No single treatment works for all people with IC/BPS. Treatment must be chosen for each patient based on symptoms. Patients usually try different treatments (or combinations of treatments) until good symptom relief occurs. It is important to know that none of these IC/BPS treatments works right away. It usually takes weeks to months before symptoms improve. Even with successful treatment, the condition may not be cured. It is simply in remission. But, most patients can get significant relief of their symptoms and lead a normal life with treatment. Most treatments are aimed at symptom control. IC/BPS treatment is often done in phases with constant monitoring of your pain and quality of life. It is important to talk to your health care provider about how your treatments are working so that together you can find the best treatment option for you. The following are the different phases of IC/BPS treatment:
First Phase: Lifestyle ChangesLifestyle changes, known as "behavioral therapy," are often the first treatments used to manage IC/BPS. In behavioral therapy, you make some changes in the way you live day-to-day. This may include changing your diet, or practicing methods that may help control your symptoms. Most patients don't get rid of all their symptoms with lifestyle changes. But many do have fewer symptoms using these types of treatments. Manipulative Physical TherapyPatients with IC/BPS often have tenderness and/or pain in the pelvic floor area, and sometime manipulative physical therapy can reduce symptoms. There is evidence that physical therapy exercises to strengthen the pelvic floor muscles do not improve symptoms, and often make them worse, so activities such as Kegel exercises are not recommended for patients with IC/BPS. Limiting StressEmotional and mental stress can worsen IC/BPS symptoms. Patients are encouraged to come up with coping methods to deal with family, work and/or past painful experiences, and may need to seek additional help to develop the best coping strategies to help manage their pain. Limiting Certain Foods and DrinksMost (but not all) people with IC/BPS find that certain foods make their symptoms worse. There are 4 foods that patients most often find irritating to their bladder:
Other foods that bother the bladder in many patients are:
Elimination DietThe list of foods that have been said to affect IC/BPS is quite long, but not all foods affect all patients the same way. Each patient must find out how foods affect his or her own bladder. The simplest way to find out whether any foods bother your bladder is to try an "elimination diet" for 1 to 2 weeks. On an elimination diet, you stop eating all of the foods that could irritate your bladder. IC/BPS food lists are available from many sources ( www.ichelp.org or www.ic-network.com). If your bladder symptoms improve while you are on the elimination diet, this means that at least 1 of the foods was irritating your bladder. The next step is to find out exactly which foods cause bladder problems for you. After 1 to 2 weeks on the elimination diet, try eating 1 food from the IC/BPS food list. If this food does not bother your bladder within 24 hours, this food is likely safe and can be added back into your regular diet. The next day, try eating a second food from the list, and so on. In this way, you will add the foods back into your diet one at a time, and your bladder symptoms will tell you if any food causes problems for you. Be sure to add only 1 new food to your diet each day. If you eat a banana, strawberries and tomatoes all in the same day, and the IC/BPS symptoms are worse that evening, you will not know which of the 3 foods caused the symptoms to flare up. Second Phase: Prescription DrugsWhen lifestyle changes do not help enough, your health care provider may ask you to try a prescription drug. You may take the drug alone or along with behavioral therapy. The 2 types of prescription drugs that may be recommended are, oral and intravesical drugs. There are many types of oral drugs, and the side effects range from drowsiness to upset stomach. Intravesical prescription drugs are placed directly into the bladder with a catheter. Two treatments are approved by the U.S. Food and Drug Administration (FDA) to treat IC/BPS: Oral Pentosan PolysulfateNo one knows exactly how this drug works for IC. Many people think that it builds and restores the protective coating of the bladder tissue. It may also help by decreasing swelling or by other actions. Possible side effects are not common, but may include nausea, diarrhea and gastric distress. A small percentage of people may have temporary hair loss. It often takes at least 3 to 6 months of treatment with this drug before you notice improvement in symptoms. It is effective in relieving pain in about 30 out of every 100 patients. Dimethyl Sulfoxide (DMSO)The other FDA approved treatment is the placement of dimethyl sulfoxide (DMSO) into the bladder through a catheter. This is usually done once a week for 6 weeks. Some people keep using it now and then as maintenance therapy. No one knows exactly how DMSO helps interstitial cystitis. It may block swelling, decrease pain sensation and remove a type of toxin called "free radicals" that can damage tissue. Some health care providers combine DMSO with other drugs such as heparin or steroids (to decrease inflammation). No studies have tested whether these combinations work better than dimethyl sulfoxide alone. The main side effect is a garlic-like odor that lasts for several hours after using DMSO. For some patients, DMSO can be painful to place into the bladder, but the pain can often be relieved with a local anesthetic. HydroxyzineHydroxyzine is an antihistamine. It is thought that some patients with IC/BPS have too much histamine in the bladder that leads to pain and other symptoms. An antihistamine may be helpful in treating IC/BPS. The main side effect is drowsiness. However, this may be a benefit because it helps the patient to sleep better at night and get up to pass urine less frequently. The only antihistamines that have been specifically studied for IC/BPS are hydroxyzine and (more recently) cimetidine. It is not known whether other antihistamines also help treat IC/BPS. AmitriptylineAmitriptyline is described as an antidepressant, but it actually has many effects that may improve IC/BPS. It has antihistamine effects, decreases bladder spasms, and slows the nerves that carry pain messages. Amitriptyline is widely used for other types of chronic pain such as cancer and nerve damage. The most common side effects are drowsiness, constipation and increased appetite. HeparinHeparin is similar to pentosan polysulfate and probably helps the bladder by similar mechanisms. Heparin must be placed into the bladder with a catheter. The usual dose is 10,000 to 20,000 units daily or 3 times a week. Complications are rare because the heparin stays in the bladder only and does not usually affect the rest of the body. Third Phase: Neuromodulation, Ulcer Cauterization and InjectionsNeuromodulation TherapyIf lifestyle changes and prescription drugs don't work, or pain or side effects interfere with your quality of life, more advanced therapies may be a better choice. You will most likely be referred to a specialist who treats patients with IC/BPS, such as a urologist. After reviewing your treatment history, the specialist may suggest neuromodulation therapy. Neuromodulation therapy is the name given to a group of treatments that deliver harmless electrical impulses to nerves to change how they work. Bladder Ulcer CauterizationIf you have a bladder ulcer, having it cauterized under anesthesia or having steriod injections may give long-term relief for up to a year or more. This treatment can be repeated if necessary. InjectionsSome injections of Botox® can be given if other treatments have not provided adequate symptom control and there is no improvement in quality of life. Small doses of this drug can paralyze muscles. When injected into the bladder muscle, it may help with the pain of IC/BPS. This treatment can wear off, and you may need to have another treatment 6 to 9 months after the first injection. Your health care provider should follow you closely to watch for complications, including difficulty in passing urine. Fourth Phase: CyclosporineWhen other treatments have not been successful, cyclosporine can be used. You should discuss this drug with your health care provider to decide if your symptoms justify the risks. There are many side effects, and because it is an immunosuppressant, it can reduce your ability to fight disease. Fifth Phase: SurgeryMajor surgery should be reserved for patients with severe, unresponsive disease, and who are willing to accept the risks and lifelong changes associated with surgery. Surgery can be offered to patients with severely limited bladder capacity or severe symptoms that have not responded to other therapies. Most patients do not require major surgery for this condition. Urinary bladder spasms occur when the bladder contracts involuntarily, which can cause a person to urinate. These spasms can be painful, and they may be embarrassing if they lead to an extreme urge to urinate or leakage of urine. A variety of conditions can cause bladder spasms, but fortunately there are many treatments available. In this article, learn what causes bladder spasms, how to prevent them, and how they relate to common bladder problems. Share on PinterestAn overactive bladder may cause bladder spasms. One of the most common conditions associated with bladder spasms is called overactive bladder (OAB). This is known to occur in people with urge incontinence. According to the Urology Care Foundation, associated with the American Urological Association, an estimated 30 percent of men and 40 percent of women in the United States experience symptoms of OAB. Urinary tract infections (UTIs) also frequently cause bladder spasms. UTIs occur when excess bacteria enter the urinary tract. In addition to bladder spasms, UTIs can cause pain in the lower abdomen, pelvis, back, and sides, as well as a fever, and a burning sensation when urinating. Other causes of bladder spasms include: Some diuretic medications may also contribute to bladder spasms. Share on PinterestBladder spasms may cause urine leakage or the need to urinate frequently. Other symptoms of bladder spasms usually depend upon the underlying cause. For example, additional OAB symptoms include:
People with autonomic disorders, such as Parkinson’s disease, multiple sclerosis, or Alzheimer’s disease, may be more likely to have bladder spasms. Autonomic disorders affect the autonomic nervous system, which is responsible for bladder contractions. As a result, a person may experience uncontrolled bladder spasms. Some symptoms of bladder spasms may mimic those of a UTI, even when an infection is not the underlying cause. Doctors can prescribe a variety of medications to reduce the incidence of bladder spasms. A doctor may first prescribe one of a group of medications called antimuscarinics. Examples include:
However, these medications can have undesired side effects, including pupil dilation, which can lead to light sensitivity, and dry mouth. If a person experiences ill effects, the doctor will prescribe a different medication. Tricyclic antidepressants can also be used to treat bladder spasms. These include amitriptyline (Elavil), doxepin (Sinequan), and imipramine (Tofranil). Additional therapiesDoctors may recommend treatments that complement medication. For example, if a person is retaining a significant amount of urine after they try to urinate normally, they may require self-catheterization. This involves inserting a thin, flexible catheter into the bladder, providing an exit route for urine. Another option is for a doctor to inject botulinum toxin (Botox) into the bladder wall. This can reduce the incidence of bladder spasms. A doctor may also recommend electrical nerve stimulation. This involves implanting or temporarily inserting a stimulator that sends electrical pulses to the nerves that affect the bladder. Share on PinterestGetting regular exercise and meditating may help prevent bladder spasms. For many people, stress can trigger or worsen bladder spasms. Taking steps to reduce stress whenever possible may lead to fewer spasms. Popular ways to reduce stress include:
A person may also use techniques to distract themselves from the urge to urinate. This is known as urgency suppression. Practicing pelvic floor exercises, such as Kegels, may also help reduce urine leakage. According to the National Institute of Diabetes and Digestive and Kidney Diseases in the U.S., no changes in nutrition have been shown to reduce the incidence of urinary incontinence. However, anecdotal evidence suggests that avoiding foods such as alcohol, tomatoes, caffeine, chocolate, and citrus drinks may help to reduce bladder symptoms. Bladder spasms usually only require emergency care when a person also has a high fever, severe pelvic pain, or a significant amount of blood in their urine. Anyone who has frequent bladder spasms, is not making it to the bathroom in time, or finds themselves leaking urine, should see a doctor. The doctor will evaluate symptoms and consider potential underlying causes before determining the best treatment plan. Bladder spasms may be uncomfortable, painful, and sometimes embarrassing, but they can be treated. People who regularly experience bladder spasms that lead to urinary incontinence should speak with a doctor. From medications to surgical interventions, many approaches can reduce the incidence of spasms and help a person to feel comfortable again. |