Diagnosis:
- History
- Potassium Challenge Test:
- Straight cath and drain bladder.
- Inject 40ml sterile water, then drain.
- Inject 40ml 0.4M KCl, then have patient void the KCl.
*If pain with KCl, then suspect IC.
- If (+), then give bladder instillation after patient voids KCl.
- Cystoscopy and hydrodistention for diagnosis (and therapeutic benefit)
Resources:
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Treatment:
(See urinary/pelvic pain intervention page for specific treatment)
*Per UpToDate:
1st Line:
● Heat or cold over the bladder or perineum.
●Avoidance of activities or food or beverages that exacerbate symptoms – Common irritants include caffeine, alcohol, artificial sweeteners, and hot pepper. These factors may be avoided until symptoms are resolved, at which time they may be reintroduced. In our experience, most patients with food sensitivities are aware of them and have already excluded these items from their diet. Highly restrictive “interstitial cystitis diets” have been proposed as treatments for IC/BPS, but there is no published evidence to indicate that such elaborate dietary restrictions are effective.
Patients should also be asked to identify and avoid exercises, recreational activities, sexual activities, or body positions that seem to worsen the bladder symptoms. A symptom diary may be useful for some patients to identify such factors.
●Fluid management – A fluid and voiding diary can provide information to guide recommendations for fluid management Patients should be instructed to avoid extremes of fluid intake. In most patients, it is not necessary to drink more than 2 L of fluid per day. Those who restrict fluids should strive to maintain a pale yellow color to their urine.
●Bladder training with urge suppression
2nd Line:
- PT
- Medications:
- Amitriptyline:10 to 25 mg daily titrated weekly over several weeks to a target dose of 75 to 100 mg as tolerated
- Pentosan polysulfate sodium (Elmiron): 100 mg 3 times/day taken with water 1 hour before or 2 hours after meals
- Hydroxyzine for insomnia related to nocturia.
3rd Line:
- Bladder hydrodistention
- Hunner lesions on cystoscopy: reports of sustained relief of symptoms with resection, electrical cauterization, or injection of these lesions with a corticosteroid, although periodic retreatment is usually required
- Intravesical dimethyl sulfoxide (DMSO) is administered via bladder catheter with instillation of 50 mL DMSO weekly for six to eight weeks, then every two weeks for 3 to 12 months.