Oral medications that may improve the signs and symptoms of interstitial cystitis include:
* Ibuprofen (Advil, Motrin, others) and other nonsteroidal anti-inflammatory drugs, to relieve pain.
* Tricyclic antidepressants, such as amitriptyline or imipramine (Tofranil), to help relax your bladder and block pain.
* Antihistamines, such as diphenhydramine (Benadryl, others) and loratadine (Claritin, others), which may reduce urinary urgency and frequency and relieve other symptoms.
Your doctor may also prescribe an oral medication, pentosan (Elmiron), the only oral drug approved by the Food and Drug Administration specifically for interstitial cystitis. How it works is unknown, but it may restore the inner surface of the bladder, which protects the bladder wall from substances in urine that could irritate it. It may take two to four months before you begin to feel pain relief and up to six months to experience a decrease in urinary frequency. Side effects include minor gastrointestinal disturbances and possible hair loss, which reverses when you stop taking the drug. Make sure your doctor knows if you're pregnant or planning to become pregnant before taking pentosan.
Nerve stimulation
Transcutaneous electrical nerve stimulation (TENS) uses mild electrical pulses to relieve pelvic pain and, in some cases, reduce urinary frequency. Electrical wires are placed on your lower back or just above your pubic area, and pulses are administered for minutes or hours, two or more times a day, depending on the length and frequency of therapy that works best for you. In some cases a TENS device may be inserted into a woman's vagina or a man's rectum.
Scientists believe that TENS may relieve pain and urinary frequency associated with interstitial cystitis by increasing blood flow to the bladder, strengthening the muscles that help control the bladder or triggering the release of substances that block pain.
Another possible nerve stimulation treatment is sacral nerve stimulation. Modulation of your sacral nerves — a primary link between the spinal cord and nerves in your bladder — may reduce feelings of urinary urgency that accompany interstitial cystitis. With sacral nerve stimulation, a thin wire placed near the sacral nerves delivers electrical impulses to your bladder, similar to what a pacemaker does for the heart. If the procedure successfully lessens your symptoms, a permanent device may be surgically implanted.
Bladder distention
Some people notice a temporary improvement in symptoms after undergoing cystoscopy with bladder distention. Bladder distention is the stretching of the bladder with water or gas. The procedure may be repeated as a treatment if the response is long lasting.
Medications instilled into the bladder
In bladder instillation, the prescription medication dimethyl sulfoxide, or DMSO, (Rimso-50) is placed into your bladder through a thin, flexible tube (catheter) inserted through the urethra. The solution sometimes is mixed with other medications, such as a local anesthetic. After remaining in your bladder for 15 minutes, the solution is expelled through urination. Delivering DMSO directly to your bladder may reduce inflammation and possibly prevent muscle contractions that cause frequency, urgency and pain.
Your doctor may initially perform DMSO treatment weekly for six to eight weeks, and then perform maintenance treatments as needed — often, every couple of weeks — for up to one year.
A garlic-like taste and odor may last up to 72 hours after treatment. DMSO can affect your liver, so your doctor may monitor your liver function with blood tests. For some people, this procedure may be painful or it may worsen symptoms. Talk with your doctor about other treatment options if this happens to you.
A newer approach to bladder instillation includes using a solution that contains a trio of medications: heparin, lidocaine and sodium bicarbonate. This combination of drugs instilled directly into the bladder significantly relieved urinary pain and urgency in the majority of people participating in a clinical trial.
Surgery
Doctors rarely use surgery as interstitial cystitis treatment because removal of part or all of the bladder doesn't relieve pain and can lead to other complications. People with severe pain and people whose bladders can hold only very small volumes of urine are possible candidates for surgery, but even then surgery is usually considered only after other treatments have failed. Surgical options include:
* Bladder augmentation. In this procedure, surgeons remove the damaged portion of the bladder and replace it with a piece of the colon, but the pain still remains and some women need to empty their bladders with a catheter multiple times a day.
* Fulguration. This minimally invasive method involves insertion of instruments through the urethra to burn off ulcers that may be present with interstitial cystitis.
* Resection. This is another minimally invasive method that involves insertion of instruments through the urethra to cut around any ulcers.
During sacral nerve stimulation, a surgically implanted device delivers electrical impulses to the nerves (sacral nerves) that regulate bladder activity. The unit is placed beneath the skin of the buttocks, about where the back pocket is on a pair of pants. In this image, the device is shown out of place to allow a better view of the unit.
Lifestyle and home remedies
Some people with interstitial cystitis find relief with self-care methods, such as:
* Dietary changes. Although no scientific evidence points to diet as the cause of interstitial cystitis, many people with the condition find that eliminating or reducing their intake of potential bladder irritants may help to relieve their discomfort.
The most irritating foods can be summarized as the "four Cs." The four Cs include carbonated beverages, caffeine in all forms (including chocolate), citrus products and food containing high concentrations of vitamin C.
If you find that your bladder is irritated by these things, you may also wish to avoid related foods such as tomatoes, pickled foods, alcohol and spices. Artificial sweeteners may aggravate symptoms in some people, as well. If you think certain foods make you feel worse, try eliminating them from your diet. Reintroduce them one at a time to determine which, if any, affect your signs and symptoms.
* Bladder training. These techniques may help reduce urinary frequency. The training involves timed urination — going to the toilet according to the clock rather than waiting for the need to go. You start by urinating at set intervals, such as every half-hour — whether you have to go or not. Then you gradually wait longer between bathroom visits. Bladder training may involve learning to control the urge to urinate by using relaxation techniques, such as breathing slowly and deeply, or distracting yourself with another activity.
These other self-care approaches may help you as well:
* Wear loose clothing. Avoid belts or clothes that put pressure on your abdomen.
* Reduce stress. Try methods such as visualization and biofeedback, and low-impact exercise.
* Try pelvic floor physiotherapy. Gently stretching and strengthening the pelvic floor muscles, possibly with help from a pelvic floor physiotherapist, may reduce muscle spasms. Pelvic floor physiotherapists sometimes combine this technique with biofeedback.
* If you smoke, stop. Smoking may worsen any painful condition, and smoking is harmful to the bladder.
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