The management of interstitial cystitis: an update

Interstitial cystitis (IC) is a poorly understood chronic condition that is difficult to diagnose and treat. The most characteristic symptom of IC is debilitating pelvic pain. This article reviews the different oral agents and other nonsurgical therapies that are available for the treatment IC, with particular emphasis on the management of pain associated with IC. Treating interstitial cystitis (IC) is one of the greatest challenges facing physicians and other health care providers who manage patients with this condition. The symptoms of urinary frequency and urgency, dysuria, and chronic pelvic pain characterize IC, but it is the debilitating pelvic pain associated with IC that is most difficult to control. The pathophysiology of IC pain is poorly understood, but is thought to be a complex entity including nociceptive, visceral, and neuropathic components. There are currently no universally effective therapies available. Oral treatments, however, are frequently used, including nonsteroidal anti-inflammatory drugs, tricyclic antidepressants, gabapentin, and pentosan polysulfate, all of which have shown varying degrees of efficacy. Recognition that IC pain is multifactorial, and probably has a neuropathic component, has led to the use of some of these agents, previously prescribed for other neurologic conditions associated with chronic pain. Intravesical and surgical options are also available, which expands the armamentarium for those who treat pain secondary to IC. Treating IC requires managing all of the symptoms of this disease. This review aims to cover standard and novel treatment options, while concentrating on the management of pain. Key Points Interstitial cystitis (IC) is characterized by lower urinary tract symptoms of frequency, dysuria, urgency and chronic pelvic pain The pathophysiology of IC is poorly understood, and several mechanisms have been implicated in this chronic condition The majority of treatments for IC are aimed at treating the pain associated with the disorder, which is the most debilitating symptom Several oral agents have been shown to be effective in controlling the pain associated with IC in some patients, including narcotics, antidepressants, gabapentin and pentosan polysulfate Some invasive therapies such as hydrodistension, intravesIcal treatments and sacral neuromodulation are also being investigated for the treatment of IC