DEAR DOCTOR K:
I have interstitial cystitis. Medications have helped, but not much. What else could help relieve my symptoms?
Interstitial cystitis is a puzzling bladder condition in which the bladder wall becomes irritated or inflamed. We don’t know what causes the condition. Some doctors speculate that an infection, most likely with viruses, is responsible. However, I’m not aware of any good evidence in support of that.
The symptoms of interstitial cystitis are similar to those of a bacterial urinary tract infection. However, in interstitial cystitis, there is no bacterial infection, and the symptoms do not respond to antibiotic treatment.
Symptoms include frequent urination, an intense urge to urinate and a burning sensation during urination. People may also experience pain, pressure or tenderness in the bladder area. In many patients, symptoms come and go. In others, symptoms continue to get worse.
In some people, interstitial cystitis is a chronic condition that lasts for many years. In others, it disappears suddenly. But symptoms may return again, even years after the first illness.
There is no therapy that cures the disorder, so the goal of treatment is to reduce symptoms. Often a person needs to try several therapies before finding the right combination:
- DIETARY CHANGES. Caffeinated beverages, alcohol, chocolate, and spicy or high-acid foods such as citrus fruits and tomatoes are some of many foods that can aggravate the condition. Each person needs to experiment to discover what she or he needs to avoid. Smoking aggravates interstitial cystitis in some people, and quitting smoking can also help.
- BLADDER TRAINING. Patients can learn to reduce frequent urination by following a schedule for urinating. You can think of it as “willing” the bladder to urinate less often. It is the same kind of discipline that works in people who have overactive bladder, a condition much more common than interstitial cystitis. While bladder training cuts down on the frequent urination, unfortunately it doesn’t reduce the pain of urination.
- ORAL MEDICATIONS. Pentosan polysulfate sodium (Elmiron) is the only medication specifically approved for the treatment of interstitial cystitis. Other drugs not specifically approved for the condition also may offer relief. They include analgesics (pain relievers), tricyclic antidepressants, antihistamines and H2 blockers used to treat heartburn.
- BLADDER DISTENTION. Sterile water is used to stretch the bladder. This may allow the bladder to hold more urine and interfere with pain signals transmitted by nerves in the bladder.
- BLADDER INSTILLATION (bladder wash). The bladder is filled with a sterile solution containing one of a number of ingredients that work directly on the bladder wall to reduce inflammation and block pain. It may also prevent muscle contractions that cause pain, frequency and urgency of urination.
- ELECTRICAL NERVE STIMULATION. Mild electrical impulses are used to stimulate nerves to the bladder. The electrical pulses may increase blood flow to the bladder, strengthen pelvic muscles or trigger the release of substances that block pain.
While these various treatments help many patients, we won’t have a sure-fire treatment for interstitial cystitis until research uncovers its cause.