Urology treats urinary tract diseases in all genders and male reproductive issues, covering the kidneys, bladder, prostate, urethra, from infections to complex cancers.
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The management of Interstitial Cystitis (IC/BPS) at Liv Hospital is defined by a personalized, tiered approach that adheres to international guidelines (such as the American Urological Association). Because the etiology of IC is multifactorial, no single treatment works for every patient. The therapeutic philosophy is to start with the least invasive, reversible therapies and escalate to more advanced interventions only if necessary. The goal is to control symptoms, maximize function, and improve quality of life, rather than promising an absolute “cure.”
The treatment plan typically involves a combination of lifestyle modifications, oral medications, intravesical therapies (bladder instillations), and physical therapy. This “cocktail” approach targets the disease from multiple angles: repairing the bladder lining, calming the nerves, relaxing the pelvic floor, and modulating the immune system.
The foundation of care involves non-medical interventions that empower the patient to manage their symptoms.
Physical Therapy: This is a critical component. Specialized Pelvic Floor Physical Therapy focuses on myofascial release to relax hypertonic muscles. It is distinct from Kegel exercises (which tighten muscles) and is often contraindicated in IC patients as it can worsen pain.
If lifestyle changes are insufficient, oral medications are introduced to modulate pain and inflammation.
Pain Management: Non-narcotic analgesics and NSAIDs are used for flares. Chronic opioid use is generally avoided due to the risk of dependence and “narcotic bowel syndrome” which can worsen symptoms.
Hyaluronic Acid/Chondroitin Sulfate: These are GAG layer replenishers instilled to coat the bladder lining and reduce permeability.
Neuromodulation (InterStim): A sacral nerve stimulator (pacemaker for the bladder) is implanted to modulate the neural signals between the bladder and the brain. It is effective for urgency and frequency but less so for pain.
Surgery is considered a last resort and is strictly reserved for patients with end-stage, small-capacity, fibrotic bladders (often severe Hunner’s lesion cases) who have failed all other therapies.
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The IC Diet involves avoiding foods that irritate the bladder, such as caffeine, alcohol, citrus fruits, tomatoes, chocolate, and spicy foods. It is not necessarily permanent. It is used as an elimination tool. Once symptoms stabilize, patients can reintroduce foods one by one to identify their specific triggers. Many patients find they can tolerate small amounts of “forbidden” foods once their bladder heals.
Most women with IC also have “High-Tone Pelvic Floor Dysfunction,” meaning the muscles supporting the bladder are in a constant state of spasm due to chronic pain. This tightness compresses nerves and worsens urinary urgency. Physical therapy uses internal and external massage (myofascial release) to relax these muscles, lengthen the tissues, and break the cycle of pain and tension.
Pentosan Polysulfate is generally well-tolerated, but common side effects include mild hair loss (alopecia), diarrhea, and nausea. A more serious, albeit rare, side effect discovered recently is pigmentary maculopathy, a condition affecting the retina of the eye. Patients on long-term Elmiron therapy are now recommended to have regular eye exams to monitor for retinal changes.
A bladder cocktail is a mixture of liquid medications instilled directly into the bladder through a catheter. It typically contains an anesthetic (like lidocaine) to numb pain, a coating agent (like heparin) to repair the lining, and a buffer (like bicarbonate). It provides immediate, temporary relief during severe pain flares and can be administered in the office or by the patient at home.
Botox is FDA-approved for overactive bladder and is used off-label for IC. It is effective at reducing frequency and urgency by relaxing the bladder muscle. However, its effect on pain is variable. The main risk is that it can relax the bladder too much, making it difficult to urinate, potentially requiring the patient to self-catheterize temporarily until the Botox wears off.
Interstitial cystitis (IC), also known as bladder pain syndrome (BPS), is a chronic condition. It causes bladder and pelvic pain, along with urinary urgency and
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