A broad spectrum of therapeutic modalities is used for treating the range of symptoms of BPS/IC. Understanding the full spectrum of this type of diseases, including indications, and contraindications for each type of evaluation and each type of treatment, risks and benefits of treatment, follow-up treatment and alternatives for treatment of chronic pelvic pain, pressure, discomfort, urgency, nocturia, bladder ulcers and retention of urine is required. The management of BPS/IC is different for each patient and treatment is specific to each patient’s symptoms. Treatment continues until symptoms are relieved or bladder pain syndrome becomes manageable.

 

Conservative therapy

For patients with simple BPS/IC, conservative therapies are recommended:

• Behavioral therapies
• Dietary restrictions
• Nonprescription analgesics
• Stress reduction
• Pelvic floor relaxation
• Pelvic floor physical therapy

When conservative therapy fails oral medication and/ or further treatment is recommended

 

Oral Medication:

• Analgesics
• Antispasmodics
• Antidepressants
• Antihistamine
• Immunosuppressants
• Sodium Pentosan polysulfate (Elmiron)

 

Minimally Invasive Therapies

Intravesical Therapy

Bladder instillations are a part of treatment of BPS. It is a technique by which medications are infused directly into the bladder to help with pain and possible repair of the epithelium. Patients, who are comfortable and trained with the procedure, can self-administer treatment at home.

The intravesical therapy drugs:

• Dimethyl sulfoxide – DMSO
• Heparin
• Pentosan polysulfate
• iAluRil

In patients with persistent symptoms, despite oral and/or intravesical therapy, more aggressive modalities may be recommended.

 

Neuromodulation

Sacral nerve stimulation: Sacral neuromodulation therapy designed for patients with severe symptoms of urinary urgency and urinary frequency. It decreases urinary urgency and urinary frequency, decreases need for medications and improves pelvic pain symptoms.

Pudendal neuromodulation: This technique is used for patients who did not respond to sacral neuromodulation and has been shown to be effective in the management of pelvic pain and pudendal neuropathy.

Posterior tibial nerve stimulation (PTNS): PTNS is a less invasive form of neuromodulation. This treatment is intermittent and does not require invasive surgery or expensive implants.

 

Pelvic floor trigger-point injections

Pelvic floor injections may be used for patients with tender areas, trigger point and muscle spasms. The anaesthetics are mixed with anti-inflammatory drug to relax the muscles and relieve pain associated with symptoms of interstitial cystitis. If the symptoms are not improved, Botox can be injected into the pelvic floor to provide more sustained muscle relaxation.

 

Botox injections

Chemical neuromodulation with Onabotulinum Toxin A (Botox) injections into the trigone and lateral bladder walls have been investigated as a neuromodulator and used for patients with medication-resistant urinary urgency and frequency.

 

Surgical treatment

• Hydrodistention
Distention of the bladder with water for 2-15 min. Treatment can be repeated. Most positive studies show a 70%- 80% efficacy rate lasting for 3–6 months.

• Fulguration (laser ablation) or cauterization
Laser beam or electrical current is used to destroy ulcers, if they are seen at cystoscopy.

• Resection of Hunner’s Ulcers
Surgically removing the ulcers in the bladder. Usually used in milder forms of BPS/IC with ulcers.

• Bladder Resection
Cystoplasty and urinary diversion, total cystectomy and urethrectomy may be considered in patients with “end stage” bladders, after many years of conservative therapy.