The document discusses interstitial cystitis (IC), highlighting its symptoms, including bladder pain and frequent urination, and detailing various treatments such as oral medications, intravesical therapies, and surgical options. It describes oral therapies like pentosan polysulfate, tricyclic antidepressants, and antihistamines, as well as non-pharmacological approaches including supportive therapies and psychosocial support. Surgical interventions mentioned are bladder augmentation and neobladder procedures, though they are rarely performed.

1. Interstitial cystitis
Akshata Rao M.Pharm
Medical Services

2. Interstitial cystitis –background
Suprapubic pain with bladder filling associated with increased daytime
and nighttime frequency, in the absence of proven urinary infection
or other obvious pathology
Retrieved from http://emedicine.medscape.com/article/2055505-overview#a2

3. Interstitial Cystitis – Aetiology
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4. Cystoscopic findings
Interstitial cystitis
Ulcerative interstitial cystitis
(Hunner Cystitis)
Non-Ulcerative interstitial
cystitis
Distinctive inflammatory lesion
presenting a characteristic deep
rupture through the mucosa and
submucosa provoked by bladder
distension.
Presented like multiple
strawberry like patches known
as glomerulations
Bladder Pathology
By Liang Cheng, Antonio Lopez-Beltran, David G Bostwick

5. Symptoms
 Urgency,
 frequency,
 suprapubic/ pelvic pain,
 dyspareunia,
 flareups and remissions
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6. Therapies in Interstitial Cystitis
Am Fam Physician 2001;64:1199-206,1212-4.

7. Oral treatments
Pentosan polysulfate
1. Pentosan polysulfate is a highly sulfated, semisynthetic
glucosaminoglycan with chemical and structural similarities to
naturally occurring glucosaminoglycans.
2. It may take three to six months for patients to respond to pentosan
polysulfate.
3. The usual dosage is 100 mg orally three times per day. Adverse
reactions to pentosan polysulfate include diarrhea, dyspepsia,
reversible alopecia, headache, rash, dizziness, abdominal pain
and uncommon liver function abnormalities (1 to 4 percent).

8. Oral treatments
Tricyclic antidepressants
Am Fam Physician 2001;64:1199-206,1212-4.
1. Tricyclic antidepressants block pain arousal and are widely used in
pain clinics for their pain blocking effects.
2. No placebo-controlled studies with tricyclic antidepressants have
been performed,
3. But these medications have been found to be beneficial in several
open-label studies

9. Oral treatments
Antihistamines
Am Fam Physician 2001;64:1199-206,1212-4.
1. Use of hydroxyzine , an antihistamine, is based on the hypothesis
that histamine released by mast cell degranulation may be
responsible for symptoms of interstitial cystitis.
2. Hydroxyzine (in a dosage of 25 to 75 mg at bedtime) and the H2-
receptor antagonist cimetidine , in a dosage of 300 mg twice daily,
were both effective in open label studies

10. Oral treatments
Intravesicular pharmacotherapy
Intravesicular pharmacotherapy - Irrigation of urinary bladder Am Fam Physician 2001;64:1199-206,1212-4.
1. The most commonly used and only intravesical agent labeled by
the U.S. Food and Drug Administration for the treatment of
interstitial cystitis is dimethyl sulfoxide.
2. Although dimethyl sulfoxide is an anti-inflammatory agent, it seems
to have some analgesic and muscle relaxant properties as well.

11. Oral treatments
heparin
Am Fam Physician 2001;64:1199-206,1212-4.
1. In an open-label study, 56 percent of patients with interstitial
cystitis experienced relief from symptoms using heparin
intravesically, in a dosage of 10,000 U three times a week
2. Heparin instillation prolonged the response to dimethyl sulfoxide

12. Hyaluronic acid
1. Hyaluronic acid is a protective barrier of the urothelium
2. In a prospective randomised study a total of 30 patients were assigned to
receive four weekly intravesical instillations of 40 mg of hyaluronic acid
followed by five monthly instillations (hyaluronic acid-9 group). Another 30
patients received 12 intravesical instillations of 40 mg hyaluronic acid every
2 weeks (hyaluronic acid-12 group).
3. The Interstitial Cystitis Symptom Index, Interstitial Cystitis Problem Index
and total score, pain visual analog scale, functional bladder capacity,
maximum flow rate, and Quality of Life Index improved significantly after 6
months in both groups.
Oral treatments
International Journal of Urology Volume 20, Issue 2, pages 203–207, February 2013

13. Surgical therapies
1. Bladder augmentation (enlarging the bladder by attaching an
isolated segment of bowel to it),
2. Neobladder (a urinary reservoir made from a bowel or stomach
segment often used to replace the bladder after cystectomy and
urinary diversion) is rarely done

14. Non-pharmacological treatment
1. Supportive therapies include general measures that can alleviate
symptoms or prevent exacerbations.
2. Psychosocial support is important because it is an essential part of
any chronic pain treatment plan.
3. Support groups of persons with the same disorder may prove to be
useful.
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