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
- Sodium Pentosan polysulfate (Elmiron)
Minimally Invasive Therapies
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
- Pentosan polysulfate
In patients with persistent symptoms, despite oral and/or intravesical therapy, more aggressive modalities may be recommended.
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.
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.
- Fulguration (laser ablation) or cauterization
- Resection of Hunner’s Ulcers
- Bladder Resection