Medicines that are applied topically as gels, creams, suppositories and patches, may cause fewer systemic side effects. Used alone or in combination formulas, these medicines sometimes require the expertise of a compounding pharmacist. Examples of topicals used to treat IC symptoms include: Lidocaine patch (Lidoderm): Some patients report success with the patch form of the anesthetic (numbing agent) Lidocaine, which is available by prescription in an adhesive patch. Vaginal and rectal diazepam (Valium) suppositories: Vaginal diazepam for women with IC and rectal diazepam for men with IC offer alternatives to oral Valium. Available by prescription through compounding pharmacies, these suppositories relax the muscles in the pelvic floor. The tablet form of Valium inserted into the vagina or rectum seems to work as effectively as the compounded formula. Topical amitriptyline (Elavil): Oral amitriptyline is a standard IC therapy. In gel form, applied to the skin, Elavil may offer relief without the unwanted side effects of the oral medicine.

Medical Treatments

At this time there is no cure for IC/BPS. There are, however, many available treatment options to help relieve the symptoms of bladder pain, urgency, and frequency.

IC/BPS Treatments

For most people with interstitial cystitis/bladder pain syndrome (IC/BPS), a combination of treatments is the best approach. Finding the optimal individual treatment protocol may also require a period of trial and error. IC/BPS treatments may include:

IC/BPS Pain Medicines

Over-the-counter Medicines

Over-the-counter medicines are available without a prescription at drug stores and pharmacies and are helpful for mild to moderate pain. Ask your doctor if any of the following medicines might be helpful for your pain:

Aspirin (Bufferin, Ecotrin)
Acetaminophen (Tylenol, Datril)**
Non-steroidal anti-inflammatory drugs (NSAIDs)
Ibuprofen (Advil, Motrin and Nuprin)
Ketoprofen (Orudis)
Naproxen sodium (Aleve and Anaprox)

Common side effects: Aspirin and other NSAIDs may cause stomach irritation, asthmatic and/or allergic reactions, and/or damage to the kidneys. And are generally not recommended if you have stomach ulcers, asthma, or are allergic to aspirin. If taken in excess of recommended dosage, acetaminophen can cause liver damage. Do not take acetaminophen with alcohol or if you suffer from liver disease.

**The FDA has expressed concern over acetaminophen regulations. Click here to read more about these concerns.

Non-Narcotic Pain Medicines

There are several non-opiod medicines currently available that are used to relieve symptoms caused by irritation of the urinary tract such as pain, burning, the feeling of needing to urinate urgently or frequently, and bladder spasms. These are also commonly used for pain associated with urinary tract infections.

Urelle Oral
Uribel™ (analgesic, antispasmodic, and antiseptic combination)
Utira

Topical Medicines

Medicines that are applied topically as gels, creams, suppositories and patches, may cause fewer systemic side effects. Used alone or in combination formulas, these medicines sometimes require the expertise of a compounding pharmacist. Examples of topicals used to treat IC symptoms include:

Lidocaine patch (Lidoderm): Some patients report success with the patch form of the anesthetic (numbing agent) Lidocaine, which is available by prescription in an adhesive patch.

Vaginal and rectal diazepam (Valium) suppositories: Vaginal diazepam for women with IC and rectal diazepam for men with IC offer alternatives to oral Valium. Available by prescription through compounding pharmacies, these suppositories relax the muscles in the pelvic floor. The tablet form of Valium inserted into the vagina or rectum seems to work as effectively as the compounded formula.

Topical amitriptyline (Elavil): Oral amitriptyline is a standard IC therapy. In gel form, applied to the skin, Elavil may offer relief without the unwanted side effects of the oral medicine.

Narcotic Pain Medicines

Narcotic Pain Medicines used for moderate pain include:

Codeine: Sometimes combined with aspirin or acetaminophen
Hydrocodone: Lortab and Vicodin (combined with acetaminophen), Lorcet Zydone (combined with acetaminophen)
Oxycodone: Percodan (combined with aspirin), Percocet, Tylox (combined with acetaminophen)
Oxymorphone (Opana): Similar to morphine, includes extended-release form for around-the-clock treatment of pain

Opioids used for severe pain include:

Long-acting opioids are generally used for IC patients who experience unremitting or frequently recurring pain. These long-acting medications are not combined with other medications such as acetaminophen or aspirin, thus reducing potential problems or side effects. They are controlled-release, meaning that they require less of a maintenance schedule, as the dosage is gradually released into the patient’s system. IC patients receiving long-acting opioids should be supplied with a fast-acting opioid “rescue drug” (e.g. Vicodin, Lorcet. etc.) for breakthrough pain, which occurs unpredictably, or when the long-acting opioid starts to wear off, prior to the time of the next scheduled dose. Examples of controlled release opioid preparations:

Long-acting morphine: MS Contin, Oramorph, Opana
Long-acting oxycodone: OxyContin
Levorphanol: Levo-Dromoran
Methadone: Dolophine
Fentanyl: Duragesic patch

Possible side effects: constipation, nausea, itching, edema, sedation, muscle spasms and possible respiratory depression. Ask your healthcare provider for advice on reducing side effects. Tolerance and physical dependency may occur.

The American Academy of Family Physicians mentions these potential warning signs of opioid medication overdose:

Stumbling while walking.
Feeling dizzy.
Slurring your speech.
Feeling confused.
Slow breathing and heartbeat.
Blue nails or lips.
Pale or clammy skin.
Feeling excessively drowsy or having trouble staying alert.
Having trouble waking from sleep.

IC Diet & Self Management

Ways to help control symptoms: diet modification, stress management, and healthy sleep habits.

Different approaches to the IC diet: allergy testing, gluten-free diets, IC Food List, antiyeast therapy, alkaline diets, nutrition supplements, and IC-friendly recipes.

Physical Therapy

Learn about hands-on therapy and tools PTs use. Also get tips on how to find a knowledgeable PT and pay for therapy.

Antidepressants

Learn about tricyclics (amitriptyline aka Elavil), SSRIs (Prozac, Paxil), SNRIs (Cymbalta), NRIs (Strattera), and bupropion (Wellbutrin).

Antihistamines

Hydroxyzine is most widely used; however, some people with IC find relieve from Claritin, Benadryl, and Singulair.

Pentosan Polysulfate Sodium

Pentosan polysulfate sodium (Elmiron) is the only oral medicine that is FDA approved for IC.

Bladder Instillations

Bladder instillations are mixtures of medicines put directly into the bladder. Read about DMSO, Sodium Hyaluronate, Heparin, and cocktails.

Immunosuppresants

Read about Cyclosporine, Mycophenolate (CellCept), and Mycophenolate mofetil as potential IC/BPS treatments.

Surgical Procedures

Laser surgery is helpful for Hunner’s Ulcers. Other bladder surgeries—such as cystoscopy with hydrodistention—are considered a treatment of last resort.

Neuromodulation

Electrical nerve stimulators, also known as neuromodulators, have been helpful for many IC/BPS patients—products include UrgentPC, InterStim, Eon Mino, and IF3WAVE.

Other Medicines

IC/BPS treatment protocols may also include lots of other medicines such as alpha blockers (Flomax), amphetamines, anti-seizure meds (Neurontin), histamine blockers (Tagamet, Zantac, Pepcid), leukotriene inhibitors, prostaglandins (NSAIDS, ibuprofen), urinary antacids (potassium or sodium citrate, tricitrates), and urinary tract antispasmodics (Detrol, Toviaz, VESIcare).

Learn more about IC/BPS therapies:

Read about the AUA IC treatment guideline and clinical guidelines from around the world.
Become an ICA donor—and get reports in the ICA Update magazine.

IC Awareness Month: Celebrating 40 Years of Dedication and Community Support