Treatment Overview
Living with interstitial cystitis (IC), often called bladder pain syndrome, can be an isolating and physically draining experience. For many, the condition is defined by a persistent, urgent need to urinate and varying levels of pelvic pressure or pain. These symptoms can disrupt sleep, interfere with work, and make social outings feel stressful. While the exact cause remains a medical mystery for many patients, the condition is manageable.
Treatment is essential to reduce inflammation, repair the bladder lining, and calm the nerves that signal pain. Because symptoms fluctuate often flaring up in response to stress or certain foods, treatment plans are rarely static. They are highly individualized, often requiring a combination of oral medications and direct bladder therapies. A treatment that provides relief for one person may not be effective for another, so patience is often required to find the right regimen (National Institute of Diabetes and Digestive and Kidney Diseases, 2017).
Overview of treatment options for Interstitial Cystitis
The management of interstitial cystitis usually follows a step-wise approach. Doctors typically begin with conservative measures, such as dietary changes and stress management, before moving to medications. When lifestyle adjustments are insufficient, pharmacologic therapy becomes the primary tool for controlling symptoms.
Medications for IC are administered in two main ways: orally (pills) or via bladder instillations (liquid medication placed directly into the bladder through a catheter). The goal is to relieve pain, relax the bladder muscles, and reduce the frequency of urination. Treatment is often multimodal, meaning patients might take an oral medication daily to prevent symptoms while using other therapies to manage acute flare-ups (Urology Care Foundation, 2023).
Medications used for Interstitial Cystitis
The only oral drug specifically FDA-approved for IC is pentosan polysulfate sodium. It is prescribed to help repair the bladder’s protective coating. Clinical experience suggests that while effective, this medication works slowly, often taking three to six months for patients to notice significant relief.
For pain management and sleep improvement, tricyclic antidepressants (TCAs), such as amitriptyline, are widely used. These are prescribed at doses much lower than those used for depression. Antihistamines, specifically hydroxyzine, are also commonly prescribed to reduce inflammation and frequency.
When oral medications are not enough, doctors may recommend bladder instillations. Dimethyl sulfoxide (DMSO) is the primary drug approved for this use. It is inserted into the bladder and held there for a short period before being expelled. Sometimes, doctors use a “bladder cocktail” which may include lidocaine (a numbing agent), heparin, and bicarbonate to soothe the bladder wall immediately.
Over-the-counter pain relievers, such as ibuprofen or acetaminophen, are often used for mild discomfort but are rarely sufficient for severe flares (Mayo Clinic, 2022).
How these medications work
Pentosan polysulfate sodium functions by mimicking the glycosaminoglycans (GAGs) found in the protective mucus layer of the bladder. In many IC patients, this layer is defective or “leaky,” allowing urine to irritate the bladder wall. Pentosan acts like a bandage, replenishing this layer to shield the tissue from irritation.
Amitriptyline works by calming the nerves. It blocks pain signals from the bladder to the brain and helps relax the bladder muscle, which can reduce the urge to urinate. Hydroxyzine works by blocking histamine released by mast cells in the bladder, which is thought to play a role in the inflammation and pain associated with IC. DMSO works as a powerful anti-inflammatory and muscle relaxant, penetrating the bladder lining to reduce swelling and pain signals (Interstitial Cystitis Association, 2023).
Side effects and safety considerations
Pentosan polysulfate sodium (PPS) is usually well-tolerated but risks pigmentary maculopathy, an eye condition, with long-term use. Regular eye exams are needed. Other side effects include hair loss or GI upset.
Amitriptyline can cause drowsiness (take at bedtime), dry mouth, and weight gain. DMSO treatments often cause a temporary garlic-like odor on breath and skin.
Patients must inform doctors of pregnancy or plans to conceive, as many medications require caution. Seek immediate medical care for severe inability to urinate (retention) or signs of a bladder infection (fever, cloudy, foul-smelling urine).
Since everyone’s experience with the condition and its treatments can vary, working closely with a qualified healthcare provider helps ensure safe and effective care.
References
- Interstitial Cystitis Association. https://www.ichelp.org
- Mayo Clinic. https://www.mayoclinic.org
- National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov
- Urology Care Foundation. https://www.urologyhealth.org
Medications for Interstitial Cystitis
These are drugs that have been approved by the US Food and Drug Administration (FDA), meaning they have been determined to be safe and effective for use in Interstitial Cystitis.