Interstitial Cystitis Natural Remedies - Interstitial cystitis (IC) treatment primarily involves managing patients' symptoms in order to improve their quality of life. This difficult-to-treat disease, with an etiology as yet undefined, is a benign disorder that, none theless, can have devastating effects on a patient's physical and mental health. Although urinary frequency and urgency (both symptoms of overactive bladder) are problematic for the patient, pain remains the hallmark of this disease and can be difficult to manage, which is frustrating to both the patient and the treating physician. This review covers the current pharmacologic and nonpharmacologic management options for IC, with an emphasis on pain management. The relative efficacy of different treatments for IC will be reviewed, including nonsteroidal anti- inflammatory drugs (NSAIDs), gaba pentin, pentosan polysulfate, antidepressants, intravesical agents, and surgery.
It is critical, however, that a thorough evaluation first rules out any reversible causes of patient symptoms, including infection, cancer, uro lithiasis, obstruction, neurologic disease, or gynecologic disorders such as endometriosis. Once other causes are excluded and a diagnosis of IC is confirmed, therapy should be aimed atcontrolling symptoms, particularly pelvic pain, which can often be debilitating. Pain can be classified as nociceptive, visceral,or neuropathic. IC pain is rather complex and can often include all three types of pain, making management extremely difficult. The most successful approaches have been multimodal therapies that incorporate psychologic inter-ventions, physical therapy, pharmacotherapy and in some cases procedural treatments, such as sacral neuromodulation. Attempting to address all aspects of pain management is beyond the scope of this review. This paper will specifically outline the current pharmacologic options available for managing IC pain, including some new developments. Historically, for a variety of reasons (i.e. chronic pain syndrome, low incidence of disease), it has been difficult to enroll IC patients in randomized studies, particularly those that involve the use of a placebo. As there are no universally successful therapies, rand-omized clinical trials for IC should include a placebo arm whenever possible. It has been suggested that limiting the length of treatment and follow-up, allowing open-label treatment at completion, and/or providing appropriate, reasonable compensation can partly ameliorate the potential problems experienced by patients in the placebo arm.
IC remains a frustrating clinical problem for any physician treating this disorder, particularly with regard to the debilitating pain associated with IC. The pathophysiology of this disease remains poorly understood, but current knowledge has spurred the investigation of novel therapies. A multitude of pain-relieving oral agents are now available to patients with IC, including narcotics, antidepressants, gabapentin, and PPS. While intravesical therapy has not been shown to be particularly successful, some instillations might help to temporarily alleviate symptoms, particularly in the management of chronic pain and acute flares. There are also a limited number of surgical options available that could potentially treat the pain caused by IC. A multimodal approach is probably necessary to obtain the most successful outcomes. IC remains a painful clinical entity that requires additional investigation to understand its pathophysiology, and further improvements in pain management.
