Interstitial Cystitis
What is Interstitial Cystitis or Bladder Pain Syndrome?
Bladder Pain Syndrome (BPS) or Interstitial Cystitis (IC) Chronic bladder discomfort is a problem associated with IC/BPS. It’s not a bladder infection, even if it could feel that way. It is a six-week or longer-lasting sensation of pressure and discomfort in the bladder region that has no apparent cause, such as an infection. Lower urinary tract symptoms, such as a frequent, intense urge to urinate, may also be present.
What are the Symptoms of IC/BPS?
Pain
Pain (often associated with pressure) can be intermittent or persistent. As the bladder fills, the pain may worsen. Some individuals also experience pain in other parts of their bodies, like the lower back, lower abdomen, or urethra. Women may experience vaginal or vulva pain. Men may experience pain in their penis, testicles, or scrotum.
Frequency
There is no evidence linking stress to IC/BPS. But it’s commonly known that stress, whether mental or physical, can exacerbate IC/BPS symptoms. Urinary frequency is sometimes the first sign of IC/BPS. The need to urinate more frequently than usual is known as frequency. This may occur throughout the day or at night.
Urgency
Even immediately after urinating, some IC/BPS patients experience an incessant urge to urinate. Due to its gradual development, a patient might not perceive this as a problem.
Treatment of IC/BPS
First-line treatment for IC/BPS
Modifications in lifestyle
First, “behavioural therapy,” or lifestyle modifications, are tried. You alter your daily routine in behavioural therapy. This could include the foods and beverages you consume or the techniques you use to manage your symptoms. Changing a few habits may help your symptoms, but changing your lifestyle may not completely eliminate them.
Second Line: Physical therapy and prescription medications
Your healthcare provider may recommend appropriate physical therapy, prescription medications, or a combination of the two if lifestyle modifications prove insufficient.
Pelvic floor pain and/or tenderness are common in patients with IC/BPS, and manipulative physical therapy can occasionally lessen symptoms. Exercises like Kegel exercises are not advised for patients with IC/BPS because there is evidence that strengthening the pelvic floor muscles through physical therapy does not alleviate symptoms and frequently makes them worse. Nonetheless, physical therapists who have received training in treating pelvic floor tenderness may provide relief in the pelvic and abdominal regions, lengthen muscle contractures, and release tissue that is scarred or restricted. This stage may benefit from a multimodal pain management strategy that includes manual physical therapy, stress management, and prescription medication.
Oral and intravesical medications are the two categories of prescription medications that might be suggested. Oral medications come in a variety of forms, with adverse effects ranging from nausea to drowsiness. Using a catheter, intravenous medications are inserted straight into the bladder.
1. Amitriptyline: Amitriptyline, also known as Vanatrip, Elavil, or Endep, is an antidepressant that is frequently used to alleviate the symptoms of IC and BPS.
2. Oral Pentosan Polysulfate Sodium: Elmiron, also known as oral pentosan polysulfate sodium, is a medication used to treat pain. The specifics of how IC/BPS operates are unknown. Many believe it strengthens and repairs the bladder tissue’s protective layer.
3. Heparin: Heparin functions similarly to pentosan polysulfate sodium in aiding the bladder. A catheter is used to insert it into the bladder. It could be utilised every day.
4. Cimetidine and Hydroxyzine
5. Dimethyl Sulfoxide (DMSO): DMSO is administered via catheter directly into the bladder. For six weeks, this is typically done once a week. For maintenance, some people use it intermittently.
Third line: cauterisation of ulcers
Hydrodistention combined with Cystoscopy – During an anesthesia-assisted cystoscopy with hydrodistention, the bladder is filled with water to expand to its maximum capacity. Following the procedure, many patients will report less frequent and severe bladder pain. In addition to being treated by injecting steroids directly into the ulcer, ulcers can occasionally be cauterised (burned off) using electricity or a laser.
Fourth Line: Injections and Neuromodulation Therapy
This class of therapies alters the way nerves function by sending them innocuous electrical impulses.
Fifth Line – Cyclosporine
Cyclosporine
An oral medication called cyclosporine (Neoral, Sandimmune, Restasis) is used when no other treatment works.
Sixth Line : Surgery
Surgery – For this condition, most patients don’t need major surgery. However, if other treatments have failed to alleviate severe bladder symptoms, surgery may be an option.