Interstitial Cystitis: Disabling Bladder Condition : Treating the Condition

by Food and Drug Administration (FDA)

(Page 2 of 2)

There is no cure for IC. All doctors can do is try to relieve the symptoms, a challenging task, because they vary from person to person. People may have flare-ups and remissions, and different patients respond to different treatments. A particular type of therapy may work for a while and then lose its effectiveness. Sometimes, stress or a change of diet triggers symptoms. Occasionally, IC goes into remission spontaneously.

Paradoxically, the cystoscopy used to diagnose IC also seems to make some people feel better. To enable the doctor to look inside the bladder with the cystoscope, the bladder is filled with water. This bladder distention helps about 30 percent of patients, at least for the short term, probably because the bladder is stretched and capacity is increased. It's also possible that the procedure may interfere with the transmission of pain signals by nerves in the bladder. The fact that IC can only be diagnosed by cystoscopy under anesthesia explains why many cases are overlooked even by urologists.

In a similar procedure, Rimso-50 is instilled directly into the bladder by a catheter. The solution is retained in the bladder for about 15 minutes before being expelled by spontaneous voiding. This treatment is given every two weeks until maximum symptomatic relief is obtained, then repeated as needed.

For some patients, Rimso-50 treatments become less effective over time. About 50 percent of patients experience significant pain relief for an average of about 10 months. The drug works by penetrating the bladder wall to reduce inflammation and acts as a muscle relaxant by preventing muscle contractions that cause pain, frequency and urgency.

Disadvantages of Rimso-50 include a garlic-like odor on the skin and breath that may last up to 72 hours. Some patients may develop a chemical cystitis after use of the drug that goes away within one or two days. Patients taking Rimso-50 also require a blood test every six months to make sure the blood count and liver and kidney function are normal. Periodic ophthalmologic examinations are also recommended.

"You have to customize therapy for the person," says Whitmore, who advocates a number of untraditional therapies, many of which have not been reviewed by FDA for this purpose. They include acid-restricted diets, alkalization of urine, bladder holding and retraining (delaying voiding for increasingly longer intervals), biofeedback and electric stimulation, acupuncture, muscle relaxants, antidepressants, anti-inflammatories, antihistamines and analgesics, and an experimental bladder "wash" consisting of an anesthetic, an antibiotic, an anticoagulant, and hydrocortisone.

From 40 to 60 percent of IC patients may benefit from low doses of the tricyclic antidepressant amitriptyline (Elavil and others), according to Vicki Ratner, M.D., and colleagues in the Journal of Women's Health, Vol. 1, No. 1, 1992. Physicians prescribe it not only to treat the depression that is common in IC patients, but to take advantage of its bladder-relaxing, allergy-fighting, pain-blocking, and sedating properties.

When pain is severe, some people may benefit from transcutaneous electrical nerve stimulation (TENS). Mild electrical impulses delivered to the body through wires placed on the lower back or abdomen or through devices implanted in the body may alter nerve transmissions to the bladder and help trigger release of pain-blocking hormones.

A bland diet helps some IC people. Doctors recommend avoiding high-acid foods, such as citrus fruits, that may irritate the bladder, or spicy foods that may cause the release of histamine. Restricting alcoholic beverages, carbonated sodas, coffee and other caffeinated products, and beverages and foods with artificial sweeteners appears to reduce symptoms in some people.

Surgery is an option when all else fails. Some urologists may remove the diseased portion of the bladder and attach a piece of the patient's bowel to the remaining healthy tissue to make a larger bladder. In other cases, the bladder is completely removed and urine is rerouted to a bag outside the body or a pouch inside the abdomen. However, about half of patients don't get pain relief from this procedure.

"I don't take the bladder out unless I've used all the tricks up my sleeve," says Whitmore. "When patients have bladders the size of a walnut or smaller, or when they have intractable pain, then they're candidates for cystectomy [bladder removal]. The operation has allowed some people to get out of the house and have a life."

Whitmore tells her patients that, as with all disorders of chronic pain, there is going to be a certain amount of anger, anxiety and depression. "I say to them, 'I have an 85 percent chance or greater to make you better, but I can't teach you how to cope with your illness, so you've got to get some help.' I encourage them to go for self-hypnosis, self-relaxation, and other coping techniques, or to seek therapy with psychologists or psychiatrists. I tell them, 'if you can't cope, you're not going to get better.'"

Researchers funded by the federal government, drug companies, and the Interstitial Cystitis Association have stepped up their efforts to find out more about the disorder. Philip Hanno, M.D., chairman, Department of Urology, Temple University School of Medicine, Philadelphia, Pa., expects that in the next decade, treatment for IC will be more beneficial than the therapy available now. He believes that ultimately there will be a cure for most cases of this painful and disabling condition.

IC Symptoms

The symptoms of interstitial cystitis are similar to those of a urinary tract infection. Most people have some of the following symptoms:

• urgent need for frequent urination both day and night
• reduced bladder capacity
• feelings of pressure, pain and tenderness around the bladder, pelvis and genital area, which may increase as the bladder fills and decrease as it empties.
• painful sexual intercourse
• in men, discomfort or pain in the prostatic area.

About the Author

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