Treatments for interstitial cystitis

Unfortunately, there's currently no cure for interstitial cystitis and it can be difficult to treat, although a number of treatments can be tried.

No single treatment works for everyone, however,and there's disagreement about how effective some of them are.You may need to try several treatments to find one that works for you.

Lifestyle changes will usually be recommended first. Medications and other therapies may be used if these don't help, and surgery may be necessary as a last resort.

Lifestyle changes

Lifestyle changes that may help improve your symptoms include:

• reducing stress anything that helps you relax, such as exercise orregular warm baths, may help reduce your symptoms
• avoiding certain foods or drinks (such as tomatoes and alcohol) if you notice they make your symptoms worse but don't make significant changes to your diet without seeking medical advice first
• stopping smoking the chemicals you breathe in while smoking may irritate your bladder
• controlling how much you drink try to reduce the amount you drink before going to bed
• planned toilet breaks taking regular planned toilet breaks may help stop your bladder becoming toofull

You may also find it useful to contact a support group, such as the Interstitial Cystitis Association or the Cystitis and Overactive Bladder (COB) Foundation for information and advice about living with interstitial cystitis.

Medication

Tablets or capsulesmay be used to treat people with interstitial cystitis, including:

• over-the-counter painkillers such as paracetamol and ibuprofen
• over-the-counter antihistamines such as loratadine and cetirizine
• stronger painkillers available on prescriptionsuch as amitriptyline, gabapentin and pregabalin
• tolterodine, solifenacin or mirabegron these help relax the bladder muscles
• pentosan polysulphate sodium (Elmiron) this may help repair the bladder lining

Some medications can alsobe passed directly into the bladder using a thin tube called a catheter . These are known as intravesical medications or bladder instillations.

Examples of intravesical medications include lignocaine (a local anaesthetic that numbs the bladder) and hyaluronic acidor chondroitin sulphate (medications that may help restore the bladder lining).

Supportive therapies and treatments

Some people also find the following therapies and supportive treatments helpful:

• physiotherapy massaging the pelvic floor muscles may help reduce any strain on your bladder
• bladder retraining where you gradually learn to be able to hold more urine in your bladder before needing to go to the toilet
• psychological therapy to help you cope with your symptoms and their impact on your life
• transcutaneous electrical nerve stimulation (TENS) where a small battery-operated device is used to relieve pain by sending electrical impulses into your body

Surgery and procedures

Surgery and other procedures may be recommended if you have clear abnormal areas (lesions) in your bladder or other treatments don't work.

Procedures that may be carried out include:

• cauterisation where ulcersinside the bladder are sealed using an electrical current or laser
• bladder distension where the bladder is stretched with fluid, which can aid diagnosis and may temporarily relieve your symptoms
• botulinum toxin injections where a substance called botulinum toxin (such as Botox) is injected directly into your bladder to temporarily relieve your symptoms
• neuromodulation where an implant that stimulates your nerves with electricity is placed in your body to relieve pain and reduce sudden urges to pee
• augmentation making the bladder larger using part of the small intestine; this usually also includes removing any inflamed areas of the bladder

In very rare cases, it may be necessary to remove the bladder completely (cystectomy). If this is done, your surgeon will need to create an alternative way for urine to leave your body.

This will usually be through a small hole in your tummy called a stoma, but might involve making a new bladder using part of your small intestine (bladder reconstruction).