Interstitial Cystitis is a very debilitating and progressive disease. Treatment of IC is very important in both the physical and medical health of the patient with this disorder.

The treatment of IC varies from very conservative to very invasive treatment. Your physician willtailor the appropriate treatment for each individual patients as different patients respond in various ways to the wide range of treatments available.

Dietary Modification

Diet modification is very important in the initial treatment of IC. It is well known that caffeine, alcohol and spicy or acidic foods can exacerbate IC.

Foods to Avoid

1. Vegetables

Tomatoes,fava and lima beans, onions

2. Fruits

Any citrus fruits, apples

3. Meats

Any canned meat (ie. they contain a large amount of acid), any smoked meat or fish.

4. Miscellaneous

Avoid any alcohol, caffeine, junk food, pepper, soy sauce, vinegar and salad dressing.Excessive vitamin C (greater than 500mg per day) can be irritating to the bladder. Tobacco is very irritating to the bladder.

Oral Medications

1. ELMIRON

Elmiron(pentosanpolysulfate sodium)

Elmironis a semi-synthetic carbohydrate derived from the bark of the beech tree.Elmiron works by restoring theglycosaminoglycan layer of the bladder lining.Elmironis the only oral medication available thattreatsinterstitial cystitis. Other oral medications treat the symptoms of IC.

The dose ofElmiron is 100mg three times perday. Patients require 6 -8 weeks to achieve relief of symptoms. Maintenancetherapy is required once relief is achieved. The dose ofElmiron can be increased to 200mg three times per day if there is only a partial response from Elmiron.

Studies show that there is up to 70% response rate from the use of Elmiron.

Side Effects ofElmiron

Elmironhas very few side effects. The following are the most common side effects:

1. nausea - 3.7%

2. diarrhea - 3.8%

3. headache - 2.9%

4. rash - 2.4%

Elmironis not recommended in patients who are pregnant.

2. Urine Alkalinization

Very acidic urine is well known to exacerbate the symptoms of IC. Urine is normally acidic. If patients do not improve with diet modification, patients can take in medications that decrease the amount of acid in the urine.

a. Sodium Bicarbonate

Sodium bicarbonate is the main substance in baking soda. It is very effective in reducing the amount of acid in the urine. One teaspoon in a glass of water two to three times a day is the recommended dose.

b.Sodium Citrate

Sodium citrate can also be used to alkalinize the urine.

3.Anticholinergic Medications

Anticholinergicmedications are drugs that are used to treat overactive bladder. They are also used to treat theirritative voiding symptoms of interstitial cystitis.Anticholinergic drugs work by blocking the nerves that sense filling of the bladder. This allows the patient's bladder to hold more and reduce the severe urgency and frequency of IC. These drugs do notreleive the pain associated with IC. The following are the most commonly used to treat urgency and frequency:

a. ditropan (oxybutinin)

Diropan is one of the most proven anticholinergic medications available. It is usually taken three times per day. The main side effect of ditropan is a dry mouth and constipation.

b.ditropan XL

Ditropan XL is a new medication and is currently available in Canada. It is taken once per day and the side effects are reduced.

c.detrol (tolterodine)

Detrol is a new anticholinergic medication which is taken two times per day. The side effects of detrol are much less than more traditional anticholinergic medications.

IntavesicalTreatments

Intravesicaltreatmentsrefers to drugs being placed directly into the bladder by a catheter. This usually requires a weekly instillation.

1. Heparin Instillation

Heparin is a drug which is used intravenously as an anticoagulant. In interstitial cystitis heparin is placed within the bladder. Heparin has bladder lining protective actions. It mimics theglycosaminoglycan (GAG)lining. It usually has to be given on a weekly basis by a catheter for six weeks.

Side effects are very rare. There is no absorption of the heparin into the rest of the body.

2. DMSO (dimethylsulfoxide )

DMSO is a solutionwdich is placed into the bladder every two weeks for 6 to 8 weeks. DMSO works as an anti-inflammatory, pain killer and muscle relaxant.

There are severe side effects of DMSO which include a severe irritation of the bladder following instillation of DMSO into the bladder. About 20% of patients experience this side effect following instillation. Another side effect is a garlic-like odor that is released from the body following instillation.

3. Cystistat (hyaluronic acid)

Hyaluronic acid is a naturally occurring substance which is found in eye fluids, bony joints and in the GAG layer of the bladder. Hyaluronic acid is placed through a catheter into the bladder on a weekly basis for 4 weeks and then on a monthly basis until symptoms improve. Symptoms may take up to nine months to improve.

Side effects: Side effects are rare with hyaluronic acid since it is a naturally occurring substance.

4. Uracyst-S

Uracyst-S (sodium chondroitin sulfate) is an intravesical treatment for interstitial cystitis.

Chondroitin Sulfate is a very prevalent bladder GAG component. Thus chondroitin sulfate theoretically is effective in restoring the GAG layer in the bladder which is deficient in interstitial cystitis.

Chondroitin sulfate is instiled into the bladder on a weekly basis for 4 to 6 weeks. It is then placed into the bladder on a monthly basis until symptoms resolve.

Resolvement of symptoms can vary and treatment may be required for up to one year.