Cystitis

Interstitial Cystitis

Symptoms of Interstitial cystitis is urinary frequency, pelvin pain, urinary urgency. Although extensively studied, no effective treatment is available now.

Medical therapy

Patient education is very important in treatment of interstitial cystitis (IC). patients with IC have an immediate, complete, and durable response to a particular therapy is not likely. Reassurance, physical and emotional support are important during treatment.


Treatment of IC should be non invasive, least expensive, and safe therapy. This include dietary and fluid management. Also there are time and stress management, behavior management.

Options include acupuncture, hypnosis, electrical stimulation, pharmacological agents.

There is always a combining a host of therapies to a patients before asssess the patient's response to each of the treatment. Patients must receive extensive counseling about the nature and prognosis of their conditions and the treatment effect. such counseling must be initiated prior to starting on invasive interventions.

dietary measures can be effective. Certain foods, including coffee, alcohol, tomatoes, vinegar, spicy foods, chocolate, and particular fruits and vegetables, have been implicated in aggravating symptoms of IC and, in the opinion of some authors, can precipitate symptomatic flares. Avoiding these food items or substituting other food items is often advised.patients are instructed to fill out a food diary, recording the relationship between the consumption of various food and drink items and their IC symptoms.

Pain management can be difficult in patients with IC. Most clinicians tend to avoid the extensive use of narcotics in patients with IC. When the pain component becomes unresponsive to nonnarcotic agents, referral to a chronic pain management facility may be helpful.

 

Drug Category: Antihistamines - These agents inhibit binding to H1 histamine receptor.

Drug Name	Hydroxyzine (Atarax, Vistaril)- H1 histamine receptor blocker. May inhibit mast cell secretion and may suppress histamine activity in subcortical region of CNS.
Adult Dose	25-75 mg/d PO
Contraindications	Documented hypersensitivity; narrow-angle glaucoma
Interactions	Potentiates effects of CNS depressants; MAOIs may potentiate anticholinergic effects
Pregnancy	C - Safety for use in pregnancy has not been established.
Precautions	May cause sedation, urinary retention, and dry mouth; may exacerbate narrow-angle glaucoma, hyperthyroidism, and peptic ulcer disease

Drug Category: Antidepressant, tricyclic- These agents increase the synaptic concentration of serotonin and/or norepinephrine in the CNS.

Drug Name	Amitriptyline (Elavil)- Oral tricyclic antidepressant. Inhibits reuptake of serotonin and/or norepinephrine at presynaptic neuronal membrane, which increases concentration in CNS. May have anticholinergic and sedative effects.
Adult Dose	25-75 mg PO hs
Contraindications	Documented hypersensitivity; MAOIs in past 14 d; history of seizures, cardiac arrhythmias, glaucoma, and urinary retention
Interactions	Phenobarbital may decrease effects; coadministration with CYP2D6 enzyme system inhibitors (eg, cimetidine, quinidine) may increase amitriptyline levels; inhibits hypotensive effects of guanethidine; may increase effects of CNS depressants and barbiturates; may increase hypotensive effects of sildenafil
Pregnancy	D-Unsafe in pregnancy.
Precautions	May cause cardiac arrhythmias and dry mouth; caution in cardiac conduction disturbances and history of hyperthyroidism, renal impairment, or hepatic impairment; avoid in elderly persons

Drug Category: Urinary analgesics- These agents relieve pain locally.

Drug Name	Pentosan polysulfate sodium (Elmiron) - Negatively charged synthetic sulfated polysaccharide with affinity for mucosal membranes. Repletes defect in glycosaminoglycan layer.
Adult Dose	100 mg PO tid
Contraindications	Documented hypersensitivity; hepatic insufficiency (metabolized in liver); history of heparin-induced thrombocytopenia
Interactions	May increase effect of anticoagulants
Pregnancy	B - Usually safe but benefits must outweigh the risks.
Precautions	May cause GI upset; risks and benefits of continued use beyond 6 mo in patients that show no response is unknown

 

Drug Category: Renal and Genitourinary Agents- These agents are used for the symptomatic relief of interstitial cystitis.

Drug Name	Dimethyl sulfoxide, ie, DMSO (Rimso-50) - Provides anti-inflammatory action, membrane penetration, antifungal activity, cryoprotective effects for living cells and tissues, collagen dissolution action, mast cell stimulation, nerve blockade, diuresis, cholinesterase inhibition, vasodilation, and muscle relaxation. May be combined with heparin, steroids, or bicarbonate.
Adult Dose	Instill 50 mL of aqueous 50% solution directly into bladder by catheter or Asepto syringe and allow to remain for 20 min
Contraindications	Documented hypersensitivity; UTI; recent bladder biopsy
Interactions	May decrease formation of active metabolite of sulindac, possibly resulting in decreased therapeutic effect
Pregnancy	X-Contraindicated in pregnancy.
Precautions	Produces garlic breath odor (approximately 20%); may cause chemical cystitis (5-10%); symptoms may worsen initially (10-15%); severe peripheral neuropathy has occurred when topical DMSO was used concurrently with sulindac

Drug Category:Cauterizing agents - These agents are used for the removal of granulation tissue.

Drug Name	Silver nitrate - Used for caustic, antiseptic, and astringent qualities.
Adult Dose	Administer concentrations ranging from 1:5000 to 2% intravesically for 2-10 min
Contraindications	Documented hypersensitivity; known VUR
Interactions	None reported (no controlled clinical trials)
Pregnancy	C- Safety for use during pregnancy has not been established.
Precautions	Not for systemic use; high concentrations require regional or general anesthesia

Drug Category: Dermatological Agents- These agents are used for their cleansing and disinfection and for the removal of necrotic debris.

Drug Name	Sodium oxychlorosene (Clorpactin WCS-90) - Exerts detergent action on bladder mucosa. Reserved for patients in whom DMSO or silver nitrate instillations fail.
Adult Dose	Administer 0.4% solution intravesically for 2-3 min at 60-80 cm water pressure (4-6 treatments qwk)
Contraindications	Documented hypersensitivity; known VUR
Interactions	None reported
Pregnancy	C- Safety for use during pregnancy has not been established.
Precautions	Requires at least regional anesthesia; results in troublesome suprapubic pain and discomfort for 48-72 h; protect skin from caustic spillage; not for systemic use

Drug Category: Polysaccharide glycosaminoglycans- These agents may exert a protective effect on the bladder.

Drug Name	Heparin - Shown to reduce relapses in patients who respond to DMSO. Analog to polysaccharide glycosaminoglycan lining of the bladder.
Adult Dose	10,000 U intravesically in 10 mL sterile water monthly
Contraindications	Documented hypersensitivity; severe thrombocytopenia, abnormal coagulation test results
Interactions	May increase effects of anticoagulants and platelet inhibitors
Pregnancy	C - Safety for the use in pregnancy has not been established.
Precautions	May cause hemorrhage and hypersensitivity

 

surgical therapies

• Urinary diversion
• Electrical stimulation
• TENS
• Laser photoradiation
  
• Peripheral denervation
• Bladder augmentation
• 
  

 

Complications

classic interstitial cystitis (IC) may lead to bladder wall scarring that results in a contracted small-capacity bladder.Other long-term sequelae of IC are unknown. However, due to the chronic nature of the condition and the significant impact on the patient's quality of life, the psychological impact of the condition can be enormous. Ongoing emotional support is essential.

Prognosis

Interstitial cystitis (IC) is a chronic condition with poor effects. Education and emotional support is the most important element during treatment. No treatment has been shown to decrease disease progression and so the aim of the treatment is to alleviate symptoms and palliate symptoms.

 

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