There is no single approach to the successful treatment of IC. The treatment must
involve a combination of various therapies and will differ for each patient. The
current treatments goal is symptom relief in IC.
You may have experienced that certain food and drinks tend to aggravate IC. You
should identify foods and beverages that will irritate the bladder and avoid taking
them. This diet modification will regulate the IC flare-ups and help in controlling
Firstly, the patient has to identify the foods that worsen the IC [Table 2] and
avoid its intake. This can be done by using the ‘elimination method’
that is, by beginning with different foods and excluding those with which the patient
has experienced symptoms.
Multivitamins such as B-complex and vitamin C are known to trigger IC. Constipation
has to be avoided to reduce exacerbations of IC symptoms. Ensure intake of fibre-rich
diet and optimum amount of fluid.
Oral treatment is mostly preferred, as it is easy to administer.
Pentosan Polysulphate Sodium
This is an FDA-approved drug for the treatment of IC. It is still uncertain how
the drug works. However, it is believed that pentosan polysulphate sodium (PPS)
repairs the defects in the bladder wall by preventing irritants from urine that
attack the bladder. Pain due to IC will not be relieved until first 2 to 4 months
after initiating therapy with PPS, and urinary frequency will require a span of
6 months to reduce. Therefore, the treatment has to be continued for an adequate
period of time to relieve the symptoms.
It is believed that patients with IC have significant amount of histamine present
in the bladder, which results in pain. Hydroxyzine is used as an antihistamine to
decrease pain. This has been proved beneficial in inducing better sleep at night.
Amitryptiline may help reduce the pain and increase the bladder capacity. The relaxation
effects on the bladder will reduce the urinary frequency. However, this drug is
not preferred because of its common side effects such as sedation and constipation.
Bladder instillations or intravesical therapies introduce the drug directly to the
bladder. This would help the drug reach the bladder at a higher dosage and a faster
pace. As the drug is not absorbed into the body, it has minimal side effects. However,
the drawback of this therapy is that the patient has to be catheterised, which may
lead to infection.
Dimethyl Sulphoxide (DMSO)
This is most common FDA-approved drug used for bladder instillation. With the help
of a catheter the drug is retained for about 15 minutes inside the bladder before
expelling out. This procedure is repeated once in a week, for a period of 6 weeks.
DMSO helps in decreasing pain and inflammation. Its main drawback is the garlic-like
odour of the breath and skin, which lasts for several hours.
Botulinum Toxin A
Botulinum toxin A (Botox) is injected intramurally into the detrusor muscle of the
bladder. This helps in reducing the pain sensations and also improves bladder muscle
strengths. Its temporary side effects such as urinary retention last till the drug
effect wears off.
Small surgical implanted devices send electrical signals to the nerves surrounding
the bladder and bladder muscles. Nonsurgical devices are also available, which can
be worn externally. These devices manage urinary functions and provide pain relief.1
The optimum pain control can be achieved only through a combination of relaxation
and medical therapies.
This can be of immense help to both the doctor and the patient, as it may help in
monitoring the success of the treatment. The number of voids (= number of times
you urinate) in a day, with the volume of urine, is noted. Factors such as excessive
water intake (>2 L/d), perspiration and climate will affect the reliability of the
Pain control is essential, as it limits the bladder from filling up. Under medical
supervision, the bladder can be retrained in pain control. This can help in increasing
the time of urine hold; however, it will be slow and short lasting.
Patients tend to gain significant awareness and control over the bladder muscles.
Hypnotherapy, pelvic floor reeducation, acupuncture and herbal supplements can be
useful in pain control.
Yoga, meditation, exercise, swimming and warm baths help in relaxation and reduction
of stress.1, 2