No cure for interstitial cystitis

DEAR DOCTOR K: I have interstitial cystitis. Medication hasn’t helped much. Could dietary changes help?

DEAR READER: In patients with interstitial cystitis (IC), the bladder wall becomes irritated or inflamed, causing pain and painful or frequent urination. Some patients need to urinate as often as 60 times a day.

The cause of IC remains a mystery. The symptoms of IC are often similar to those of a bacterial urinary tract infection. However, in IC, there is no bacterial infection and the symptoms do not respond to antibiotics.

Diagnosing IC can be tricky. Some women with painful and frequent urination, and no bacteria found on a urine culture, can actually have an infection of their urethra, the tube that carries urine out of the bladder.

When a person clearly has IC, there are several treatment options. Because there is no cure for IC, the goal of treatment is to reduce symptoms.

Dietary modifications can indeed help to control your symptoms. You should avoid smoking, alcohol, caffeinated beverages, artificial sweeteners, spices and hot peppers, citrus fruits or juices, other high-acid foods such as tomatoes, and (unfortunately) chocolate.

Other treatment options include:

• Bladder training: Learn to reduce frequent urination by letting longer periods of time pass before urinating. This does not reduce pain.

• Oral medications: Pentosan polysulfate sodium (Elmiron) is the only medication approved for the treatment of IC, but it is effective in only about one-third of patients. Other oral medications are not approved specifically for IC but may offer relief. One such medicine is amitriptyline, a medicine first used for depression. It also reduces pain caused by irritated nerve endings.

• Bladder distention: Sterile water is used to stretch the bladder. Most patients feel worse for a couple weeks after the procedure. After that, up to half of patients feel better. This procedure may work by increasing bladder capacity or interfering with pain signals. It is done under general anesthesia.