Krajcir notes that in her early days of managing her own IC/BPS, hyper-focusing on restriction led her to develop food fear and nutrient deficiencies, which she finds in many of her clients too. It’s the reason you’ll want to work closely with your GP or a registered dietitian if you plan to explore an IC diet.
Pelvic floor physical therapy
For those experiencing pelvic floor tenderness or tightness (among their symptoms), the AUA specifically recommends pelvic floor physical therapy aimed at lengthening those muscles and softening scar tissue. Just note, this is not the same as doing pelvic floor-strengthening exercises like Kegels, which could make matters worse. Instead, a pelvic floor physical therapist might offer manual massage, walk you through stretches, and help you use a tool called a pelvic wand to release tension — the last of which Krajcir credits in part for her own relief.
Medications and procedures
The optimal choice in this department depends on whether or not you have those visible Hunner’s lesions. For people who do, the AUA suggests a procedure called fulguration, where a doctor essentially zaps the abnormal areas with a laser, or steroid injections, both done during a cystoscopy. (Though Dr. Moldwin notes that such procedures often need to be repeated, since these lesions tend to resurface.)
For those who don’t have Hunner’s lesions or pelvic floor troubles, the AUA guidelines present a handful of possible options; there’s not enough evidence to suggest any single treatment helps most people over time, so it’s up to your doctor to choose based on your symptoms and scenario.
If they suspect your bladder is harbouring some inflammation or oversensitive nerves, for instance, they might recommend an instillation. This involves filling your bladder with a solution of drugs (via a catheter) that can numb the lining and relax the muscle, and then letting you hang out with it in there for 15 or 30 minutes to see if your symptoms ease up, Dr. Moldwin says. “It’s like a temporary nerve block for the bladder,” he explains. If it works, they’ll likely have you come back every few weeks for repeat instillations, sometimes including a medication called heparin, which helps re-coat the bladder and patch holes in its protective layer, Dr. Bahlani says. There’s also one oral medication FDA-approved to help with IC/BPS called Elmiron (pentosan polysulfate), which is also thought to help restore that shield, but it’s not been shown to be consistently effective and comes with a risk of certain vision issues, so it isn’t very widely used these days.
If a bladder instillation doesn’t help, or your doctor thinks your pain is springing from a source outside of this organ, they might recommend oral meds that work systemically — say, a tricyclic antidepressant (like amitriptyline or nortriptyline) that can help block pain transmission or an antihistamine (like hydroxyzine or cimetidine) that can tamp down inflammation. There are also straight-up painkillers like OTC and prescription urinary analgesics (AZO, Cystex, Pyridium) that can temporarily numb things, as well as the usual acetaminophen, ibuprofen, and prescription opioids (though all of these mask, rather than resolve, symptoms). And if none of these things bring relief, or when frequency and urgency are the main concerns, your doctor may recommend neuromodulation. This involves implanting a small device in your lower back that sends electric pulses to the nerve regulating urinary function — and it’s the only thing that ultimately helped Claudia King, CEO of the ICA, get her life back from her bladder. That, and OTC pain meds like Cystex whenever the fiery feeling still hits, she reveals.
Kozal can keep the burning and urgency at bay largely by staying on top of her dietary triggers; Krajcir is now symptom-free, thanks to regular pelvic floor physical therapy and stress management. Finding relief looks different for every person with IC/BPS and often involves sampling a handful of therapies, Dr. Moldwin says. “One person might be on a dose of amitriptyline to diminish chronic pain, while also seeing a physical therapist, and another could be getting bladder instillations and working on behavioural changes to reduce pelvic floor tension,” he says. “There’s no cookie-cutter approach here whatsoever.”
This feature originally appeared on SELF.
If you are concerned about your bladder health, it’s always recommended to book an appointment with your GP to discuss diagnosis and treatment. You can find your local GP here.