Diagnosis
To diagnose, your urologist will first decide whether the symptoms are typical of BPS/IC. Your urologist will take a detailed medical history and perform a physical exam and urine tests for evaluation to rule out other conditions that might be causing the symptoms.
In most cases, painful bladder syndrome is a diagnosis of exclusion, meaning your doctor rules out other possible causes such as urinary tract infections, bladder cancer, and, in women, endometriosis.
Your urologist may discuss and recommend further diagnostic testing if IC is suspected. Testing may include:
- Potassium Sensitivity Test (PST) can be performed in the office, and recovery time is usually quick. A potassium solution and water are placed into the bladder one at a time, and pain/urgency scores are compared. A person with IC feels more pain/urgency with the potassium solution than with the water, but patients with normal bladders cannot tell the difference between the two solutions. This test is diagnostic for interstitial cystitis. Learn more.
- Cystoscopy with hydrodistention is performed under anesthesia. A scope or tube is inserted into the bladder. The bladder is stretched to see the pinpoint hemorrhages (bleeds) on the bladder wall that are the hallmark of this disease. A biopsy of the bladder wall may be necessary at this time to rule out bladder cancer and to help in the diagnosis of IC. Learn more.
Urinalysis, urine culture, and urodynamic testing may also be performed to assess bladder function, detect infection, and measure how much urine the bladder can hold and how quickly it empties.
- Urinalysis – Urinalysis involves examining a patient’s urine under a microscope to look for signs of infection or other disease.
- Urine culture – In a urine culture, urine is kept under conditions designed to allow any bacteria in the urine to grow. Doctors can then identify and treat the bacteria.
- Urodynamic testing – Urodynamic tests are tests designed to examine the function of the urinary tract. These tests can measure the amount of urine the bladder holds, how fast urine flows when released, and more.
Treatment
No single treatment works for everyone, and no treatment is “the best.” Treatments are individualized for every patient based on his or her symptoms. The usual course is multimodality therapy or using a combination of medications and other treatments until the patient gets good relief of their symptom(s).
The following two treatments are currently approved by the United States Food and Drug Administration (FDA) to treat BPS/IC:
- Medication: Oral pentosan polysulfate sodium (Elmiron) is taken one capsule three times a day on an empty stomach, and it may take several months to be effective. Only about 6% of the medication reaches the bladder, so some doctors may adjust the dose until symptoms are controlled.
- Bladder instillations: Dimethyl sulfoxide (DMSO) is instilled into the bladder through a catheter. Other instillation treatments may include a combination of lidocaine, heparin, and bicarbonate to soothe the bladder lining and neutralize acidic urine. These installations are typically performed under local anesthesia and may significantly improve pain and urgency. Some urologists combine DMSO with medications such as heparin or steroids to decrease inflammation.
Various other treatments are used for BPS/IC, though they are not specifically approved by the FDA.
- Antihistamine: It is thought that some patients have too much histamine in the bladder and that histamine promotes pain and other symptoms. Therefore, an antihistamine, such as hydroxyzine, can help treat BPS/IC.
- Antidepressants: Amitriptyline, an antidepressant, has many effects that may improve symptoms. It has antihistamine effects, decreases bladder spasms, and slows the nerves that carry pain messages.
- Heparin has anti-inflammatory and surface protective actions and may help temporarily “repair” the bladder layer.
- Overactive bladder medications: These may be used to reduce frequency and urgency while the bladder heals.
- Pain management: Many patients may not respond to any of the above BPS/IC therapies, but can still have significant improvement in their quality of life with adequate pain management. Pain management can include non-steroidal anti-inflammatory drugs, moderate-strength opiates, stronger long-acting opiates, nerve blocks, acupuncture, and other non-drug therapies.
Long-term, multimodality therapy layering treatments may be utilized until symptoms improve, and treatments are slowly tapered once stable relief is achieved.
Your physician may suggest following a strict diet for 3 weeks, avoiding alcohol, citrus, tomato and tomato-based products, chocolate, caffeinated coffee or tea (decaffeinated only), sodas, sparkling drinks, tap water, and certain bottled waters with added potassium. Foods are then reintroduced one at a time to monitor for symptom flares.
