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How is bladder Pain and Interstitial Cystitis treated?

Interstitial Cystitis / Bladder Pain Syndrome (IC/BPS) is a complex condition and can be challenging to treat, both for doctors and patients. Your specialist will discuss the available treatments in detail with you. It may be necessary to try a number of different treatments before finding the right one for you and treatments which help one patient do not necessarily help another, even if their symptoms are very similar.

It is important to accept that these treatments may not cure the pain. Most treatments can make IC/BPS symptoms better and more tolerable but usually some degree of intrusive pain remains. The symptoms can wax and wane and flare-ups can sometimes be triggered by stress or other illnesses. The aim of treatment is to make the condition manageable rather than to get rid of it completely.

As well as treatments to help the bladder, it can be helpful to see a specialist in pain management who can help with more advanced pain treatment options. They can also provide much-needed support. Because of the impact of Interstitial Cystitis / Bladder Pain Syndrome on people's overall life, psychological support and cognitive behavioural therapy are often very helpful.

Dietry changes

Some patients find that their symptoms are made worse by certain foods ("trigger foods"). These tend to vary from patient to patient, although there appear to be a list of foods which are commonly implicated. It might be worth experimenting by cutting out a certain foods for 2 weeks, and then reintroducing it to see if your symptoms change.

The following foods are often implicated in Interstitial Cystitis / Bladder Pain Syndrome. If you eat these foods, the pain might be worse and if you avoid them, the pain could be better. Every patient is different and not everyone reacts to the same foods, however.

  • Alcohol, especially white wine
  • Caffeinated drinks, like tea and coffee
  • Fizzy drinks
  • Many fruit juices (other than blueberry or pear)
  • Spicy foods
  • Chocolate (also contains caffeine)
  • Fruit – particularly berry fruits and grapefruit
  • Tomatoes
  • Onions

Tablets

There are a variety of medications which can help with Bladder Pain Syndrome. Some patients also benefit from treatments which are delivered directly into the bladder through a catheter.

  • amitryptiline
  • pentosan polysulphate (Elmiron)
  • antihistamines
  • anticholinergics (oxybutynin, solifenacin, detrusitol, trospium etc)

Treatment delivered into the bladder

  • Cystistat (Hyaluronan)
  • Condroitin
  • iAluRil
  • DMSO
  • Local anaesthetics (eg lignocaine) and "Parson's solution"
  • Oxybutinin

Interventional treatments

  • Distension of bladder with baldder cauterisation
  • Botox bladder injections
  • Sacral neuromodulation
  • Cystectomy (removal of the bladder)

Bladder distention can help to determine whether the bladder reacts abnormally to filling up. It can sometimes reveal areas of inflammation within the bladder. If there is an inflamed area or an area of damage to the bladder lining, this is called a "Hunner's Ulcer". If a Hunner's ulcer is found, cauterisation of this area can be highly effective in improving the bladder pain symptoms. Although the symptoms may come back, the pain can be kept under control for a significant period of time (months and sometimes years).