Interstitial Cystitis Treatment
What is Interstitial Cystitis (IC)?
Interstitial Cystitis is a chronic condition in Singapore that causes painful urinary symptoms, such as bladder pressure, bladder pain and sometimes pelvic pain. The bladder can be inflamed, ulcerated, scarred or stiff.
With interstitial cystitis, patients often have the urge to urinate frequently and urgently, often many times per hour. Symptoms worsen as the bladder fills, and can range from mild to severe discomfort and pain. Though men and children can be affected, about 90% of cases of interstitial cystitis occur in women.
How is Interstitial Cystitis diagnosed?
Your urologist will first take a detailed medical history, as well as a physical exam, to better understand your symptoms and condition. A pelvic examination is done in women in order to assess internal pelvic organs.
A urine culture test can also help determine whether you suffer from a urinary tract infection (UTI) or interstitial cystitis.
A cystoscopy (insertion of a endoscope through the urethra) is done to examine the walls of the bladder or to get a tissue sample for further testing (a biopsy) to exclude bladder cancer and to confirm the diagnosis of IC. It uses a thin telescope to observe the inside of the bladder and urethra to look for any ulcers, tumours, or bladder stones. Direct visualisation of the urothelium can also help to document bladder inflammation.
Treatments for Interstitial Cystitis
There is currently no cure for interstitial cystitis, but several treatments are available to manage the symptoms. Response to treatment varies between individuals.
For some, symptoms may gradually improve and disappear completely while some may need to continue with treatment indefinitely. There are also some who do not respond to any treatment but, with adequate pain management, can improve their quality of life tremendously.
Treatment options may include:
Lifestyle changes
- Reducing spicy foods and foods high in potassium in your diet
- Avoiding smoking and alcohol
- Bladder training, where patients follow a fixed schedule for urinating
- Stress reduction
Medication
- Pentosan polysulfate sodium (Elmiron) can be taken to restore the inner lining of the bladder. Improvement may only be seen after two to four months.
- Nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen, naproxen, and aspirin, are taken for pain and inflammation.
- Tricyclic antidepressants (such as amitriptyline) help with pain and to relax your bladder.
- Antihistamines (such as Claritin) could decrease urinary urgency and frequency.
Intravesical treatment
- Prescription medication (dimethyl sulfoxide DMSO, Rimso-50) is filled into the bladder and held for around 15 minutes before it is emptied. You might receive treatment weekly for six to eight weeks, followed by maintenance treatments when needed for up to a year.
The medication could reduce inflammation of the bladder wall and prevent muscle spasms that cause pain, frequency, and urgency.
Other medications used are:
- Heparin and lignocaine
- Pentosan polysulfate sodium (PPS)-oral and intravesical
- Hyaluronic acid (Available at Aare Urocare)
- Combination of the above treatments
Bladder distention
- The bladder is stretched using water under pressure (also known as bladder hydrodistention) to relieve symptoms by increasing capacity of the bladder under general anaesthesia. Improvement commonly takes two to four weeks.
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Neuromodulation therapy
- Sacral nerve stimulation: a thin wire is placed near the sacral nerves, sending electrical impulses to your bladder to reduce urinary urgency symptoms.
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- Percutaneous Tibial Nerve Stimulation (PTNS): Tibial nerve stimulation (PTNS) uses a needle at the level of the ankle to stimulate the tibial nerves which in turn, lead to the sacral nerves (Available at Aare Urocare).
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Neurotoxin injections
This procedure relaxes the bladder muscle to help relieve some of the pain and to increase the bladder capacity.
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Surgery
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- Surgical options are only considered when symptoms are severe and other treatments have failed to provide relief. Surgery aims to increase the size of the bladder and treat ulcers in the bladder.
Substitution cystoplasty (using bowel as an expander) and urinary diversion (to shunt urine away from bladder) may be undertaken when the alternative treatment options have been exhausted and are inadequate in controlling the symptoms. Urinary diversion may be able to help in relieving frequency of urination and nocturia.
Summary
Interstitial cystitis is a chronic bladder inflammation condition that often causes pelvic pain, urinary frequency and urgency. Diagnosis involves exclusion of other causes for symptoms, cystoscopy, and biopsy. While a cure is rare, treatments can improve symptoms. Treatment options consist of lifestyle changes, medication, bladder distention, bladder instillations and surgery.
