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Medical intervention


Oral medications, including anti-inflammatories and anti-histamines, could help manage symptoms. In more severe cases, anti-depressants and anti-epileptic drugs can be used to dampen nerve responses. Often used in combination, these drugs can be very effective, but should only be prescribed by specialists.1,52–54

Bladder instillations

The bladder is filled with an intravesical rescue solution that contains a mixture of an aesthetic agent, steroid and heparin. If the patient does not respond to this, other intravesical therapies dimethyl sulfoxide (DMSO), hyaluronic acid or chrondroitin sulphate can also be used, depending on local availability. For the best results, it should be retained in the bladder for at least 30 minutes before being drained through a catheter. Instillations are usually repeated on a weekly cycle for six weeks and then once a month until the patient’s symptoms resolve. It’s important to make sure patients aren’t discouraged if the treatment doesn’t work immediately, as they might need five or six treatments before symptoms improve.1,51,52,59,60

There are several advantages to instillation therapy:1,52

  • A high concentration of drug at target location
  • Fast symptom relief
  • Minimum side effects
  • Out-patient treatment
  • Potential for self-instillation

Most patients with BPS/IC notice an improvement in symptoms three or four weeks after the first cycle of treatments.1,52

Bladder distension (bladder stretching)

This procedure can be used for diagnosis or therapy. Patients are given a general anaesthetic, their bladders are then filled with fluid and stretched for two minutes. If reduced bladder capacity, redness, inflammation and bleeding is observed it’s suggestive of BPS/IC. A biopsy is often taken to look for mast cells in the bladder wall as they produce histamine, and an increased number is also suggestive of BPS/IC.1,52,54,55

Many patients find their BPS/IC improves after the procedure, but researchers aren’t sure why. There is a belief it may increase capacity and interfere with pain signals transmitted by nerves in the bladder.1,52

Symptoms may temporarily worsen 24 to 48 hours after distension, but should return to normal levels or improve within two to four weeks. About 30% of patients report an improvement.1,52

Botulinum toxin injections

Botulinum toxin is injected directly into the bladder to temporarily relieve symptoms.1,51,52,55

Electrical nerve stimulation

Mild electrical pulses are used to stimulate the nerves to the bladder through the skin or with an implanted device in weekly sessions to relieve pain.1,51,52,55

With Transcutaneous Electrical Nerve Stimulation (TENS) impulses are delivered through the skin on trigger points such as the lower back, perineum, pubic area or by placing special devices into the vagina (in women) or rectum (in men). These electrical pulses strengthen pelvic muscles that help control the bladder, and trigger the release of substances that block pain.1,51,52,55

Percutaneous Tibial Electrical Nerve Stimulation (pTENS) is when electrical stimulus is applied through acupuncture needles placed in the ankle to stimulate the tibial nerve, which also supplies the bladder.1,51,52,55

However, the implantation of a Sacral Nerve Stimulator (SNS) is the most recent development. When the nerves to the bladder are stimulated directly through the sacrum in the lower back. An external ‘test’ implant is worn for three weeks, before a permanent ‘bladder pacemaker’ is placed in fat over the upper buttock.1,51,52,55


  • 1.Meijlink JM. Interstitial Cystitis/Bladder Pain Syndrome. Int Painful Bl Found. 2014.
  • 51.Tirlapur S, Birch J, Carberry C, et al. Management of Bladder Pain Syndrome: RCOG Green-Top Guideline No. 70. Vol 124.; 2016. doi:10.1111/1471-0528.14310.
  • 52.London Urology. Painful bladder syndrome (PBS) and Interstitial Cystitis (IC) Painful. www.londonurology.org.uk/services/bladder-pelvic-pain/. Published 2017. Accessed September 1, 2017.
  • 53.Jerauld A, Wormuth L, Carlson B. New Approaches in Managing Interstitial Cystitis/Bladder Pain Syndrome. US Pharm. 2016;41(9):29-33.
  • 54.Hanno PM, Burks DA, Clemens JQ, et al. AUA Guideline for the Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome. J Urol. 2011;185:2162-2170. doi:10.1016/j.juro.2011.03.064.
  • 55.Hanno PM, Burks DA, Clemens JQ, et al. Diagnosis and Treatment Interstitial Cystitis / Bladder Pain Syndrome.; 2014.
  • 59.Mishra NN. Clinical presentation and treatment of bladder pain syndrome/interstitial cystitis (BPS/IC) in India. Transl Androl Urol. 2015;4(5):512-523. doi:10.3978/j.issn.2223-4683.2015.10.05.
  • 60.Downey A, Hennessy D, Curry D, Cartwright C, Downey P, Pahuja A. Intravesical chondroitin sulphate for interstitial cystitis/painful bladder syndrome. Ulster Med J. 2015;84(3):161-163. http://www.ncbi.nlm.nih.gov/pubmed/26668417. Accessed October 25, 2017.