Treatment of interstitial cystitis

Interstitial cystitis (IC), or painful bladder syndrome (PBS), is a chronic syndrome characterised by the progressive destruction of the most superficial layer of the bladder (the GAG layer), which makes it increasingly sensitive to any stimulus, causing symptoms such as:

• increased urinary frequency
• urgency
• suprapubic pain
• very limited bladder capacity
• nocturia

IC/PBS is caused by multiple factors acting simultaneously:

• bladder inflammation
• muscle contraction
• neuropathy

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These are the available treatments:

• GAG (Glycosaminoglycans)
• Bladder instillations
• Infiltrations
• Bladder hydrodistension
• Tibial nerve stimulation
• Behavioural strategies
• Pelvic floor relaxation
• Electrical therapies
• Hyperbaric oxygen therapy, vaginal pessaries and liposomes
• Sacral neuromodulation
• Surgical therapies

Here you can find a list of professionals specialised in the treatment of interstitial cystitis affiliated with our association.

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Initially, it is necessary to repair the protective layer of the bladder epithelium through the administration of GAGs (glycosaminoglycans). A study conducted on patients refractory to conventional treatments demonstrated the usefulness of the concomitant administration of:

• quercetin
• glucosamine sulphate
• chondroitin sulphate
• hyaluronic acid
• almond oil

both for the repair of the GAGs on the bladder surface and to reduce inflammation.

There are various supplements on the market that contain GAGs. Our association, thanks to twenty years of experience in contact with patients, has had Purorepair GAG Plus specially produced, a dietary supplement useful for strengthening and repairing the bladder wall, and Puronerv Dol to reduce pain and inflammation of the nerve endings.

At the same time, inflammation must be reduced through:

• antihistamines (Hydroxyzine acts on mast cells and must be administered for at least 2–3 months to achieve noticeable results; cimetidine reduces inflammation by inhibiting the activity of T lymphocytes)
• anti-inflammatory/painkillers (Aspirin and Moment can relieve pain in mild and early cases of the disease when the pain is not yet neurological; methylsulfonylmethane – MSM – reduces pain and inflammation)
• aliamides (reduce the activity of inflammatory mast cells)
• natural substances (quercetin, boswellia, horsetail)

It is essential to prevent further bladder infections, which would reactivate inflammation and worsen the condition. D-mannose is a simple sugar that binds to bacteria present in the bladder; unable to adhere to the bladder wall, they remain suspended in the urine and are eliminated through urination. D-mannose also binds to the toxins produced by bacteria that damage the GAG layer and reach the deeper, more fragile and unprotected mucosal layer, where they then take hold.

Equally important is the relaxation of the pelvic muscles through intravaginal massages, muscle relaxants, electrical therapies, and reverse Kegel exercises, which help to reduce symptoms.

Many of these therapeutic substances can be taken orally, inserted directly into the bladder via bladder instillations, or injected with a needle directly into the muscle or bladder mucosa (infiltrations).

In some patients, bladder hydrodistension has reduced urgency, frequency, and pain.

When the pain shifts from the tissue to the nerves, anticonvulsants or antidepressants are more effective than local anti-inflammatories in controlling neurogenic pain. In this case, tibial nerve stimulation through acupuncture or PTNS, and electrical therapy (TENS and SEF) have also proven very useful.

Still little used but very promising are therapies with liposomes, vaginal pessaries, and hyperbaric oxygen therapy.

Behavioural modification strategies can improve symptoms by adhering to important rules regarding:

• diet
• urination habits
• exercise
• stress management
• hydration

Patients with severe symptoms who have not responded to standard treatments may benefit from opioid medications.

If all this is insufficient to make life acceptable, more invasive treatments (sacral neuromodulation) and less conservative options (bladder surgery) are used.

It is important to remember that the treatment of interstitial cystitis is currently only symptomatic and not curative (especially if the diagnosis is made very late), that the first benefits are only noticeable after several months of treatment, that the response to therapy is entirely subjective, and that the disease can flare up even during treatment.