Interstitial Cystitis
  • Other Proposed Treatments for Interstitial Cystitis
  • References
En Español (Spanish Version)

Interstitial cystitis (IC) is a severe, chronic inflammation of the bladder that's both disruptive and painful. Many more women than men suffer from the condition—of the 700,000 people with IC, 90% are female.

The symptoms of IC are notoriously variable and can differ from one person to another, or for one person from day to day. People with IC usually have an urgent and frequent need to urinate. They may experience recurring discomfort, tenderness, pressure, or intense pain in the bladder and surrounding pelvic area. This pain often intensifies as the bladder fills and may be exacerbated by sexual intercourse.

Certain foods may trigger symptoms; the most commonly mentioned include tomatoes, vinegar, spicy foods, coffee, chocolate, alcohol, and fruits and vegetables particular to the individual.

IC is generally diagnosed after other conditions with similar symptoms, such as bladder infection , herpes , and vaginal infection , have been excluded.

The cause of IC is unknown. Although its symptoms resemble a bladder infection, IC does not appear to be caused by bacteria. One theory proposes that IC is caused by an infectious agent that simply hasn't been detected yet. A different theory holds that IC is an autoimmune reaction; still another, that it is related to allergies. Because it varies so much in symptoms and severity, IC may be not one disease but several.

A variety of treatments are often tried alone or in combination before one is found that works. Oral antihistamines such as hydroxyzine (Atarax) and certirizine (Zyrtec) may provide relief, and the drowsiness they produce often wears off over time. Other medications used for IC include pentosan polysulfate sodium (Elmiron), pyridium, and anti-inflammatory drugs.

Distending the bladder by filling it to capacity with water for 2-8 minutes is frequently useful, but although the beneficial effects may persist for months, symptoms usually return eventually. In some cases, medications such as dimethyl sulfoxide and heparin may be introduced into the bladder with a catheter; actual surgical alteration of the bladder is rarely used to treat IC.

Other Proposed Treatments for Interstitial Cystitis
Quercetin is a bioflavonoid that may have anti-inflammatory properties. A small double-blind placebo-controlled trial found that a supplement containing quercetin reduced symptoms of interstitial cystitis. 11

The amino acid arginine helps the body make nitric oxide, a substance that relaxes smooth muscles like those found in the bladder. Based on this mechanism, arginine has been proposed as a treatment for IC. 1,2

A 3-month, double-blind trial of 53 individuals with interstitial cystitis found only weak indications that arginine might improve symptoms of interstitial cystitis. 3 Several participants dropped out of the study; when this was properly taken into account using a statistical method called "ITT analysis," no benefit at all could be proven.

A very small double-blind study also failed to find arginine more effective than placebo. 4

There is some evidence that in interstitial cystitis the surface layer of the bladder is deficient in protective natural substances called glycosaminoglycans. 12 This in turn might allow the bladder to become inflamed; it might also initiate autoimmune reactions.

Based on these highly preliminary findings, using of supplemental glycosaminoglycans in the form of mesoglycan or chondroitin sulfate have been suggested for interstitial cystitis. 15 However, there is no reliable evidence as yet that they really work.

Transcutaneous Electrical Stimulation
Transcutaneous electrical stimulation, or TENS, is primarily used (with mixed results) in the treatment of muscular pain. It has also been tried in interstitial cystitis, but thus far the evidence that it works is highly preliminary. 13

Myofascial Physical Therapy
After locating painful areas in the pelvic floor muscles, a myofascial physical therapist uses her fingers to manipulate the tender areas to release tight muscle fibers. A study involving 81 women with interstitial cystitis and pelvic area pain were randomized to receive myofascial physical therapy or regular massage therapy for 10 treatments. 17 Those who received the myofascial approach experienced greater overall improvement, but bladder pain specifically did not differ between the groups.

Although there is no solid scientific evidence that dietary changes can relieve IC, many people find that certain foods increase their symptoms. The most frequently cited offenders are coffee, chocolate, ethanol, carbonated drinks, citrus fruits, and tomatoes. 14 Based on these reports, it may be worthwhile to experiment with your diet.

Guided Imagery
Extremely preliminary evidence suggests that guided imagery may help some women with IC. In one study, listening to a script designed to focus attention on healing the bladder, relaxing the pelvic-floor muscles, and quieting the nerves specifically involved in IC showed some benefit. Without an adequate placebo comparison, though, it is questionable whether these improvements were significant. 16

References Smith SD, Wheeler MA, Foster H Jr, et al. Improvement in interstitial cystitis symptom scores during treatment with oral L-arginine. J Urol . 1997;158:703–708. Wheeler MA, Smith SD, Saito N, et al. Effect of long-term oral L-arginine on the nitric oxide synthase pathway in the urine from patients with interstitial cystitis. J Urol . 1997;158:2045–2050. Korting GE, Smith SD, Wheeler MA, et al. A randomized double-blind trial of oral L-arginine for treatment of interstitial cystitis. J Urol . 1999;161:558–565. Cartledge JJ, Davies AM, Eardley I. A randomized double-blind placebo-controlled crossover trial of the efficacy of L-arginine in the treatment of interstitial cystitis. BJU Int . 2000;85:421–426. Smith SD, Wheeler MA, Foster H Jr, et al. Improvement in interstitial cystitis symptom scores during treatment with oral L-arginine. J Urol . 1997;158:703–708. Ehren I, Lundberg JON, Adolfsson J, et al. Effects of L-arginine treatment on symptoms and bladder nitric oxide levels in patients with interstitial cystitis. Urology . 1998;52:1026–1029. Rodriguez LV, Janzen N, Raz S, et al. Treatment of interstitial cystitis with a quercetin containing compound: a preliminary, double-blind placebo control trial. Presented at: American Urological Association 2001 Annual Meeting; June 2–7, 2001; Anaheim, Calif. Hurst RE, Roy JB, Min RW, et al. A deficit of chondroitin sulfate proteoglycans on the bladder uroepithelium in interstitial cystitis. Urology . 1996;48:817. Fall M, Lindstrom S. Transcutaneous electrical nerve stimulation in classic and nonulcer intersitial cystitis. Urol Clin North Am . 1994;21:131–139. Erickson DR. Interstitial cystitis: update on etiologies and therapeutic options. J Womens Health Gend Based Med . 1999;8:745–758. Palylyk-Colwell E. Chondroitin sulfate for interstitial cystitis. Issues Emerg Health Technol. 2006;84:1-4. Carrico DJ, Peters KM, Diokno AC. Guided imagery for women with interstitial cystitis: results of a prospective, randomized controlled pilot study. J Altern Complement Med. 2008 Jan 16. FitzGerald MP, Payne CK, Lukacz ES, et al. Randomized multicenter clinical trial of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome and pelvic floor tenderness. J Urol. 2012 ;187(6):2113-2118.
Last Reviewed August 2013

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