladder retraining, and physical therapy), oral medicines, bladder instillations, electrical nerve stimulation, and surgery.

Does drinking less water help?

Some IC patients try to reduce their water intake so they don’t have to pee as much. However, you need to drink enough water to keep your urine diluted because concentrated urine can increase your IC pain. Not drinking enough water can also cause dehydration, which puts you at higher risk for constipation, urinary tract infections, and other health problems. Eight glasses a day of water is recommended. However, talk with your IC healthcare provider about how much water you need to drink. Some IC experts recommend keeping a bottle of water with you and taking a sip every 5 to 10 minutes. This allows a slow drip on the bladder which can be less irritating to IC symptoms. Read more about IC and water on Diet Bytes.

What is a rescue solution?

Rescue solutions, as the name implies, are bladder instillations used to soothe and quickly reduce bladder pain. Doctors first used the term to refer to anesthetic instillations given right after potassium sensitivity tests were administered; the rescue solutions were used to ease the pain the test can cause. The term rescue solution has also come to be used to mean the anesthetic instillations that “rescue” you from an IC flare. IC experts are also starting to consider using anesthetic instillations, not just to ease flares, but also for long-lasting symptom control. That’s a change in mindset from “rescue,” and research will tell us whether this new approach will be helpful. These solutions contain an anesthetic and, often, other added ingredients, such as an alkalinizer, bladder coating agents such as heparin or pentosan polysulfate (Elmiron), steroids, and antibiotics.

How can I avoid flare-ups of my IC?

Though it may not be possible to hold off all IC flares, there are self-help techniques to manage flares. Learn to recognize what triggers your flares. Some common triggers include diet, medicines (including certain vitamins and supplements), exercise, sexual intimacy, hormone fluctuations, stress, certain modes of transportation or long trips, and even tight clothing.

Learn more:

Why am I being prescribed antidepressants for my IC?

When a healthcare provider prescribes an antidepressant to treat your IC, she/he is using them for their effects on specific IC symptoms such as urinary urgency, frequency, nighttime voiding, and pelvic pain, not for their antidepressant effects. Antidepressants have long been used to treat many chronic pain conditions, including IC. Learn more about treating IC with antidepressants.

I have very severe IC. Should I have my bladder removed?

Probably not. The success rates for treating IC with available bladder surgeries (augmentation cystoplasty, urinary diversion, and various pouches) have been varied and unpredictable. Read more about IC and surgery.

What do you find effective for frequency?

A combination of things, not just one thing, is the best approach to control the urge “to go” often. InterStim is effective for some, pelvic physical therapy works others, and sometimes, medicines known as anticholinergics help once your IC is controlled. For more on InterStim, go to the InterStim section of the FAQ page.

This question was answered in the ICA webinar, Q & A: Finding Better Relief, featuring urogynecologist Barry Jarnagin, MD, and urologist Ragi Doggweiler, MD. View the webinar to learn more about this topic.

How are bladder spasms treated? Does InterStim have any value for spasms?

There are different reasons for bladder spasms. Talk with your doctor to learn what treatment options may be best for you. Bladder spasms can be treated with medications, sometimes with diet, and sometimes InterStim helps control them.

This question was answered in the ICA webinar, Q & A: Finding Better Relief, featuring urogynecologist Barry Jarnagin, MD, and urologist Ragi Doggweiler, MD. View the webinar to learn more about this topic.

What is the best cocktail for bladder instillation?

There are no studies demonstrating that one bladder instillation is better than another. Your doctor and you need to figure out which instillation works best for you. Some use bupivacaine (Marcaine) and heparin. Heparin is an anti-inflammatory and Marcaine is an anesthetic. Others use Elmiron or lidocaine instillations. Often a combination of medicines called a bladder cocktail is the best option.

This question was answered in the ICA webinar, Q & A: Finding Better Relief, featuring urogynecologist Barry Jarnagin, MD, and urologist Ragi Doggweiler, MD. View the webinar to learn more about this topic.

Do you have InterStim patients who are still in chronic pain?

InterStim has not been approved for pain but for voiding dysfunction. Pain persists for some IC patients who have these implants. Patients with InterStim may also need to see a physical therapist, stick to their IC diet, and figure out strategies that help them live their life. This means finding what hurts you and what helps you. This varies from person to person. It is a discovery!

This question was answered in the ICA webinar, Q & A: Finding Better Relief, featuring urogynecologist Barry Jarnagin, MD, and urologist Ragi Doggweiler, MD. View the webinar to learn more about this topic.

For me, Lyrica causes severe swelling and weight gain. Do other patients experience these side effects and should I continue to take it?

Lyrica is a medicine that is prescribed for pain. If it is helping with your pain, then you have to decide if the side effects are worth the benefit. If you get only side effects and no benefit after several weeks on Lyrica, talk with your doctor to decide if continuing to take this medication makes sense.

This question was answered in the ICA webinar, Q & A: Finding Better Relief, featuring urogynecologist Barry Jarnagin, MD, and urologist Ragi Doggweiler, MD. View the webinar to learn more about this topic.

I had a hysterectomy for endometriosis and then developed pain. I am in a pain cycle that is daily. I have limited my diet to a few foods. IC is dominating my everyday life. I cannot take Elmiron. I do self instillations, and I have retention with Elavil.

You would do well visiting a pelvic pain clinic with pelvic physical therapy/trigger point injections and potentially other treatments added. A multidisciplinary and multimodal (combination of treatments) approach may be best for you.

This question was answered in the ICA webinar, Q & A: Finding Better Relief, featuring urogynecologist Barry Jarnagin, MD, and urologist Ragi Doggweiler, MD. View the webinar to learn more about this topic.

I have had IC for 16 years and also suffer from generalized anxiety/social anxiety. My doctors have not been able to find a medication to treat these conditions because everything flares my IC.

This is where the multidisciplinary approach is vital. There needs to be medication and cognitive therapy, best done by someone who is an expert in these health issues. Some IC healthcare teams include a psychiatric nurse practitioner. Your IC doctor can work on the IC and the psychiatric nurse practitioner on the anxiety. Your situation is not uncommon. Most patients who have long-term health problems combat depression and anxiety.

This question was answered in the ICA webinar, Q & A: Finding Better Relief, featuring urogynecologist Barry Jarnagin, MD, and urologist Ragi Doggweiler, MD. View the webinar to learn more about this topic.

I am having frequency 45 times a day and vulvar pain. Which treatment choice have you seen making the most improvement? I also have cold chills as my pain goes past a 7.

Sometimes, patients with this much pain need some five to seven different treatments over the course of several months to break the cycle such as a combination of instillations, Elmiron, and InterStim. You may also need cognitive therapy. You may also need an antidepressant.

This question was answered in the ICA webinar, Q & A: Finding Better Relief, featuring urogynecologist Barry Jarnagin, MD, and urologist Ragi Doggweiler, MD. View the webinar to learn more about this topic.

What are treatments to increase bladder capacity?

The first step is to figure out why your bladder capacity is low. If your bladder is fibrotic, the bladder capacity can be expanded. If your bladder is overactive (requires emptying every 100 to 150 ccs or 3 to 4 ounces), urodynamic studies can determine if it is the pelvic floor muscles that need treatment and if instillations with a local anesthetic can be helpful. For some patients with low bladder capacity, physical therapy is helpful.

This question was answered in the ICA webinar, Q & A: Finding Better Relief, featuring urogynecologist Barry Jarnagin, MD, and urologist Ragi Doggweiler, MD. View the webinar to learn more about this topic.

Does pudendal nerve dysfunction occur in IC?

Some IC patients have pudendal nerve dysfunction. The pudendal nerve is probably related to the chronic inflammatory pathways in the pelvis. However, surgery on the pudendal nerve is not the answer for everyone. For many patients with this dysfunction, trigger point injections or CT guided injections can be helpful.

This question was answered in the ICA webinar, Q & A: Finding Better Relief, featuring urogynecologist Barry Jarnagin, MD, and urologist Ragi Doggweiler, MD. View the webinar to learn more about this topic.

What are the upper limits of safety with Botox injections into the pelvic floor? What is the effectiveness and success rate?

Currently Botox is experimental. Treatments typically wear off in six months. Though there are many protocols for injection into the bladder, there is no standard dosage. Most of the literature suggests utilizing two ampoules. However, we have to standardize this over time. Not all IC patients benefit. Some go into urinary retention and are not pleased with the results. It is case by case.

This question was answered in the ICA webinar, Q & A: Finding Better Relief, featuring urogynecologist Barry Jarnagin, MD, and urologist Ragi Doggweiler, MD. View the webinar to learn more about this topic.

It has been recommended to remove our 23 year-old son’s bladder. What are your thoughts on this?

Surgery for IC is a last resort option. This is a big intervention and can be very traumatic for a patient.

This question was answered in the ICA webinar, Q & A: Finding Better Relief, featuring urogynecologist Barry Jarnagin, MD, and urologist Ragi Doggweiler, MD. View the webinar to learn more about this topic.

Do you think cystoscopy with distention helps with a flare?

Yes in some cases, cystoscopy with distention under anesthesia can help with a flare.

This question was answered in the ICA webinar, Q & A: Finding Better Relief, featuring urogynecologist Barry Jarnagin, MD, and urologist Ragi Doggweiler, MD. View the webinar to learn more about this topic.

Is it safe to take three teaspoons of baking soda a day with meals for IC symptom relief?

Yes, it is safe to take baking soda daily to help de-acidify or alkalize the body. This is good for IC, as it is good for any chronic pain or inflammatory issue.

This question was answered in the ICA webinar, IC’s Role in CAPPS, featuring Dr. Robert Echenberg. View the webinar to learn more about this topic.

Can IC be treated with antibiotics?

No. Antibiotics are useless unless there is a bacterial infection present at the time. This is why it is so important to ask your practitioner to order a culture on the urine before starting any type of treatment. The urine test using a “dipstick” can easily mislead by showing red and white cells, protein, and other abnormalities that occur commonly with IC. It does take at least 48 hours to get a culture report, so it is generally alright for your practitioner to treat your symptoms with an antibiotic during those first 2 days, if there is a strong suspicion of a UTI. The antibiotic can then be stopped if the urine culture is negative.

This question was answered in the ICA webinar, IC’s Role in CAPPS, featuring Dr. Robert Echenberg. View the webinar to learn more about this topic.

Tanezumab seemed promising for chronic widespread nerve pain, is there any movement back towards that approach?

Tanezumab is a part of a class of chemicals that block nerve growth factor (NGF)—a factor necessary for pain to be transmitted and experienced. In 2010, the Food and Drug Administration (FDA) halted the clinical trials that were in progress because of severe unwanted side effects in osteoarthritis patients. The FDA just lifted the ban on the research so stay tuned for drugs of this nature to help alleviate neuropathic pain.

This question was answered in the ICA webinar, IC’s Role in CAPPS, featuring Dr. Robert Echenberg. View the webinar to learn more about this topic.

How well is Botox working for IC patients?

I do use Botox into the pelvic floor for those female patients that, following all other treatments, still have a particularly stubborn pelvic floor. I have found that this commonly helps alleviate some of the rectal and pelvic floor clenching type pain and tightness, but the results are hard to quantify. Most patients do feel improvement for variable lengths of time. One downside is expense. Not all insurances cover the Botox itself.

This question was answered in the ICA webinar, IC’s Role in CAPPS, featuring Dr. Robert Echenberg. View the webinar to learn more about this topic.

How often and long can I use pyridium for urethral pain?

Pyridium should usually only be used 3-4 days at a time. There is a “blue” medication called Uribel that is similar in its effectiveness but can safely be used on a more continuous basis.

This question was answered in the ICA webinar, IC’s Role in CAPPS, featuring Dr. Robert Echenberg. View the webinar to learn more about this topic.

How long can I expect to be on Elmiron to treat IC?

One of several downsides to Elmiron is that it takes 3-6 months to be effective, and it actually continues to become more effective up to 36 months of use. This is why I generally advise patients to expect to be on the medication for at least 18-24 months.

This question was answered in the ICA webinar, IC’s Role in CAPPS, featuring Dr. Robert Echenberg. View the webinar to learn more about this topic.

Do you ever prescribe your patients Elmiron instillation via bladder catheterization?

Yes. Bladder instillations in our office usually include the use of our patient’s own Elmiron capsules. We use the contents of one capsule per treatment and do weekly treatments for about two months. Later, many patients are treated with this instillation during an IC flare.

This question was answered in the ICA webinar, IC’s Role in CAPPS, featuring Dr. Robert Echenberg. View the webinar to learn more about this topic.

Revised Monday, March 30th, 2015