Materiały źródłowe

• #1 Interstitial cystitis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/interstitial-cystitis/diagnosis-treatment/drc-20354362

  No simple treatment eliminates the signs and symptoms of interstitial cystitis, and no one treatment works for everyone. You may need to try various treatments or combinations of treatments before you find an approach that relieves your symptoms. […] Working with a physical therapist may relieve pelvic pain associated with muscle tenderness, restrictive connective tissue or muscle abnormalities in your pelvic floor. […] Certain medicines that you take by mouth (oral medications) may improve signs and symptoms of interstitial cystitis: Nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), to relieve pain. Tricyclic antidepressants, such as amitriptyline or imipramine (Tofranil), to help relax your bladder and block pain. Antihistamines, such as loratadine (Claritin, others), which may reduce urinary urgency and frequency and relieve other symptoms. Pentosan polysulfate sodium (Elmiron), which is approved by the Food and Drug Administration specifically for treating interstitial cystitis.

• #2 Treatment of Interstitial Cystitis – NIDDK

  https://www.niddk.nih.gov/health-information/urologic-diseases/interstitial-cystitis-bladder-pain-syndrome/treatment

  Health care professionals treat interstitial cystitis (IC) in different ways. They will work with you to determine what treatment reduces or stops your symptoms. Your care plan may include lifestyle changes, bladder training, physical therapy, medicines, neuromodulators, bladder procedures, and surgery. […] A health care professional may recommend you try bladder training. Bladder training can help your bladder hold more urine, reduce pain and urgency, and help you to go to the bathroom less often. […] If you have IC symptoms or spasms in your pelvic floor muscles, you may be referred to a physical therapist who specializes in pelvic floor problems. The therapist will help you stretch tight pelvic floor muscles and keep them relaxed. […] If you have mild bladder pain, health care professionals may suggest over-the-counter pain relievers. They may prescribe other medicines if lifestyle changes, bladder training, physical therapy, and over-the-counter medicines don’t relieve your IC symptoms.

• #3 Interstitial Cystitis Treatment – Brigham and Women’s Hospital

  https://www.brighamandwomens.org/obgyn/urogynecology/interstitial-cystitis

  Many different types of treatment are available to help manage IC symptoms and relieve pain. Some may work well for one person and not for another, so several types of treatment may be tried before you and your doctor determine the plan thats best for you. […] Avoid certain foods that may worsen your symptoms. These include alcohol, spicy food, chocolate, caffeine, citrus fruits and juices, tomatoes, and carbonated drinks. You may want to try cutting certain foods out of your diet for several weeks, and then add the food back into your diet to see whether this has any effect on your symptoms. […] Retrain your bladder if recommended by your doctor. Many women with IC have become accustomed to urinating very frequently to try and avoid discomfort. As a result the bladder becomes less and less able to hold urine creating a vicious cycle. Bladder retraining involves holding urine in for longer and longer periods to help stretch the bladder and increase the amount the bladder can hold comfortably.

• #4 Interstitial Cystitis Treatment – Brigham and Women’s Hospital

  https://www.brighamandwomens.org/obgyn/urogynecology/interstitial-cystitis

  Manage stress in your life. Stress doesnt cause IC, but it can make your symptoms worse. Ask your doctor about techniques to help you relax and relieve stress. Meditation, massage, acupuncture and yoga are some possibilities. Exercise is an excellent way to help relieve stress. Walking and swimming are two good choices that may be comfortable enough for you to do regularly. […] Your doctor may give you one or more of the medications below. Other medications may be availabletalk to your doctor about your options. […] Pain medications may be taken for a short time to help ease discomfort. […] Antispasmodic medications may help relax the bladder muscles and decrease the need to urinate. […] Nonsteroidal anti-inflammatory drugs (NSAIDs) and antihistamines may help reduce inflammation and relieve pain.

• #5 Patient education: Treatment of interstitial cystitis/bladder pain syndrome (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/treatment-of-interstitial-cystitis-bladder-pain-syndrome-beyond-the-basics/print

  Patient education: Treatment of interstitial cystitis/bladder pain syndrome (Beyond the Basics) […] A number of treatments are available for IC/BPS, many of which are effective for at least some patients. Most patients with IC/BPS need to try more than one treatment, sometimes in combination, to find the one(s) that provides the greatest relief. […] This topic discusses the treatment of IC/BPS. […] IC/BPS is not a psychologic disorder, but the symptoms can be worsened by stress, anxiety, depression, and other psychologic factors. […] Behavioral therapies are treatments that can improve bothersome symptoms through changes in behavior. […] Timed voiding is inexpensive and has no side effects. In one small study of patients with IC, timed voiding significantly reduced symptoms of IC/BPS.

• #6 Patient education: Treatment of interstitial cystitis/bladder pain syndrome (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/treatment-of-interstitial-cystitis-bladder-pain-syndrome-beyond-the-basics/print

  Pelvic floor physical therapy (PT) may be recommended to decrease tightness in these muscles. PT can decrease bladder or pelvic pain as well as urinary urgency and frequency. […] Several studies have demonstrated the benefit of PT for tight and tender pelvic muscles associated with IC/BPS. […] Amitriptyline (Elavil) is an antidepressant that is commonly used to treat people with chronic pain. […] Pentosan polysulfate sodium (PPS; Elmiron) is an oral medication that was developed to repair the lining of the bladder in people with IC/BPS. […] Your clinician may perform cystoscopy (examination of the bladder with a thin telescope that goes into the bladder through the urethra). […] Dimethylsulfoxide (DMSO) is a liquid medication that has been approved by the US Food and Drug Administration to treat IC/BPS. […] Botulinum toxin can be injected into the bladder wall using a cystoscope. […] If other treatments for IC/BPS fail to improve pain or cannot be tolerated, some clinicians will consider performing a surgical treatment called sacral nerve stimulation.

• #7 Ask the Doctors – What can be done for bladder pain syndrome? | UCLA Health

  https://www.uclahealth.org/news/article/ask-the-doctors-what-can-be-done-for-bladder-pain-syndrome

  Dear Doctor: What can be done about interstitial cystitis syndrome, or bladder pain syndrome? Im told theres no cause or cure, and that some doctors dont even believe it exists. […] The first treatment step is to eliminate behaviors and foods/drink that irritate the bladder, meaning stopping all consumption of caffeine, alcohol and tobacco. You can also consider the restriction of spicy foods and citrus. The second step would be to consider behavioral modification to decrease the frequency of urination. One study, published in the Journal of Urology, showed that diet and behavioral changes decreased symptoms in 45 percent of patients. […] Physical therapy with a therapist who specializes in interstitial cystitis can relieve some of the pain in the pelvic region by working on tender areas and increasing muscle stability in the lower abdomen. A 2012 study published in the Journal of Urology showed a 59 percent decrease in symptoms compared to 26 percent who did general therapeutic massage.

• #8 Bladder pain syndrome (interstitial cystitis)

  https://www.nhs.uk/conditions/interstitial-cystitis/

  When you have been diagnosed by a specialist as having BPS (interstitial cystitis), there are several treatments that may help. […] No single treatment works for everyone, and there is no conclusive evidence they work. You may need to try several treatments to find one that works for you. […] Tablets or capsules may be used to treat people with BPS (interstitial cystitis). […] These include: over-the-counter painkillers such as paracetamol and ibuprofen, medicines for nerve pain such as amitriptyline, gabapentin and pregabalin, tolterodine, solifenacin or mirabegron these can reduce the urgency to pee, a prescription medicine that may help by blocking the effect of a substance called histamine in the bladder, pentosan polysulfate sodium (Elmiron) this may reduce pain (this can only be prescribed by a specialist as it’s only suitable for some people).

• #8 Bladder pain syndrome (interstitial cystitis)

  https://www.nhs.uk/conditions/interstitial-cystitis/

  Some medicines can also be passed directly into the bladder using a thin tube called a catheter. […] These are known as intravesical medicines or bladder instillations. […] Examples of intravesical medicines include: lignocaine – a local anaesthetic that numbs the bladder, a mixture of compounds including steroids, sodium bicarbonate and heparin are used, hyaluronic acid or chondroitin sulphate this may help restore the bladder lining, antibiotics alone or combined with a local anaesthetic and steroid this can calm inflammation and reduce infection. […] Some people may also find the following therapies and supportive treatments helpful: physiotherapy a specialist pelvic floor physiotherapist can help you relax your muscles to ease pain, acupuncture may help with pain relief, talking therapies and counselling to help you cope with your symptoms and their impact on your life, transcutaneous electrical nerve stimulation (TENS) where a small battery-operated device is used to relieve pain by sending electrical impulses into your body, pain management ask the GP to refer you to a pain specialist.

• #9 Interstitial Cystitis/Painful Bladder Syndrome | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0515/p1175.html

  Interstitial cystitis/painful bladder syndrome affects more than 1 million persons in the United States, but the cause remains unknown. […] Treatment options include oral medications, intravesical instillations, and dietary changes and supplements. Oral medications include pentosan polysulfate sodium, antihistamines, tricyclic antidepressants, and immune modulators. […] Pentosan polysulfate sodium is the only oral therapy and dimethyl sulfoxide is the only intravesical therapy with U.S. Food and Drug Administration approval for the treatment of interstitial cystitis/painful bladder syndrome. […] Multimodal therapy that includes pentosan polysulfate sodium (Elmiron), a tricyclic antidepressant, and an antihistamine is proposed to relieve symptoms of interstitial cystitis/painful bladder syndrome via complementary pathophysiologic mechanisms.

• #10 Interstitial Cystitis/Painful Bladder Syndrome | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0515/p1175.html

  Pentosan polysulfate sodium is the only oral therapy approved by the U.S. Food and Drug Administration (FDA) for the treatment of interstitial cystitis. […] Despite limited clinical trial data, dimethyl sulfoxide is the only FDA-approved intravesical agent to treat painful symptoms of interstitial cystitis/painful bladder syndrome. […] Pentosan polysulfate sodium can also be used in bladder instillations. […] Intravesical hyaluronic acid is a natural proteoglycan used in Europe and Canada for the treatment of interstitial cystitis/painful bladder syndrome, but it is not approved for this use in the United States because supporting clinical trial data were lacking. […] Cystectomy with urinary diversion is a treatment of last resort.

• #11 Ask the Doctors – What can be done for bladder pain syndrome? | UCLA Health

  https://www.uclahealth.org/news/article/ask-the-doctors-what-can-be-done-for-bladder-pain-syndrome

  Amitriptyline, a tricyclic antidepressant with multiple uses beyond depression, has potential as well. In a 2010 Journal of Urology study, the drug given at 50 milligrams was shown to decrease symptoms in 55 percent of patients with interstitial cystitis. The problem is that many patients cannot tolerate the side effects of this 50 milligram dose, so I would consider doses of 10 milligrams to 20 milligrams. […] Pentosan polysulfate sodium, which seems to protect the lining of the bladder, may help as well, and the sedating antihistamine hydroxyzine can help patients who have symptoms of pain and frequency of urination during the night.

• #12 Patient education: Treatment of interstitial cystitis/bladder pain syndrome (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/treatment-of-interstitial-cystitis-bladder-pain-syndrome-beyond-the-basics

  PHYSICAL THERAPY FOR PAINFUL BLADDER Pelvic floor physical therapy (PT) may be recommended to decrease tightness in these muscles. PT can decrease bladder or pelvic pain as well as urinary urgency and frequency. […] ORAL MEDICATIONS FOR BLADDER PAIN Amitriptyline (Elavil) is an antidepressant that is commonly used to treat people with chronic pain. […] Pentosan polysulfate sodium (PPS; Elmiron) is an oral medication that was developed to repair the lining of the bladder in people with IC/BPS. Studies have shown that this medication is effective in reducing symptoms in some patients with IC/BPS, although it rarely causes the symptoms to go away completely. […] CYSTOSCOPY Your clinician may perform cystoscopy (examination of the bladder with a thin telescope that goes into the bladder through the urethra). This can identify possible causes for the bladder symptoms.

• #13

  https://www.laparoscopyhospital.com/forum/forum.php?p=83&cat_id=&tid=1451

  Interstitial cystitis is really a chronic condition seen as an a variety of uncomfortable bladder pressure, bladder pain and quite often pain inside your pelvis, which could range from mild burning or discomfort to severe pain. […] Although there is no one single proven treatment that reliably eliminates interstitial cystitis, a variety of medications and other therapies offer relief. […] No simple treatment exists to eliminate the twelve signs and signs and symptoms of interstitial cystitis, with no one treatment works for everyone. […] You might need to try various treatments or combinations of treatments with the advice of your urologist when you find an approach that relieves your symptoms. […] Oral medications that could help the signs and symptoms of interstitial cystitis include: Ibuprofen, naproxen as well as other nonsteroidal anti-inflammatory drugs, to alleviate pain.

• #14

  https://www.laparoscopyhospital.com/forum/forum.php?p=83&cat_id=&tid=1451

  Tricyclic antidepressants, such as amitriptyline or imipramine, to assist relax your bladder and block pain. […] Antihistamines, such as diphenhydramine and loratadine, which may reduce urinary urgency and frequency and relieve other symptoms. […] Pentosan, is the only oral drug approved by the Food designed for interstitial cystitis. […] It could take two to four months before you begin to feel remedy and as much as half a year to get a decrease in urinary frequency. […] 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.

• #15 Interstitial cystitis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/interstitial-cystitis/diagnosis-treatment/drc-20354362

  Nerve stimulation techniques include: Transcutaneous electrical nerve stimulation (TENS). With TENS, mild electrical pulses relieve pelvic pain and, in some cases, reduce urinary frequency. […] Some people notice a temporary improvement in symptoms after cystoscopy with bladder distention. Bladder distention is the stretching of the bladder with water. […] In bladder instillation, your provider places the prescription medication dimethyl sulfoxide (Rimso-50) into your bladder through a thin, flexible tube (catheter) inserted through the urethra. […] Doctors rarely use surgery to treat interstitial cystitis because removing the bladder doesn’t relieve pain and can lead to other complications.

• #16 Treating interstitial cystitis – Harvard Health

  https://www.health.harvard.edu/diseases-and-conditions/treating-interstitial-cystitis

  Interstitial cystitis is a chronic inflammation of the bladder that causes people to urinate — sometimes painfully — as often as 40, 50, or 60 times a day. There’s no cure for interstitial cystitis, but many treatments offer some relief, either on their own or in combination. Treatment is aimed at relieving pain and reducing inflammation. The two main approaches are oral medications and bladder instillations — drugs that are introduced into the bladder by catheter and held for 15 minutes. […] The full effect may take three to six months. Side effects, which are rare, include reversible hair loss, diarrhea, nausea, and rash. […] DMSO is the only FDA-approved bladder instillation drug for interstitial cystitis. It helps relax the bladder and alleviate pain and inflammation. Some research suggests that more than half of patients improve after six weeks of once-a-week treatments.

• #17 Interstitial Cystitis – Symptoms, causes, treatment | National Kidney Foundation

  https://www.kidney.org/kidney-topics/interstitial-cystitis

  DMSO (dimethyl sulfoxide): This medication is believed to work as an anti-inflammatory agent which reduces pain. DMSO can be mixed with steroids, heparin, sodium bicarbonate and/or local anesthetics to form a bladder cocktail. […] BCG (Bacille Calmette-Guerin): This is an experimental treatment that is currently in the clinical trial phase and is not yet approved by the FDA. It appears to work by boosting the immune system. […] Cystistat (hyaluronic acid): This medication is also in clinical trials and is not yet approved for use in IC. It is thought to work by replacing the defective lining of the bladder. How well it works is not yet known. […] Other Bladder Instillations: These include heparin or bladder cocktails consisting of several substances combined into one mixture. […] Diet: Eliminating certain foods, such as those that are acidic or spicy, may decrease the severity of IC symptoms. Also, cigarettes, coffee, tea and alcohol may irritate IC.

• #18 Interstitial Cystitis (Painful Bladder Syndrome) | The Urology Group of Virginia

  https://www.urologygroupvirginia.com/urologic-care/incontinence/interstitial-cystitis-painful-bladder-syndrome

  What are the treatments for IC / PBS? Scientists have not yet found a cure for IC / PBS, nor can they predict who will respond best to which treatment. Symptoms may disappear without explanation or coincide with an event such as a change in diet or treatment. Even when symptoms disappear, they may return after days, weeks, months, or years. Scientists do not know why. […] Because the causes of IC / PBS are unknown, current treatments are aimed at relieving symptoms. Many people are helped for variable periods by one or a combination of the treatments. As researchers learn more about IC / PBS, the list of potential treatments will change, so patients should discuss their options with a doctor. […] Many patients have noted an improvement in symptoms after a bladder distention has been done to diagnose IC / PBS. In many cases, the procedure is used as both a diagnostic test and initial therapy.

• #19 Interstitial Cystitis (Painful Bladder Syndrome) | The Urology Group of Virginia

  https://www.urologygroupvirginia.com/urologic-care/incontinence/interstitial-cystitis-painful-bladder-syndrome

  Researchers are not sure why distention helps, but some believe that it may increase capacity and interfere with pain signals transmitted by nerves in the bladder. Symptoms may temporarily worsen 24 to 48 hours after distention, but should return to predistention levels or improve within 2 to 4 weeks. […] The only drug approved by the U.S. Food and Drug Administration (FDA) for bladder instillation is dimethyl sulfoxide (DMSO, RIMSO-50). DMSO treatment involves guiding a narrow tube called a catheter up the urethra into the bladder. A measured amount of DMSO is passed through the catheter into the bladder, where it is retained for about 1 hour. Treatments are given every week or two for 6 to 8 weeks and repeated as needed. Most people who respond to DMSO notice improvement 3 or 4 weeks after the first 6- to 8-week cycle of treatments.

• #20 Bladder Pain Syndrome | Conditions & Treatments | UR Medicine

  https://www.urmc.rochester.edu/conditions-and-treatments/interstitial-cystitis

  UR Medicine’s Treatments for Bladder Pain Syndrome […] While there is no cure or permanent fix for IC, there are many treatment options available: […] Diet modification can identify foods and drinks that may trigger symptoms. […] Pelvic Floor Physical Therapy and exercise can help relax and stretch the muscles that support your bladder. […] Bladder instillation delivers medication directly to the bladder. […] Medications like antidepressants, antihistamines, and anti-heartburn medications can be used to relieve IC symptoms. […] Transcutaneous electrical nerve stimulation (TENS) provides mild electrical pulses to the body to help block pain. […] Stopping smoking may help reduce symptoms while also reducing your risk of bladder cancer. […] Cystoscopy with hydrodistension may relieve or decrease IC symptoms for up to 6 months. Removing any ulcers seen inside the bladder during cystoscopy may also provide relief.

• #21 Treatment of Interstitial Cystitis – NIDDK

  https://www.niddk.nih.gov/health-information/urologic-diseases/interstitial-cystitis-bladder-pain-syndrome/treatment

  Though neuromodulators or electric nerve stimulators are not FDA-approved for IC, your health care professional may recommend one if other treatments for your symptoms don’t work. […] Bladder instillation, also called bladder wash or bath, may help relieve IC symptoms. A health care professional guides a catheter into your bladder and slowly adds a liquid medicine. […] Bladder stretching, also called hydrodistention, may increase how much liquid your bladder can hold. […] Though botulinum toxin type A, also called Botox, is not FDA-approved for IC, your health care professional may suggest using it if your symptoms do not go away with other treatments. […] Electrocauterization may help relieve the symptoms of Hunner lesions, a type of IC. […] People rarely need surgery to treat IC. If you’ve tried all other options and your pain remains severe, you and your health care professional may consider surgery to enlarge or remove the bladder.

• #22 Interstitial Cystitis (IC): Symptoms, Causes, Treatment

  https://www.webmd.com/urinary-incontinence-oab/interstitial-cystitis

  For about half the cases, interstitial cystitis goes away by itself. Most of those who need treatment find relief and get their lives back to normal. […] Treatment is mainly about symptom control. It takes trial and error to find the right combination of treatments. And it usually takes weeks or months to calm the symptoms. […] Your doctor may suggest lifestyle changes to help along with any treatment. These include: Reduce stress. Stress can be a trigger for IC. Taking five minutes a day to do something for yourself can be a start. […] Interstitial cystitis therapies include bladder retraining, physical therapy, bladder instillations, hydrodistension or bladder stretching, and neurostimulation. […] Interstitial cystitis medications include amitriptyline, pentosan (Elmiron), heartburn medicines, hydroxyzine, dimethyl sulfoxide (DMSO), steroids, and onabotulinumtoxinA (Botox) injections.

• #23 Bladder pain

  https://womenshealth.gov/a-z-topics/bladder-pain

  Prescription medicines. Pentosan polysulfate sodium, also known as Elmiron, may relieve pain and lessen the need to urinate in some people. […] Bladder instillation. During a bladder instillation, also called a bladder bath, your doctor uses a catheter to fill your bladder with a liquid or solution. […] Nerve stimulation. Your doctor uses wires to send mild electric pulses to nerves in the bladder. […] Botox injections. Your doctor injects botulinum toxin (Botox) into the muscle in the bladder lining to help the bladder relax and store more urine, or into the pelvic floor muscles if they are in spasm. […] Surgery. If other treatments have not worked, your doctor may suggest surgery to remove the bladder or parts of the bladder. […] Your doctor will talk to you about steps you can take at home to improve your symptoms. These steps may include: Reduce stress.

• #23 Bladder pain

  https://womenshealth.gov/a-z-topics/bladder-pain

  Bladder pain syndrome (also called interstitial cystitis or painful bladder syndrome) is a chronic (long-term) pain condition that affects the bladder. […] There is no cure, but there is treatment to help relieve your symptoms, including pain. […] But there are treatments that can improve the symptoms. […] The first treatment many people try includes steps you can take at home. […] If your symptoms do not get better, other treatments your doctor may suggest include: Physical therapy. Some or all of the pain that is diagnosed as bladder pain syndrome may be caused by spasm in the pelvic floor, lower abdomen, or back muscles. A physical therapist who specializes in pelvic floor disorders can help treat the pain by teaching you strengthening and relaxation techniques. […] Over-the-counter pain relievers. Medicine that you can buy without a prescription from the doctor, such as aspirin and ibuprofen, may help with mild bladder pain.

• #24 Treatment of Interstitial Cystitis/Bladder Pain Syndrome: A Contemporary Review | EMJ Reviews

  https://www.emjreviews.com/urology/article/treatment-of-interstitial-cystitis-bladder-pain-syndrome-a-contemporary-review/

  DMSO is the only FDA- and Health Canada-approved intravesical agent. […] A 2007 Cochrane review reported no significant improvement over placebo; however, further studies suggested there may be a role for DMSO, particularly in patients with ulcerative disease. […] OnabotulinumtoxinA (BTX-A) has been studied for the treatment of IC/BPS based on the antinociceptive and motor-paralytic actions of this agent. […] A contemporary meta-analysis of 12 RCT, including 459 patients, found a significant improvement in Interstitial Cystitis Symptom Index (ICSI) and Problem Index (ICPI) scores, pain scores, and daytime frequency in patients with IC/BPS treated with BTX-A. […] Sacral neuromodulation (SNM) is not approved for the treatment of IC/BPS but is used for urgency incontinence and frequency-urgency syndrome, both of which commonly occur with IC/BPS. […] The AUA considers SNM to be a fourth-line therapy, while the CUA considers SNM optional in select patients.

• #25 Interstitial Cystitis Pain – London Urology Specialists

  https://www.londonurologyspecialists.co.uk/interstitial-cystitis-pain/

  Bladder distension or stretching is used for diagnosis and therapy of interstitial cystitis. Under a general anaesthetic, your Urologist fills the bladder with fluid and keeps it stretched for 1 minute. […] During a bladder instillation, the bladder is filled with a drug solution via a catheter (narrow tube) that is then retained in the bladder for up to one hour before removal. […] Electric stimulation can be used to neuromodulate (regulate) the nerves to the bladder. […] Botulinum toxin can be injected into the bladder wall to block nerve endings and relax the bladder (Detrusor) muscle. […] Surgery should be considered only if all available treatments have failed and the pain is disabling. Surgical intervention for PBS and IC is complex, and should only be done by specialist surgeons with extensive experience of this work. […] Fulguration involves burning bladder (Hunners) ulcers with electricity or a laser. […] This is a surgical treatment designed to make the bladder larger. […] This is a more rarely used surgical option, only suitable for the most severe and debilitating cases.

• #26 Clinical Management of Bladder Pain Syndrome/Interstitial Cystitis: A Review on Current Recommendations and Emerging Treatment Options

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7455607/

  Lastly, radical surgery should be reserved for those with severe, unremitting BPS, in which quality of life is severely affected and not improved by previously mentioned interventions. Future work investigating exact aetiological factors will help target the development of efficacious treatment options, and several promising oral and intravesical treatments are emerging.

• #26 Clinical Management of Bladder Pain Syndrome/Interstitial Cystitis: A Review on Current Recommendations and Emerging Treatment Options

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7455607/

  Bladder pain syndrome (BPS) is a chronic condition characterized by pelvic pain or pressure which is perceived to be originating from the bladder, accompanied by one or more urinary symptoms, including frequency, urgency and nocturia. […] Treatments targeted at each of these mechanisms have been developed with mixed outcomes. High-quality research into the treatment options is lacking and it is difficult to draw definite conclusions. The treatment approach is multimodal and should be patient specific, targeting the symptoms which they find most bothersome. Conservative treatment, including patient education, behavioural modification, dietary advice, stress relief and physical therapy is an essential initial management strategy for all patients. […] If no response is observed, oral treatments such as amitriptyline are likely to offer the greatest response. Cystoscopy is essential to phenotype patients, and Hunner lesion directed therapy with fulguration or resection can be performed at the same time. Intravesical instillation of DMSO or lidocaine, detrusor injections of botulinum toxin A and neuromodulation can be used if initial management fails to improve symptoms.

• #27 Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome (2022) – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/diagnosis-and-treatment-interstitial-of-cystitis/bladder-pain-syndrome-(2022)

  Amitriptyline, cimetidine, hydroxyzine, or pentosan polysulfate may be administered as oral medications. […] DMSO, heparin, and/or lidocaine may be administered as intravesical treatments. […] Cystoscopy under anesthesia with short-duration, low-pressure hydrodistension may be undertaken as a treatment option. […] If Hunner lesions are present, then fulguration (with electrocautery) and/or injection of triamcinolone should be performed. […] Intradetrusor onabotulinumtoxin A may be administered if other treatments have not provided adequate improvement in symptoms and quality of life. Patients must be willing to accept the possibility that intermittent self-catheterization may be necessary. […] A trial of neuromodulation may be performed if other treatments have not provided adequate symptom control and quality of life improvement. If a trial of nerve stimulation is successful, then the permanent neurostimulation device may be implanted.

• #27 Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome (2022) – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/diagnosis-and-treatment-interstitial-of-cystitis/bladder-pain-syndrome-(2022)

  Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome (2022) […] The purpose of this clinical guideline is to provide a clinical framework for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome (IC/BPS), including discussion of treatments that should and should not be offered. […] Treatment decisions should typically be made after shared decision-making, with the patient informed of the risks, potential benefits, and alternatives. Except for patients with Hunner lesions, initial treatment should be nonsurgical. […] Efficacy of treatment should be periodically reassessed, and ineffective treatments should be stopped. […] Multimodal pain management approaches (e.g., pharmacological, stress management, manual therapy if available) should be initiated. Pain management should be continually assessed for effectiveness because of its importance to quality of life. If pain management is inadequate, then consideration should be given to a multidisciplinary approach and the patient referred appropriately.

• #28 The Pathomechanism and Current Treatments for Chronic Interstitial Cystitis and Bladder Pain Syndrome

  https://www.mdpi.com/2227-9059/12/9/2051

  The primary treatment for HIC should be the fulguration of HIC lesions, either by electrocauterization or laser ablation. […] Antiviral medications, such as oral valacyclovir treatment, can effectively relieve IC symptoms and reduce urinary inflammatory biomarker levels, which shows that antiviral therapy can efficiently treat HIC with EBV infection. […] A detailed historical review and physical examination should be performed for patients with NHIC and persistent IC symptoms. […] For patients with significant bladder pain and high-grade glomerulation, intravesical BoNT-A injection every 6 months or suprapubic LESW bladder treatment, followed by intravesical instillation of GAG supplementation, is recommended. […] All patients should also be evaluated in terms of their anxiety or depression status.

• #29 Bladder pain syndrome (interstitial cystitis)

  https://www.nhs.uk/conditions/interstitial-cystitis/

  Surgery and other procedures may be recommended if you have clear abnormal areas (lesions) in your bladder or other treatments do not work. […] Procedures that may be carried out include: cauterisation ulcers inside the bladder are sealed using an electrical current or laser, bladder distension the bladder is stretched with fluid, which can aid diagnosis and may temporarily relieve symptoms, botulinum toxin injections (such as Botox) injected directly into your bladder wall to temporarily relieve symptoms of frequent peeing and pain, neuromodulation an implant that stimulates your nerves with electricity is placed in your body to relieve pain and reduce sudden urges to pee. […] In very rare cases, and only as a last resort, it may be necessary to remove the bladder completely (cystectomy).

• #30 Interstitial Cystitis – Symptoms, causes, treatment | National Kidney Foundation

  https://www.kidney.org/kidney-topics/interstitial-cystitis

  Self Help: These techniques can improve the quality of life and reduce the incidence and severity of flare-ups. They include: changes in diet, stress reduction, visualization, biofeedback, bladder retraining (learning to urinate according to a schedule), exercise. […] Electronic Nerve Stimulations: TENS (transcutaneous electrical nerve stimulation): The stimulation comes from a device that is worn externally. It helps relieve bladder pain in some people with IC. […] Sacral Nerve Stimulation Implant: This surgically implanted device was recently approved by the FDA for treating a type of urinary incontinence. It is currently undergoing tests for use in IC. […] Surgery: For a small minority of patients whose symptoms are severe and who do not respond to other IC treatments, bladder surgery may be considered. […] Note: A small number of IC patients have a type of IC caused by painful ulcers on the bladder wall (Hunners ulcer). These can be treated using laser surgery, but this is the only use of lasers recommended for IC patients.

• #31 Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome (2022) – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/diagnosis-and-treatment-interstitial-of-cystitis/bladder-pain-syndrome-(2022)

  Major surgery (e.g., substitution cystoplasty, urinary diversion with or without cystectomy) may be undertaken in carefully selected patients with bladder-centric symptoms, or in the rare instance when there is an end-stage small fibrotic bladder, for whom all other therapies have failed to provide adequate symptom control and quality of life improvement. […] The treatments below appear to lack efficacy and/or appear to be accompanied by unacceptable adverse event profiles. Long-term oral antibiotic administration should not be offered. Intravesical instillation of bacillus Calmette-Guerin should not be offered outside of investigational study settings. High-pressure, long-duration hydrodistension should not be offered. Systemic (oral) long-term glucocorticoid administration should not be offered.

• #32 Interstitial Cystitis(IC)/Bladder Pain Syndrome | University of Michigan Health

  https://www.uofmhealth.org/conditions-treatments/adult-urology/interstitial-cystitisic-bladder-pain-syndrome

  If lifestyle changes and prescription drugs don’t work, or pain or side effects interfere with your quality of life, more advanced therapies may be a better choice. You will most likely be referred to a specialist who treats patients with IC/BPS, such as a urologist. […] When other treatments have not been successful, cyclosporine can be used. You should discuss this drug with your health care provider to decide if your symptoms justify the risks. […] Major surgery should be reserved for patients with severe, unresponsive disease, and who are willing to accept the risks and lifelong changes associated with surgery. Surgery can be offered to patients with severely limited bladder capacity or severe symptoms that have not responded to other therapies. Most patients do not require major surgery for this condition.

• #32 Interstitial Cystitis(IC)/Bladder Pain Syndrome | University of Michigan Health

  https://www.uofmhealth.org/conditions-treatments/adult-urology/interstitial-cystitisic-bladder-pain-syndrome

  No single treatment works for all people with IC/BPS. Treatment must be chosen for each patient based on symptoms. Patients usually try different treatments (or combinations of treatments) until good symptom relief occurs. It is important to know that none of these IC/BPS treatments works right away. It usually takes weeks to months before symptoms improve. Even with successful treatment, the condition may not be cured. It is simply in remission. But, most patients can get significant relief of their symptoms and lead a normal life with treatment. […] Most treatments are aimed at symptom control. IC/BPS treatment is often done in phases with constant monitoring of your pain and quality of life. It is important to talk to your health care provider about how your treatments are working so that together you can find the best treatment option for you.

• #33 Interstitial Cystitis Treatment & Management: Approach Considerations, Behavioral Therapy, Dietary Therapy

  https://emedicine.medscape.com/article/2055505-treatment

  The authors’ algorithm for treatment is largely based on whether the patient has predominantly pelvic pain or urgency/frequency. […] In patients with significant voiding symptoms, the authors suggest an algorithm proposed by Hanno. […] If the improvement in symptoms is inadequate, begin oral therapy with antispasmodics/antimuscarinics and nonnarcotic analgesics. […] If conservative measures and medical therapy fail to provide adequate relief, surgical therapy should be considered. […] Managing the pain component can be difficult in patients with interstitial cystitis/bladder pain syndrome (IC/BPS). […] Agents used for pain relief include the following: Anti-inflammatory drugs, Acetaminophen, Gabapentin, Tricyclic antidepressants, Selective serotonin reuptake inhibitors (SSRIs), Various other agents.

• #34 Interstitial Cystitis Treatment & Management: Approach Considerations, Behavioral Therapy, Dietary Therapy

  https://emedicine.medscape.com/article/2055505-treatment

  Most clinicians tend to avoid the extensive use of narcotics in patients with interstitial cystitis. […] Patients in whom medical therapy fails may benefit from another bladder hydrodistention if the initial diagnostic hydrodistention was therapeutic. […] If patients still do not respond, intravesical therapy may be initiated, beginning with weekly dimethyl sulfoxide (DMSO) therapy for 6 courses. […] DMSO may be combined with steroids, bicarbonate, and heparin. […] Intravesical botulinum toxin has been used for the treatment of interstitial cystitis as an isolated treatment, as well as in combination with other treatments. […] Transurethral intradetrusor injection of onabotulinumtoxinA (OBA) coupled with therapeutic hydrodistention has been shown to be superior to hydrodistention alone in improving symptoms and bladder capacity in patients with interstitial cystitis.

• #35 Interstitial Cystitis Treatment & Management: Approach Considerations, Behavioral Therapy, Dietary Therapy

  https://emedicine.medscape.com/article/2055505-treatment

  Interventions may include the following: Oral pharmacologic agents (eg, pentosan polysulfate sodium [Elmiron], antihistamines, tricyclic antidepressants, analgesics, anti-inflammatory agents) […] Intravesical therapy (ie, medications intermittently instilled directly into the bladder via a catheter or injected into the bladder wall) […] Surgical therapies […] Electrical stimulation (neuromodulation) […] Complementary therapies (eg, acupuncture, hypnosis, pelvic floor massage). […] In a chronic, often poorly controlled condition such as interstitial cystitis, patients may seek alternative, holistic, or complementary therapies. These patients should be cautioned that such therapies, while potentially successful, often have not been validated scientifically. Desperate patients should be counseled to avoid potentially harmful, unproven therapies. However, one such complementary therapy, pelvic floor massage, has been shown to have modest efficacy in a select group of patients in a well-done controlled trial.

• #36 Interstitial Cystitis (IC): Symptoms, Causes, Treatment

  https://www.webmd.com/urinary-incontinence-oab/interstitial-cystitis

  In very rare cases when nothing else works, surgery may be an option. This is a complex operation that diverts your urine away from your bladder. […] Pain management using over-the-counter painkillers, acupuncture, or other methods may keep your symptoms at bay. Supplements also may help, but keep in mind that supplements aren’t regulated the same way as drugs are. […] Other things that may help when you’re living with interstitial cystitis include drinking lots of water, avoiding your triggers, using ice or heat on your belly, yoga poses, deep breathing exercises, meditation, massage, and taking pain relievers before sex. […] There’s no cure for IC/BPS, but many treatments, lifestyle changes, and alternative treatments may help.

• #37 Interstitial Cystitis Treatment – Brigham and Women’s Hospital

  https://www.brighamandwomens.org/obgyn/urogynecology/interstitial-cystitis

  Antidepressants in low doses may help relieve IC symptoms, perhaps by blocking pain receptors. […] Medications to restore the bladder lining such as pentosan polysulfate sodium (Elmiron). […] Bladder instillation may help relieve inflammation or repair the bladders protective lining. During this treatment, the bladder is filled with medications using a slender tube called a catheter. […] Hydrodistention is a process where your bladder is filled with fluid to stretch the walls of the bladder. Some patients have relief from symptoms for a time after bladder hydrodistention is done to diagnose IC. […] Biofeedback is a painless technique that can help you learn to control the movement of your bladder muscles. […] Stimulation of the area around your bladder with electrical signals may help relieve symptoms by blocking the nerve sensations to and from the bladder, by improving blood flow, or by strengthening the pelvic muscles. […] Very rarely, surgery may be recommended for severe cases of IC that are not relieved by any other types of treatment. The results of surgery can be unpredictable. If your doctor recommends surgery, he or she can discuss the procedures risks and benefits with you.

• #38 Interstitial Cystitis(IC)/Bladder Pain Syndrome | University of Michigan Health

  https://www.uofmhealth.org/conditions-treatments/adult-urology/interstitial-cystitisic-bladder-pain-syndrome

  Most patients need to continue treatment indefinitely or the symptoms return. Some patients have flare-ups of symptoms even while on treatment. In some patients the symptoms gradually improve and even disappear. […] Some patients do not respond to any IC/BPS therapy. However, with pain management, they can still have significant improvement in quality of life. Pain management can include other drugs, acupuncture, and other non-drug therapies. Professional pain management may often be helpful in more severe cases. […] Although most patients will find that their symptoms improve as they are treated for IC, not all patients will become fully symptom-free. Many patients still have to pass urine more often than normal, or will have some degree of persistent discomfort and/or have to avoid certain foods or activities that make symptoms worse.

• #39 Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome (2022) – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/diagnosis-and-treatment-interstitial-of-cystitis/bladder-pain-syndrome-(2022)

  Patients should be educated about normal bladder function, what is known and not known about IC/BPS, the benefits versus risks/burdens of the available treatment alternatives, the fact that no single treatment has been found effective for the majority of patients, and the fact that acceptable symptom control may require trials of multiple therapeutic options (including combination therapy) before it is achieved. […] Self-care practices and behavioral modifications that can improve symptoms should be discussed and implemented as feasible. […] Clinicians may prescribe pharmacologic pain management agents (e.g., urinary analgesics, acetaminophen, NSAIDs, opioid/non-opioid medications) after counseling patients on the risks and benefits. Pharmacological pain management principles for IC/BPS should be similar to those for management of other chronic pain conditions.

• #40 Interstitial Cystitis(IC)/Bladder Pain Syndrome | University of Michigan Health

  https://www.uofmhealth.org/conditions-treatments/adult-urology/interstitial-cystitisic-bladder-pain-syndrome

  It is possible for IC/BPS symptoms to come back even if the disease has been in remission for a long time. It is not known what causes a recurrence. Also, there is no known guaranteed way to prevent recurrences. Patients can try to prevent the return of symptoms by: staying on their medical treatments even after remission, avoiding certain foods that may irritate the bladder, avoiding certain activities or stresses that may make IC/BPS worse.

• #41 Bladder pain

  https://womenshealth.gov/a-z-topics/bladder-pain

  Change your eating habits. […] Train your bladder to go longer between bathroom visits. […] Do pelvic floor muscle relaxation exercises. […] Wear looser clothing. […] Quit smoking. […] Get regular physical activity. […] Researchers continue to search for new ways to treat bladder pain. Some current studies focus on: New medicines to treat bladder pain, Meditation as a way to control bladder pain, The role of genetics in bladder pain, Acupuncture treatment.

• #42 The Pathomechanism and Current Treatments for Chronic Interstitial Cystitis and Bladder Pain Syndrome

  https://www.mdpi.com/2227-9059/12/9/2051

  Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic and debilitating condition characterized by symptoms such as bladder pain, frequent urination, and nocturia. […] Treatment of IC/BPS should involve identifying the different clinical phenotypes and underlying pathophysiology causing clinical symptoms and developing strategies tailored to the patient’s needs. […] Various bladder treatment modalities are explored, including glycosaminoglycan replenishment, botulinum toxin A injection, platelet-rich plasma injection, low-energy shock waves, immunosuppression, and low-dose oral prednisolone. […] Pelvic floor muscle physiotherapy and bladder therapy combined with psychiatric consultation can help alleviate psychological stress and enhance the quality of life of patients with IC/BPS.

• #43 Treatment of Interstitial Cystitis/Bladder Pain Syndrome: A Contemporary Review | EMJ Reviews

  https://www.emjreviews.com/urology/article/treatment-of-interstitial-cystitis-bladder-pain-syndrome-a-contemporary-review/

  Interstitial cystitis/bladder pain syndrome (IC/BPS) is a debilitating condition affecting approximately 3% of the female population. […] There are few well-studied treatment options and no cure for this condition, which is therefore challenging to treat. […] The purpose of this narrative review is to summarise the contemporary literature, including the Canadian Urological Association (CUA) and American Urological Association (AUA) guidelines, on various treatment options that exist for IC/BPS, including conservative therapies, oral therapies, intravesical therapies, and more invasive surgical options. […] Most importantly, this review highlights the need for an individualised, multimodal approach to the treatment of IC/BPS. […] Treatment must be focussed on maximising quality of life (QoL), as there is no treatment that will change the natural history of this condition or cure IC/BPS. […] A classification system, UPOINT, has been proposed as a way to direct multimodal therapy with an individualised approach.

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