Understanding Your Treatment Options for Interstitial Cystitis

Do you often experience a painful urge to urinate, even if you don’t necessarily have to go? You may have a chronic condition known as interstitial cystitis (IC). Between 3 million and 8 million American women suffer from this condition, which can also cause severe, recurring bouts of pressure and pain in your bladder. In fact, the symptoms of IC can disrupt your life in significant ways, including missing work.

Because September is Interstitial Cystitis Awareness Month, we thought we’d shed some light on the treatment options for this prevalent and uncomfortable issue. If you think you may have this condition, we encourage you to schedule an appointment with Dr. Melissa Delgado or one of our nurse practitioners — Wendy Roberts or Amanda McClay — at The Chronic Pelvic Pain Center of Northern Virginia.

When you first come in, we take a detailed medical history and do a gentle pelvic exam. We then discuss your treatment options and develop a customized treatment plan. We integrate prescription medicine with supplements and herbs to help treat the root causes of your IC, namely inflammation, infection, and bacterial biofilms.

Lifestyle changes

Certain activities and behaviors may increase the frequency of flare-ups, so making some changes in your habits may help. Try to wear loose clothing, reduce stress as much as you can using mindfulness techniques, and avoid food and drinks that irritate your bladder, such as caffeine and citrus fruits. We can supply you with a list of IC-friendly foods and drinks that can help you avoid a flare-up.

Medications and supplements 

We use a combination of medication and supplements for interstitial cystitis that addresses the infection, inflammation, and biofilms. Some of the first oral options we typically recommend are aloe vera, uribel, calcium, vitamin D, quercetin, alkaline water, and low-acid multivitamins. 

Bladder instillations

Bladder instillations, or bladder cocktails, are mixtures of medicines that we put directly into your bladder. The instillations we use are a type of local anesthetic, which helps decrease symptoms of urinary urgency, urinary frequency, bladder pain, bladder awareness, and bladder spasms. 

These instillations work well during a flare-up and can decrease the intensity and frequency of your symptoms. Most of our patients experience symptoms that last for several hours to several days, and symptoms diminish with each bladder instillation. 

We can administer the instillation in our office, or you can do it at home with a prescription. Most of our patients opt to have the installation done in our office, and the process takes about 15 minutes. Most patients tolerate the procedure well, with a few reporting mild discomfort during catheter placement.

Ozone therapy

Ozone is a gas derived from oxygen — it’s a molecule that consists of three oxygen atoms (O3) instead of two oxygen atoms (O2). We use ozone therapy to treat interstitial cystitis in a procedure called a bladder insufflation, which we perform weekly after a bladder instillation until your symptoms subside. These insufflations may be done 2-3 times per week depending upon the severity of your symptoms, and you may require periodic booster treatments in order to stay symptom-free.

Physical therapy 

Another effective weapon in the battle against IC is physical therapy, specifically pelvic floor therapy, which works extremely well for women who experience pelvic floor dysfunction or pain. Women with IC typically have several chronic overlapping pain conditions, and pelvic floor dysfunction is one of them. The pelvic floor muscles that are often tight in patients with the condition increase pain and inflammation in the area. 

Working with a pelvic floor physical therapist can help relieve the pain associated with interstitial cystitis, pelvic floor dysfunction, painful intercourse, and vaginal spasm, helping you develop better control over your pelvic floor muscles.

Surgical procedure 

If your IC resists less invasive measures, we may turn to a cystoscopy with hydrodistention under anesthesia to both diagnose and treat your IC. Although we can usually diagnose IC through a clinical history, physical exam, and Pelvic Pain and Urgency/Frequency Symptom Scale (PUF) questionnaire, a cystoscopy with hydrodistention can help us clarify your diagnosis and decrease your IC symptoms. 

To perform a cystoscopy, we use general or regional anesthesia and then slowly stretch your bladder with fluid (hydrodistention). We then insert a cystoscope to take a closer look inside your bladder in order to check for changes that are typical of IC, including the presence of pinpoint-sized red marks on your bladder wall, also called glomerulations or petechial hemorrhages. 

This procedure also allows us to spot Hunner’s ulcers or patches and glomerulations, which are present in a small number of people with IC. 

Cystoscopy with hydrodistention is no longer considered the gold standard in the diagnosis of IC because we can also see glomerulations upon hydrodistention in those without IC symptoms. Also, sometimes the degree of severity of the glomerulations does not correlate with the severity of your IC symptoms, and some people with symptoms of IC do not have glomerulations.

Ultimately, your treatment plan depends on your symptoms and any overlapping conditions you have. While you may experience a bit of immediate relief, it could take at least six months or more to significantly reduce your pain.

To get started on an individualized treatment plan for your interstitial cystitis — and get your life back — click here to request your appointment online or call our office in Annandale, Virginia, at 571-261-8069.

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