Other Treatments for IC
Multiple, complementary treatments often are used for interstitial cystitis. In addition to medication, other types of treatment include biophysical techniques (e.g., behavioral changes, stress management, dietary changes) and surgery.
Biophysical techniques used to control IC symptoms include physical therapy of the pelvic floor, bladder retraining, transcutaneous electrical nerve stimulation (TENS), stress reduction with biofeedback, diet modification, and exercise.
The chronic irritation of the bladder seen in IC can eventually up-regulate the nerve supply to the pelvic floor muscles, resulting in their increased spasticity and tension. The pelvic floor muscle groups share the same nerve roots as the bladder at the level of the sacral spinal cord and are "wound up" as a result of the bladder irritation. This results in symptoms or urinary frequency and urgency, as well as pelvic pain.
Pelvic floor rehabilitation uses "hands-on" and internal physical therapy to relax pelvic muscle trigger points, release abnormal myofascial attachments, and provide deep tissue massage of these muscle groups in spasm. Biofeedback and electrical stimulation is often used as part of the "hands-on" technique to facilitate recovery. Neuromuscular re-education is critical for the return of normal functional activities of daily living, relief of pelvic pain, and return of normal urinary and bowel function.
This therapy can be performed only by specially-trained physical therapists and usually requires visits to the physical therapy office one or two times per week for at least two months.
Physical therapy for the pelvic floor muscles may help decrease pain and spasms. Bladder retraining is a self-help process in which patients learn to control their urge to urinate. The theory behind bladder retraining is that the bladder muscle actually weakens with frequent urination because it is not allowed to distend fully. Patients with IC experience the impulse to urinate frequently because they have pain or urgency as the bladder fills.
Bladder retraining programs vary. Generally, the patient schedules times for urination (a voiding schedule) and uses a series of relaxation techniques and distractions to help keep the schedule. The interval is progressively lengthened, thus strengthening the bladder muscle. Bladder retraining may be complicated by severe pain.
Transcutaneous electrical nerve stimulation involves the application of mild electric pulses to the body for minutes or hours a day. It is believed that the electric pulses increase blood flow to the bladder, strengthen pelvic muscles that aid in control, and trigger the release of pain-blocking hormones. TENS therapy may help with IC pain, though it may take a couple of months before any benefit is realized. A TENS device is worn outside of the body, usually near the sacral nerve.
Sacral Nerve Stimulation to Treat IC
The InterStim® device, a relatively new treatment for bladder control problems, is being used experimentally in preclinical trials to evaluate its effects on IC. The device (which is about the size of a silver dollar) is implanted under the skin of the lower back, near the sacral nerve, where it delivers electrical pulses to the nerves involved in bladder function. It may help control the frequency, urgency, and pain associated with IC, although the Food and Drug Administration (FDA) has not approved it for IC therapy.
Surgery is rarely performed today, and only when all other treatments fail to provide relief. It may be ineffective and may worsen IC symptoms.
Laser burning (fulguration) and surgical removal (resection) are two methods used to remove Hunner's ulcers from the bladder in ulcerative IC. They are performed with a cystoscope inserted through the urethra under general anesthesia.
Urinary diversion involves creating a tube in the abdomen from intestinal tissue, rerouting the tubes that carry urine from the kidneys (ureters) to the tube, and connecting it to an opening (stoma) in the abdomen. Urine then drains continuously into a collection bag that can be emptied as necessary. Alternatively, an internal pouch, known as a Koch, Florida, or Indiana pouch, may be constructed from intestinal tissue to hold urine from the ureters. The patient periodically drains the pouch through the stoma with a self-administered catheter.
Bladder removal (cystectomy) may be performed with urinary diversion and internal pouch procedures.
Augmentation cytoplasty is performed rarely in cases where heavily scarred portions of the bladder need to be removed, though it is not considered a standard treatment. A section of intestinal tissue may be cut and shaped to replace the damaged portion of the bladder. It is attached to the remainder of the natural bladder so that urine can be stored and expelled through the urethra.