Treatment for Interstitial Cystitis Bladder Pain Syndrome
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Comprehensive Treatments for Interstitial Cystitis Bladder Pain Syndrome and Chronic UTIs
IC/BPS presents a challenging array of symptoms and discomfort for those affected. Fortunately, numerous treatment options exist to alleviate the pain and improve quality of life for individuals grappling with this condition. From lifestyle modifications and physical therapy to medications and minimally invasive procedures, the spectrum of treatments aims to address the underlying causes and manage symptoms effectively.
Each approach carries its own benefits and considerations, tailored to the unique needs of the patient. In this introductory exploration of bladder pain syndrome treatments, we delve into the diverse strategies offered by our medical professionals to relieve and restore comfort to those afflicted with this debilitating condition.
Procedures Provided at the Bladder Clinic
The most bladder procedures under one roof.
Sacral Neuromodulation (SNM)
Neuromodulation uses electrical agents to change how nerves carry information to and from the brain.
Sacral neuromodulation (SNM), also known as sacral nerve stimulation, is a minimally invasive medical procedure that uses electrical stimulation to treat urinary frequency. It involves implanting a programmable stimulator subcutaneously that delivers low amplitude electric stimulation to the sacral nerve. The stimulation helps the brain communicate with the bladder, which may reduce bladder control issues.
The first phase of this procedure is done in the office with a test lead that is placed internally near the sacrum, with external components that you can see and touch. The test lead will be in place for one week. Patients will then keep a voiding diary to determine how much the frequency of urination is improved. If it improves by over 50% you will be a candidate for a permanent implant which is typically done at a surgery center.
Percutaneous Tibial Nerve Stimulation (PTNS)
Another option for treating urinary frequency with neuromodulation is done by placing a very thin needle, similar to an acupuncture needle, under the skin above the ankle where a special nerve called the tibial nerve can be stimulated.
The posterior tibial nerve is close to the surface of the skin and travels in close proximity to the nerves supplying bladder stimulation.
Patients receive 12 in-office weekly treatments lasting 30 minutes each, followed by monthly maintenance treatments. The advantage of this method is that no permanent device is implanted.
Alternatively, a permanent eCoin device the size of a nickel can be placed under the skin using local anesthesia. The battery life of the eCoin is approximately 2-3 years.
Cystoscopy
There are different varieties or phenotypes of interstitial cystitis (IC): ulcerative and non-ulcerative. Ulcerative IC can only be diagnosed or ruled out by gently inserting a cystoscope into the urethra up to the bladder where your provider can view the urinary tract and bladder. A cystoscopy can also help diagnose problems such as infection, narrowing, blockage or bleeding. A cystoscopy can also rule out cancer.
BLADDER INSTILLATION THERAPY
A catheter is gently inserted through the urethra up to the bladder. The bladder is then filled with a mixture of medications (e.g. heparin, lidocaine, etc.) we refer to as a bladder cocktail. It brings relief during a bladder flare. This can be made up of several different medications depending on symptoms as well as previous response.
CYSTOSCOPY WITH HYDRODISTENTION
Bladder hydrodistension is a procedure where the provider stretches the bladder by inserting sterile water under low pressure until the bladder is full. Stretching the bladder can increase the amount of urine it can hold and may also calm or break the overactive nerve endings telling your brain that your bladder is in pain. It is done through a cystoscopy and under local anesthesia with the option of nitrous. For some patients this can be too uncomfortable in the clinic, in those cases arrangements can be made to do this under anesthesia.
BTX-A INJECTIONS
Injecting Botulinum Toxin A (BTX-A) into the bladder muscle through a cystoscope has proven to be effective in the management of urge incontinence (loss of bladder control) as well as urinary frequency syndrome. The use of BTX-A has been included in the American Urologic Association Guidelines for treatment of IC/BPS since 2015.
A patient with IC/BPS can expect up to a 70% reduction in symptoms for approximately 4 months after which the injections can be repeated. While BTX-A injections are not right for everyone, it is another tool we use here at The Bladder Clinic to ensure you have access to every treatment available.