Treatment for Interstitial Cystitis
How do doctors treat IC?
Researchers have not found one treatment for interstitial cystitis (IC) that works for everyone. Doctors aim current treatments at relieving symptoms in each person on an individual basis.
A health care professional will work with you to find a treatment plan that meets your needs. Your plan may include
- lifestyle changes
- bladder training
- physical therapy
- bladder procedures
Some treatments may work better for you than others. You also may need to use a combination of these treatments to relieve your symptoms.
A health care professional may ask you to fill out a form, called a symptom scale, with questions about how you feel. The symptom scale may allow a health care professional to better understand how you are responding to treatment.
You may have to try several different treatments before you find one that works for you. Your symptoms may disappear with treatment, a change in what you eat, or without a clear reason. Even when your symptoms go away, they may return after days, weeks, months, or even years. Researchers do not know why. With time, you and your doctor should be able to find a treatment that gives you some relief and helps you cope with IC.
Change your eating habits. Some people with IC find that certain foods or drinks trigger their symptoms. Others find no link between symptoms and what they eat. However, be sure to drink enough water to stay hydrated. Talk with your health care professional about how much liquid you should drink to prevent dehydration based on your health, how active you are, and where you live. Read more about eating, diet, and nutrition and how they relate to IC.
Quit smoking. Some people feel that smoking makes their IC symptoms worse. Researchers don’t know exactly how tobacco affects IC. However, smoking is a major cause of bladder cancer. If you smoke, one of the best things you can do for your bladder and overall health is to quit.
If you smoke or use other tobacco products, stop. Ask for help so you don’t have to do it alone. You can start by calling the national quitline at 1-800-QUITNOW or 1-800-784-8669. For tips on quitting, go to Smokefree.gov.
Reduce stress. Researchers don’t think stress causes IC, yet stress can trigger painful symptom flares in some people with IC. Learning to reduce stress in your life by taking time to relax every day may help control some symptoms of IC.
Be physically active. If you have IC, you may feel that the last thing you want to do is be physically active. However, many people feel that easy activities like walking or gentle stretching exercises help relieve symptoms.
Get support. Having the emotional support of family, friends, and other people with IC is a very important part of helping you cope. People who learn about the disorder and become involved in their own care do better than people who do not.
Bladder training may help your bladder hold more urine. People with bladder pain often get in the habit of using the bathroom as soon as they are aware of any need to go to avoid pain or urgency. They then feel the need to go before the bladder is really full. The body may get used to urinating often. Bladder training helps your bladder hold more urine before your body tells you to urinate.
Keep a bladder diary (79 KB) to track how you are doing. Start by writing down the times when you urinate. For example, you may find that you return to the bathroom every 40 minutes. Try to wait a few more minutes and gradually stretch out the time between urinating. This may be easier if you are well hydrated. Read more about the importance of getting enough liquids in your diet.
If your bladder becomes painful, use the bathroom. You may find that your first urge to use the bathroom goes away if you ignore it. Find ways to relax or distract yourself when the first urge strikes.
After a week or two, you may be able to stretch the time out to 50 or 60 minutes, and you may find that the urge to urinate does not return as soon.
If you have IC symptoms or pelvic floor muscle spasm, your doctor may suggest that you work with a physical therapist who specializes in pelvic floor problems. The physical therapist will work to stretch tight pelvic floor muscles and help you keep them relaxed.
Your doctor may suggest that you take over-the-counter (OTC) pain medicine to help control mild bladder pain, including:
Talk with your doctor if you feel you need a stronger pain medicine. If you have severe pain, you may need your doctor to prescribe narcotic analgesics, or pain-relieving medicines, such as acetaminophen with codeine or longer-acting narcotics.
However, long-term use of pain medicines can be dangerous. Talk with your doctor about how to safely manage your chronic, or long-term, pain—possibly with the help of a pain specialist, a doctor who diagnoses, treats, and manages pain. You may also want to discuss alternatives to pain medicines or complementary pain medicines.
If lifestyle changes, bladder training, physical therapy, and pain medicines don’t do enough to relieve your IC symptoms, your doctor may prescribe other medicines, including:
- pentosan polysulfate (Elmiron)
- tricyclic antidepressants or antihistamines
- botulinum toxin A (Botox) injections into your detrusor muscle
All medicines, even OTC medicines, have side effects. Always consult a doctor before using any medicine or supplement for more than a few days.
Some people who have IC find relief after a treatment in which a doctor puts a small amount of liquid medicine into the bladder, called bladder instillation or a bladder wash or bath. The doctor guides a tube called a catheter into your bladder and slowly adds a liquid that eases irritation of the bladder wall. The liquid may be a compound called dimethyl sulfoxide (DMSO) or a solution that contains heparin, steroids, and a topical anesthetic, such as short-acting lidocaine, or long-acting marcaine.
You will be asked to keep the liquid in your bladder for about 15 minutes and then release it. You can have this treatment once every week or every other week for 1 or 2 months. You may not feel any better until the third or fourth treatment.
A doctor may use a procedure called bladder stretching, or hydrodistention, to treat your bladder pain, if only for a short time. Bladder stretching occurs when a doctor stretches your bladder by filling it with fluid. You will be given a local or general anesthesia to help you tolerate the bladder stretching.
Some people have temporary relief of their symptoms after this treatment. Researchers are not exactly sure why bladder stretching helps some people. Stretching may temporarily block pain signals sent by nerves in the bladder.
Sometimes your pain symptoms may temporarily get worse 4 to 48 hours after bladder stretching. However, your pain levels should return to your previous level or improve within 2 to 4 weeks.
If none of the other treatment methods work, your doctor might suggest bladder surgery to enlarge or remove your bladder. Surgery does not cure the pain of IC in all cases. If you have tried every other option and your pain is still unbearable, you and your doctor may consider surgery. Most people with IC do not require surgery. Serious possible complications of surgery may include kidney infection and small bowel obstruction. Talk with your doctor and family about the possible benefits and side effects of bladder surgery.
Bladder augmentation. Doctors use a surgical procedure called bladder augmentation to make the bladder larger. During bladder augmentation, a doctor removes scarred and inflamed sections of your bladder and leaves only the base of the bladder. The doctor then removes and reshapes a piece of your colon and attaches it to what remains of the bladder. After you heal, you may urinate less often.
The effect the surgery has on pain varies greatly; IC can sometimes come back. Pain, urinary frequency, and urgency may remain or return after surgery. You also may have problems with bladder infections and a hard time absorbing nutrients with the shortened colon. Some people become incontinent, or unable to hold their urine, and others cannot urinate at all and must use a catheter.
Bladder removal. You and your doctor may decide to remove your bladder, a surgery called a cystectomy. Bladder removal surgery cannot be reversed and causes major lifestyle changes. For these reasons, doctors rarely suggest bladder removal.
Urinary diversion. Once a doctor surgically removes your bladder, he or she will create a new route to carry urine out of your body, a surgery called urinary diversion. In most cases, ureters are attached to a piece of small intestine or colon that opens onto the skin of your abdomen. This procedure is called a urostomy, and the opening is called a stoma. Urine empties through the stoma into a bag outside your body.
Some surgeons use an approach that allows urine to be stored in a pouch inside your abdomen. The pouch is made from a piece of the small intestine or colon. In either case, you will need to put a catheter into the opening, or stoma, to empty the pouch several times a day. You will need to be careful to keep the area in and around the stoma clean to prevent infection.
Even after having their bladders totally removed, some people still have some phantom pain. Phantom pain is pain that feels real, but isn’t actually there. The decision to have a cystectomy should be made only after you and your doctor try all other options and seriously consider the possible outcome of bladder removal.
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.