There is not yet a treatment that can permanently cure interstitial cystitis. Having said that, several pharmaceuticals et treatments may be offered to relieve symptoms. It should be noted that there is still little data on the effectiveness of these treatments and that some of them are used as experimental. Since everyone responds to treatment differently, it can take several months to find the right one (s).

In cases where the interstitial cystitis is very debilitating, follow-up in a pain clinic, with a medical team specializing in chronic pain, may be indicated. (To learn more about the multidisciplinary approach offered in specialized clinics, see our article Relieve chronic pain? Hope….)

Oral pain medications

It is often the first relief treatment suggested by the doctor. The choice of medication is largely based on the type of symptom that predominates.

– Medication analgesics (pain reliever) or nonsteroidal anti-inflammatory drugs (anti-inflammatory drugs other than cortisone derivatives) can relieve pain and inflammation. They are seldom sufficient. It may be paracetamol (acetaminophen) or ibuprofen, naproxen or for example acetylsalicylic acid (aspirin) or even morphine derivatives. The most effective combination of painkillers and / or anti-inflammatories must be sought for each person.

— Medication antispasmodics, the muscle relaxants or even anticonvulsants can also be used to relax the bladder as much as possible.

— Anticonvulsants like for example the Gabapentine, medicine used to treat chronic pain because it changes the nerve transmission of pain to the brain. This medication is usually effective, but it does not get pain relief quickly. It slightly raises the threshold beyond which pain is felt.

— Medication Antidepressants. Some antidepressants used in low doses have pain relieving properties. They act as pain neuromodulators. Amitriptyline (Elavil®) is often used and provides pain relief in about two-thirds of people with interstitial cystitis²⁰. Reuptake inhibitor antidepressants serotonin (fluoxetine or Prozac®, sertraline) can also be used, although there is less data on their use.

— Antihistamine (antiallergic) drugs such as, for example, hydroxyzine, a drug used against allergies, is sometimes used. However, few studies have confirmed its effectiveness. The effect on the symptoms would not appear until about 3 months²⁰. The cimetidine, another antihistamine, appears to be effective in some people with the condition, according to several recent studies^19,21. It is generally offered to people with interstitial cystitis who also have an allergic ground.

— Immunosuppressive agents like for example the Cyclosporine A. A study showed that administration of low dose cyclosporin A was more effective than administration of sodium pentosan (Elmiron®) in reducing symptoms of interstitial cystitis²⁴.

— Le sodium pentosan (Elmiron®) is the only oral medication that is specifically indicated for the relief of pain caused by interstitial cystitis. It is therefore the most used. This medicine is believed to adhere to the lining that lines the inside of the bladder, thus protecting it from the irritating components of the urine. The optimal therapeutic effect does not appear until after 6 to 12 months of treatment²⁰. About 30% to 60% of people report a decrease in pain after 3 months of treatment. Pentosan sodium is contraindicated in pregnant women.

— Le cytoprotek : it is a food supplement containing quercetin, chondroitin sulfate, sodium hyaluronate, and glucosamine sulfate.

— La Quercétine, a flavonoid is a pigment giving its colors to fruits or vegetables and seems in addition, to improve pain.

Introduction of fluids into the bladder (instillations bladder)

The doctor can put a sterile solution that contains one or more drugs into the bladder by inserting a tube (catheter) into the urethra. These drugs then act directly on the wall of the bladder. Their purpose is to temporarily replace the surface layer of the inside of the bladder so that it is less irritable. Several drugs can be used. For example :

Cystistat® composed of sodium hyaluronate (salt of hyaluronic acid).

GepanInstill® or Uracyst® contain chondroitin sulfate.

The most frequently used drug is dimethyl sulfoxide (DMSO). Depending on the case, the solution should be kept in the bladder for 15 to 60 minutes and then eliminated by urinating. It is usually given every week for 6 weeks. DMSO can be used alone or in combination with corticosteroids or heparin.

THEheparin can also be used alone. It strengthens the protective layer that lines the inside of the bladder. The instillations are generally weekly, but the relief is obtained less quickly than with DMSO.

Several other drugs have been tested to provide relief for people with interstitial cystitis. Among them, hyaluronic acid, botulinum toxin, capsaicin or even CG (Calmette-Guérin bacillus) have shown promising results. However, more studies are needed to confirm their effectiveness.^19,20.

Dietary modifications

If the diet increases the degree of acidity of the urine, the pains of interstitial cystitis are increased. Also, people with interstitial cystitis notice that their pain gets worse 2 to 4 hours after eating certain foods. Thus, up to 6 in 10 people with interstitial cystitis can clearly recognize harmful foods responsible for increased pain². In some cases, a change in diet is enough to relieve pain. From one person to another, however, the same foods do not exacerbate the symptoms. Everyone is therefore advised to recognize “harmful” foods in order to avoid them.

For this purpose, it is very useful to hold a food journal consisting in noting the content of the meals and the intensity of the symptoms. This process of observation and adaptation of the diet takes place over several months. The help of a dietician or nutritionist is strongly recommended.

As the first avenues of research, here are various trigger foods known to worsen symptoms in many people with interstitial cystitis²⁰.

• All soft drinks, sodas and colas.
• Caffeine or theine (non-decaffeinated coffee, cola-type soft drink, tea, chocolate).
• Alcohol (beer, white, red or rosé wine, champagne, strong alcohols).
• Hot peppers and spicy dishes.
• Very acidic foods and juices (several fruits, but especially citrus fruits and tomatoes).
• Certain fruits and vegetables: broad beans, beans, pineapple, citrus fruits, bananas, rhubarb …
• Most nuts.
• Smoked meats and fish, tofu.
• Synthetic sweeteners, preservatives and food additives.
• Vinegar (and foods marinated in vinegar), mustard, soy sauce.

Psychotherapy

La interstitial cystitis, because of the pain it causes and the incessant urge to go to the toilet, greatly affects the quality of life of those affected. All areas of life can suffer, from employment to leisure, including couple and family life. Psychotherapy can help keep physical pain from taking over. Psychotherapy provides significant emotional support, helps people learn to deal with pain and stress, and helps resolve relationship difficulties, etc. This often facilitates the active search for strategies to alleviate symptoms.

Transcutaneous electrical nerve stimulation (TENS)

This treatment is mostly used when symptoms are predominant During the night. Transcutaneous electrical neurostimulation is performed using a device that generates a low voltage electrical current. This device is connected to electrodes affixed to the lower back, pubis, rectum or vagina. In some people, TENS reduces pain and the frequency of urination. It might do this by increasing blood flow to the bladder, strengthening the muscles of the bladder, or causing the release of natural pain relievers.

Surgeries

As a last resort, if the pain is very intense and no oral or intravesical treatment relieves it, surgical interventions may be offered.

Hydrodistension bladder. This procedure involves, under general anesthesia, filling the bladder with physiological liquid (lightly salted sterile water) to “inflate” it, as at the time of the diagnostic examination. This temporarily relieves symptoms in almost half of those affected²⁰. The beneficial effect can last for several months. However, the procedure becomes less and less effective over time (this is called habituation).

Neurostimulation of the sacral nerve. This technique involves stimulating the sacral nerve continuously with a light electric current. The sacral nerve, located in the lower back, controls the muscles of the bladder. Stimulating it can, in some people, reduce urinary urgency and frequency of urination, and sometimes decrease pain. If the treatment works, a case is permanently implanted under the skin, towards the top of the buttock.

Bladder removal. If no treatment helps to alleviate the symptoms, a total or partial removal of the bladder may be performed as a last resort. It is a heavy intervention, conceivable only in people who have previously been treated in the clinic for pain and who have not had the hoped-for results and can no longer bear to suffer. Most often, the bladder is removed partially, and the surgeon then enlarges the remaining bladder by grafting a fragment of the intestine (enterocystoplasty). This procedure reduces the frequency of urination, but the pain may persist in a minority of people. In these cases, complete removal of the bladder (cystectomie) can be considered. This intervention requires the establishment of an external pocket that collects urine (ostomy).

Finally, Hunner’s ulcers, if present, can be treated by laser. This treatment appears to relieve symptoms.