Interstitial cystitis, often mistaken for bladder pain syndrome or urinary tract infection, needs interventions that start with comprehensive patient teaching about the continuous nature of the condition as well as accurate assessments of the condition, prognoses, and likely reactions to the interventions. Continuous reassurance along with emotional and physical support is vital as the diagnostic assessment goes on and therapies are being done. Rarely will patients who have interstitial cystitis achieve complete, instant, and long-lasting reaction to any specific intervention. They should be guided wholly about the non-existence of universally efficient interventions. Most of the time, referral to the Interstitial Cystitis Association, especially if to a nearby chapter, could be very helpful in giving a continuing system of support for the person.
Preferably, in clinical practice, interstitial cystitis treatment ought to begin with the most conservative, least costly, and most reversible intervention. Typically, this includes dietary as well as fluid management, stress and time controlling, and behavioural adjustment. Then, interventions are provided in a progressive manner, each time getting more invasive until there is symptomatic relief achieved. Initial treatment level could also be affected by clinical opinion, considering the seriousness of the symptoms presented and factors that are specific to the patient.
After every intervention, the patient is assessed for reaction. Sad to say, interventions, most of the time, are given in a random fashion, mixing a lot of different treatments before really assessing the reaction of the patient to each. This kind of approach is, at times, propelled by unrealistic demands of the patient and expectations about the success of the interventions. It should be emphasized that patients should receive broad guidance about the nature as well as the prognosis of their condition and the probable reactions to therapy. This is very important, and the counselling ought to be started before actually going on the invasive interventions which have not revealed any benefit that could be achieved. Treatments like biofeedback, pelvic floor rehabilitation, as well as bladder training programs, among other behavioural measures are great starting interventions and actually have been used by some who have seen some successful outcomes. Dietary measures have also been tried. Some foods are found to aggravate symptoms like alcohol, coffee, vinegar, tomatoes, chocolate, spicy foods, and particular vegetables and fruits. Patients are advised to avoid such food. Patients write down on a dietary journal what they usually have and these are modified in order to prevent exacerbations. About 3-6 months length of behavioural therapy is necessary before moving in to more invasive or costly interventions.
Oral medications ought to be regarded only after the above conservative interventions have not been successful. The duration for each medication is variable. The following drugs are often prescribed:
- Oral pentosan polysulfate sodium
- Anticholinergics (oxybutynin, tolterodine)
- Cyclosporine A
Oral therapy should be used with as much precaution since there are some side effects that could be unpleasant to the patient or could exacerbate the condition.