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  1. #1
    ICN Founder icnmgrjill's Avatar
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    AUA Guidelines For The Diagnosis and Treatment of IC/BPS Released

    (By Jill Osborne MA)

    The long awaited new clinical guidelines for the treatment of interstitial cystitis (aka bladder pain syndrome) were released by the American Urology Association (AUA) this month, offering what may be the most comprehensive clinical care article written to date in the USA. Solidly written, it offers new insight into diagnostic testing as well as a new, six stage IC treatment algorithm that can be used by physicians and patients as you consider your treatment and pain management plans.

    Please help us share this vital new resource by printing both this summary and the guidelines out to share with all of your medical care providers.

    What is an AUA Guideline?

    With its mission of improving the knowledge of urologists around the USA, the AUA occasionally releases documents that assist urologists in the diagnosis and treatment of various urologic diseases. We are thrilled that they devoted almost two years to the creation of a new set of guidelines for interstitial cystitis. They are intended to instruct clinicians and patients how to recognize IC/BPS, make a valid diagnosis and evaluate potential treatments.

    Why is it important?

    Have you ever had a physician tell you that there were no treatments for IC or a family member who said that IC was a figment of your imagination? How about a physician who refuses to provide pain care? This document provides desperately needed education for medical care providers, patients, family members and the community at large.

    Who drafted it?

    In 2008, the American Urology Association convened a diverse panel of more than a dozen IC researchers and medical care providers to draft the guidelines. The effort was led by panel chairman Phil Hanno MD (Univ. of PA). An additional 84 peer reviewers reviewed the final document before it was approved by the AUA Board of Directors in January 2011. None of the participants were compensated by AUA for their work.

    How was it created?

    The panel performed a systematic review of IC research studies published from 1983 through July 2009. Using this research “evidence” as well as “clinical principles” and “expert opinions” offered by the panelists, the guidelines consist of 27 statements to guide a patient through diagnosis and treatment.

    What’s their definition of IC/BPS?

    They chose to use the definition first established by the Society for Urodynamics and Female Urology.

    “An unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms of more than six weeks duration, in the absence of infection or other identifiable causes.”

    Is IC more than just a bladder disease?

    Citing several studies which explored the related conditions found in IC patients, the authors explored several theories, one of which is “IC/BPS is a member of a family of hypersensitivity disorders which affects the bladder and other somatic/visceral organs, and has many overlapping symptoms and pathophysiology.” IC could be a primary bladder disorder in some patients and yet, for others, may have occurred as the result of another medical condition. The answer remains elusive.

    Symptoms

    The guideline emphasizes pain as the hallmark symptom of IC/BPS, particularly pain related to bladder filling. Pain can also occur in the urethra, vulva, vagina, rectum and/or throughout the pelvis. Urinary frequency is found in 92% of patients with IC/BPS.

    Urgency is an often debated symptom because it is the primary symptom of overactive bladder, a condition often confused with IC. Yet, the authors make a critical distinction. Patients with IC experience urgency and then rush to the restroom to avoid or reduce pain whereas patients with OAB experience urgency and rush to the restroom to avoid having an accident or becoming incontinent.

    Diagnosis - Hydrodistentions No Longer The Standard

    The authors urge clinicians to perform a thorough history and physical examination of the patient. Symptoms should be present at least six weeks in the absence of infection for a diagnosis to be made. A physical examination of the pelvis should be conducted for both men and women and “The pelvic floor should be palpated for locations of tenderness and trigger points.”

    Several conditions should be ruled out, including bladder infection, bladder stones, vaginitis, prostatitis and, in patients with a history of smoking, bladder cancer. Additional testing, however, should be weighed with respect to their potential risks vs. benefits. They offer “In general, additional tests should be undertaken only if the findings will alter the treatment approach.” Cystoscopy and urodynamics, for example, are to be considered if a diagnosis of IC is not clear. The authors do note that cystoscopy helps to rule out other conditions which can mimic IC symptoms, such as bladder cancer or stones.

    The presence of Hunner’s ulcers on the bladder wall will lead to a diagnosis of IC however the finding of glomerulations on the bladder wall during hydrodistention with cystoscopy is often vague, variable and consistent with other bladder conditions, thus the panel suggests that “hydrodistention is not necessary for routine clinical use to establish a diagnosis of IC/BPS.” Hunner’s ulcers are described in an acute phase “as an inflamed, friable, denuded area” or in a more chronic phase “blanched, non-bleeding area.”

    Pain Management

    The guidelines are extremely proactive when it comes to pain acknowledgement and management. The authors offered “Pain management should be continually assessed for effectiveness because of its importance to quality of life. If pain management is inadequate, then consideration should be given to a multidisciplinary approach and the patient referred appropriately.”

    Pain management can include the use of various medications, physical therapy and/or the relaxation of tense, painful muscles, biofeedback and a wide variety of other options. The guidelines encourage physicians to refer patients to other pain specialists if they are unable to provide an effective pain management strategy.

    Treatment Goals & Principles

    The improvement of patient quality of life is the key goal of therapy and consideration should be made for a treatments invasiveness, potential adverse events and the reversibility of a treatment. As a rule, the panelists suggest that treatment should begin with generally safe “conservative” therapies. If no improvement is found, “less conservative” treatments that may have more risk of side effects and adverse events can be explored. Surgical treatment is rarely suggested and only under specific circumstances because it is irreversible.

    Grade A = have well-conducted clinical trials and/or exceptionally strong observational studies.
    Grade B = have clinical trials that have weaknesses in their procedures or generally strong observational studies.
    Grade C = have observational studies that are inconsistent, small or have other problems which could influence the data.

    Specific treatment choices should depend upon the patients current symptoms, patient preference and clinician judgement. In addition, it is not unusual for patients to be using multiple, concurrent treatments. If patients have not shown improvement in their symptoms after multiple treatments, the panelists suggest that the diagnosis of IC should be revisited to determine if another underlying disorder (i.e such as pudendal nerve entrapment, endometriosis, etc.) could be present.

    The guidelines emphasize the importance of evaluation and tracking a patients progress using a voiding diary and/or other surveys. They suggest that ineffective treatments be stopped after a “clinically meaningful interval.” Only effective treatments should be continued.

    First Line Treatments - Should be offered to all patients

    Patient Education - Patients should be educated about normal bladder function, what is known about IC and that multiple therapies may need to be tried in order to find symptom relief.


    Self-care - Patients should learn about and avoid specific behaviors that can either worsen or give them more control over their symptoms, including: water intake, diet modification to avoid irritating foods and common flare management methods (i.e. the use of heat or cold to relax pelvic floor muscles, the use of meditation or guided imagery to reduce muscle tension, the avoidance of some exercises, tight fitting clothing, constipation treatment, etc.) 


    Stress Management - While stress does not cause IC, it is well known to increase IC symptoms and heighten pain sensitivity. The guidelines encourage patients to be aware of their overall stress levels. Stress management and/or better coping techniques should be practiced regularly, perhaps through use of stress management classes and/or the help of a counselor as needed.

    

(Editors note - A study released in early 2011 found that cats struggling with feline interstitial cystitis experienced a reduction of their symptoms and became healthier when their stress levels were reduced. This comes as no surprise to the vast majority of patients who have learned, first hand, that high stress can trigger an IC flare. Source: Stella JL, Lord LK, Buffington CA. Sickness behaviors in response to unusual external events in healthy cats and cats with feline interstitial cystitis. Journal of the American Veterinary Medical Association. 238; 67-73, 2011. doi: 10.2460/javma.238.1.67)

    Second-Line Treatments

    Physical Therapy - If experience and knowledgeable physical therapy staff are available, appropriate physical therapy techniques should be used “to resolve pelvic, abdominal and/or hip muscular trigger points, lengthen muscle contractures and release painful scars or other connective tissue restrictions.” Kegel exercises and exercises aimed at strengthening the pelvic floor are NOT recommended. Why? In pelvic floor dysfunction, muscles are often too tight and kegel exercises act to increase rather than reduce muscle tension. 

(Editors Note - Two books are available which describe pelvic floor treatment in depth, including a variety of home exercises that can be used to resolve symptoms. Ending Female Pain by Isa Herrera PT and Heal Pelvic Pain by Amy Stein PT) 


    Pain Management - “Pain management should be an integral part of the treatment approach and should be assessed at each clinical encounter for effectiveness,” the guidelines encourage. With respect to the use of pain medications, such as narcotics, the authors suggest that while the risk of tolerance and dependence is possible, only rarely does addiction occur. They offer “It is clear that many patients benefit from narcotic analgesia as part of a comprehensive program to manage pain.” Yet, they also state that the use of pain medication alone does not constitute a sufficient treatment plan. Pain management should be just one component of treatment.


    Oral Medication Options 



    Amitriptyline (aka Elavil) has several studies reporting strong success in reducing IC symptoms yet side effects were highly likely with the potential of disrupting a patients quality of life, particularly sedation, drowsiness or nausea. Side effects were the primary reason why patients stopped using the medication. Grade B

    

Cimetidine (aka Tagamet) acts to inhibit acid production in the stomach. Two long term studies reported that 44% to 57% of patients experienced improvement in their symptoms with no adverse events reported, making this a viable second line strategy. Grade B

    

Hydroxyzine (aka Vistaril, Atarax) had mixed research studies, one of which reported that 92% of patients experienced improvement yet those participating patients also had systemic allergies. Other studies found much more modest effectiveness (i.e. 23%). Adverse events were common and generally not serious. Grade C

    

Pentosan polysulfate (aka Elmiron), the only oral FDA approved for IC, is the most studied medication currently use with five placebo controlled clinical trials. The results were clinical significantly (21 to 56% effectiveness). Roughly 10 to 20% of patients experienced side effects that were “generally not serious.” Pentosan may have a lower efficacy in treating patients with Hunner’s Ulcers. Grade B

    Bladder Instillation Options

    

DMSO (aka RIMSO-50), the only FDA approved bladder instillation for IC, is one of three considered a second-line therapy. Several studies were reviewed with various levels of success ranging from 25% to 90%. “If DMSO is used, then the panel suggests limiting instillation dwell time to 15-20 minutes” because longer dwell times are associated with more significant pain. Grade C



    Heparin instillations have been studied using various concentrations and treatment modalities (i.e. 10,000 IU heparin in 10cm3 sterile water 3x per week or 25,000 IU in 5 ml of distilled water 2x per week) with intriguing results. The 10,000 IU study showed a 56% improvement at 3 months, whereas the 25,000 IU study showed a 72.5% improvement at 3 months. No placebo controlled studies have been done. Adverse events were infrequent and apparently minor. Heparin is frequently combined lidocaine to create an instillation popularly known as a “rescue instillation.” Grade C



    Lidocaine instillations have also been studied in various dosages, cocktails and/or treatment schedules. The guidelines include several formulas for various cocktails that can be used, often including sodium bicarbonate, heparin, lidocaine and/or triamcinolone. Adverse events were typically not serious, earning this treatment option a Grade B.

    Third-Line Treatments

    Hydrodistention with cystoscopy may be considered if first or second line treatments have no provided relief. The panel ONLY recommends low-pressure (60-80 cm H2O) and short duration (less than 10 minutes) procedures to reduce the risk of bladder rupture. Grade C


    Hunner’s ulcers can be treated with fulguration (laser or electrocautery) and/or by injection of triamcinolone into the ulcer . One observational study reported 100% pain relief and 70% reduced frequency from 2 to 42 months after heat treatment. Laser studies showed similar effectiveness however, in both cases, ulcers may require additional treatment. One triamcinolone treatment reported that 70% of patients experienced a sustained improvement over 7 to 12 months. Grade C.

    Fourth-Line Treatments

    Neuromodulation is not FDA approved for IC treatment but has been used for the treatment of frequency urgency. Neuromodulation can occur at the sacral or pudendal nerve with studies confirming that pudendal stimulation appeared to provide greater symptom relief. Long term follow up data is not available. Grade C

    

(Editors Note - We’re stunned to see the panelists conclude that adverse events related to neuromodulation appear to be minor and this is the one area of the report that we strongly disagree with. A review of the FDA MAUDE database for adverse events reveals hundreds of severe complications ranging from MRSA infection, difficulty walking, device malfunction and, in the past two years, more than a dozen reports of fatality. We will be inquiring of the panel if they are aware of this federal adverse event data.)

    

Fifth-Line Treatments

    Cyclosporine A is an immunosuppresant that has been studied in two small trials with IC patients with solid results. One study compared CyA with pentosan and reported a 75% improvement in patients using cyclosporine, as well as a 50% decrease in frequency. The results of two additional studies found sustained pain relief that lasted one year or longer. Unfortunately, there is potential for more severe adverse events, including immunosuppression, nephrotoxicity, high blood pressure, increased serum creatinine and others. Grade C


    Botulinum Toxin (BTX-A) injections into the bladder may be considered if other therapies have not produced improvement, however “the patient must be willing to accept the possibility that intermittent self-catheterization may be necessary-post treatment,” often for several months. BTX is not appropriate for patients who cannot self-catheterize. Grade C

    Sixth-Line Treatments

    Surgical intervention, such as urinary diversion, substitution cystoplasty or cystectomy, may be considered for patients who have found no relief with all other therapies and/or have developed a severe, unresponsive, fibrotic bladder. “Patients must understand that symptom relief is not guaranteed. Pain can persistent even after cystectomy, especially in nonulcer IC/BPS.” Patients with small bladder capacities under anesthesia and the absence of neuropathic pain appear to have a better response to surgical treatment. Grade C


    Discontinued Treatments

    The panel suggests that the following treatments should not be offered due to the lack of effectiveness found in studies and/or the risk of serious adverse events. In these cases, the risk appears to outweigh the potential benefits.

    • Long-term oral antibiotics
    • Intravesical Bacillus Calmette Guerin (BCG)
    • Intravesical Resiniferatoxin (RTX)
    • High pressure, long duration hydrodistentions
    • Systemic glucocorticoids


    Download the official AUA Guidelines for IC/BPS at:

    http://www.auanet.org/content/guidel...ent_ic-bps.pdf
    Last edited by icnmgrjill; 10-18-2012 at 12:52 PM.
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  2. #2
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    AUA guidelines

    Thanks,Jill. This will be very helpful when working with doctors and talking to family.
    Laurie

  3. #3
    ICN Member flowerangela's Avatar
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    i really like these new guidelines. they are written in a very clear way.
    Newly IC diagnosed as of February 2011.

    Medications I'm on that seem to work:
    Zoloft- one once a day
    Butrans pain patch 5 mcg (THANK GOD FOR WHOEVER INVENTED THIS!SO MUCH PAIN RELIEF ITS UNREAL,I AM IN NO PAIN AT ALL UNLESS I STRESS OR SCREW UP ON THE DIET)

    Failed Meds:
    Elmiron-after 4 months,digestive side effects got to be too much
    tramadol-allergic
    DMSO treatments(5-6)
    probiotics

    THERAPIES:gardening,cooking,IC Diet,Counseling,Lots of warm baths,stress reduction,heating pad or ice packs,meditation/deep breathing,listening to relaxing music,having fun on pain free days,drinking chamomile or peppermint tea,pelvic floor physical therapy
    AROMATHERAPY-candles,incense
    Village Naturals Aches and Pains Peppermint Bath Salts
    Johnson and Johnsons Lavender Melt Away Stress Body Wash/Lotion

    ACUPUNCTURE/HERBS
    Significant pain relief so far.

    MAY TRY:yoga,swimming/hydrotherapy and anti-candida diet if i can kick my sugar addiction
    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
    ***TO MY IC SISTERS AND BROTHERS:WE ARE OUR OWN ADVOCATES!,PLEASE DO AS MUCH RESEARCH ON YOUR OWN AS POSSIBLE AND TRY DIFFERENT TREATMENTS TO GET WELL.NOT ONE TREATMENT WORKS FOR EVERYONE.MOST IMPORTANTLY,TRY TO KEEP A POSITIVE ATTITUDE,DISTANCE YOURSELF FROM NEGATIVITY/NEGATIVE PEOPLE AND NEVER,EVER GIVE UP!***

    Add me on facebook Angela Hasic

    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
    Lord, make me an instrument of your peace;
    where there is hatred, let me sow love;
    when there is injury, pardon;
    where there is doubt, faith;
    where there is despair, hope;
    where there is darkness, light;
    and where there is sadness, joy.
    Grant that I may not so much seek
    to be consoled as to console;
    to be understood, as to understand,
    to be loved as to love;
    for it is in giving that we receive,
    it is in pardoning that we are pardoned,
    and it is in dying [to ourselves] that we are born to eternal life.

  4. #4
    ICN Member cmclien's Avatar
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    This is GREAT! It is clear, concise and to the point what treatments should be used/offered as well as in diagnosing. The stress on dealing with pain management is also good to see as so many people are turned away who need help with their pain.
    I also hope it gets acknowledged and read by Uro's who won't diagnose without cysto w/hydro as clearly that is not seen as necessary and is so invasive a procedure.
    Cindi


    Gelnique for frequency/urgency - works great
    Macrobid after sex
    Prilosec, continuous birth control pills
    synthroid .088mg, mucinex-d, restasis

    Supplements: Desert Harvest Aloe vera, Cysta-q, prelief, magnesium and calcium, Vit D, flaxseed oil

    Diag Mild IC Jan 11 but have had symptoms for 25 years. Also have GERD, TMJ, IBS-C, chronic dry eye syndrome, hashimotos thyroiditis, non-allergic rhinitis.

    IC Diet Link: http://www.ic-network.com/diet/2009icdietlist.pdf
    AUA 2011 Guidelines to diagnosing and treating IC overview- http://www.ic-network.com/forum/showthread.php?p=571592
    AUA 2011 Guidelines to diagnosing and treating IC PDF: http://www.auanet.org/content/guidel...ent_ic-bps.pdf
    Great treatment flowchart on page 19 of the pdf

  5. #5
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    AUA guidelines

    Thanks So much for posting this Jill.This is wonderful information well written for anyone to understand.Lillian

  6. #6
    Support Volunteer sailawaygrl's Avatar
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    I would recommend going to the AUA website and reading the entire publication, I found a lot of helpful information and further explanation of the overview.
    thanks for posting this

  7. #7
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    I am so glad about the new guide lines, but I cried because my first Uro let me stay in agonizing pain for three months.

    Thank God I got a good Uro now, when I reflect on what was done to me last spring and part of the summer I still cry.

    I pray to God to never get that bad again, my heart go's out to the ones who can't find a good Uro. Pray for a cure

  8. #8
    Forum Manager ICNDonna's Avatar
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    Thank you! It's great to see that the guidelines include pain control.

    Donna
    Have you checked the ICN Shop?
    http://www.icnsales.com for US & Canada
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    I am not a medical authority nor do I offer medical advice. In all cases, I strongly encourage you to discuss your medical treatment with your personal medical care provider. Only they can, and should, give medical recommendations to you.

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  9. #9
    ICN Member cmclien's Avatar
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    I am reading the pdf but I especially like the treatment flowchart on page 19. I printed it out. Its basically every treatment and in what order they should be charged. Really helpful, might give it to my UG next time I see him but wouldn't want to insult him either...its a fine line.
    Cindi


    Gelnique for frequency/urgency - works great
    Macrobid after sex
    Prilosec, continuous birth control pills
    synthroid .088mg, mucinex-d, restasis

    Supplements: Desert Harvest Aloe vera, Cysta-q, prelief, magnesium and calcium, Vit D, flaxseed oil

    Diag Mild IC Jan 11 but have had symptoms for 25 years. Also have GERD, TMJ, IBS-C, chronic dry eye syndrome, hashimotos thyroiditis, non-allergic rhinitis.

    IC Diet Link: http://www.ic-network.com/diet/2009icdietlist.pdf
    AUA 2011 Guidelines to diagnosing and treating IC overview- http://www.ic-network.com/forum/showthread.php?p=571592
    AUA 2011 Guidelines to diagnosing and treating IC PDF: http://www.auanet.org/content/guidel...ent_ic-bps.pdf
    Great treatment flowchart on page 19 of the pdf

  10. #10
    ICN Member Jereme's Avatar
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    Jill, are the editors notes your opinions? It's too bad there are no A treatments yet.
    What helps
    Elmiron 200 mg bid
    Wellbutrin XL anxiety and depression
    Oxybutynin ER 10 mg
    Yoga


    tried and failed
    Cardura, Hytrin, Flomax, Prosed DS, Vesicare, Pyridium, Cystoprotek (caused GI problems), Lyrica, Pamelor

    "We can't wait until the storm is over. We need to learn to dance in the rain."

  11. #11
    ICN Member nanawaggs's Avatar
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    Hi, Jill ~ I, too, am urgently wondering about the "Editor's Comments" (assuming they may be your's???)....particularly the following:

    

(Editors Note - We’re stunned to see the panelists conclude that adverse events related to neuromodulation appear to be minor and this is the one area of the report that we strongly disagree with. A review of the FDA MAUDE database for adverse events reveals hundreds of severe complications ranging from MRSA infection, difficulty walking, device malfunction and, in the past two years, more than a dozen reports of fatality. We will be inquiring of the panel if they are aware of this federal adverse event data.)

    I'm in the position of having the Interstim brought into the picture for my treatment and I'd love to understand more about this comment if this applies to this device.

    Thank you!
    Never heard of IC until it was suspected....Never knew so many are suffering from it.
    Praying for a cure.


    11/2007 IC Symptoms began during recovery period of surgery for bladder suspension and hysterectomy, painful urgency/frequency
    8/2009 Suspected IC
    1/2010 Treatment began
    2/2010 Diagnosed PFD, began Physical Therapy
    2/2010 Surgery to remove mesh from bladder suspension
    5/2010 Surgery to repair bladder, vaginal vault and small intestine prolapse
    5/2010 IC officially diagnosed during surgery
    7/2010 Diagnosed with Candida Esophagitis, Gastritis, Diviticulosis, Gallstones
    8/2010 Surgery to remove gallbladder

    Treatments:
    Heparin/Lidocaine/Bicarb/Kenalog Instills
    Macrodantin 100 mg after each instill
    Valium Vaginal Suppositories: Cyclo/diaz/lido, 10/5/62.5 mg
    Pyridium as needed up to 3xday
    Celexa 10mg daily
    Premarin Cream 3xweek
    Aloe Vera
    Prelief
    Dual Action Acid Reducer/Antacid
    Fiber supplement
    Probiotics
    Physical Therapy for PFD
    IC Diet since 8/2009
    Gabapentin, 12/2011....seems to be working great!

    Medications Tried and Discontinued
    Elavil, worked up to 50mg (started 1/2011), caused retention & high blood pressure
    Urelle, caused retention
    Vesicare, caused retention


  12. #12
    ICN Member Jereme's Avatar
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    Nannawags, my concern is the same. This site is heavily biased against the use of interstim. I Think so much so that people who could benefit from the treatment don't get it out of fear and IMO that is sad. All treatments have risk. Hundreds of women die every year from complications of birth control pills. Lots more die from liver disease from excessive tylenol use. I won't debate the fact that there are risks associated with a surgical procedure, but we can't overlook the fact that interstim can and does make a huge difference to the majority that choose that as a final treatment option. It's effectiveness for frequency and urgency is well established in multiple good research studies. In fact it is probably the most effective FDA approved treatment for frequency and urgency available right now. Certainly it is not for pain and should only be used when less invasive options do not work. However for those that need it it's great it is available. Good luck to you. Do your research and find a doctor with lots of experience with the device.
    What helps
    Elmiron 200 mg bid
    Wellbutrin XL anxiety and depression
    Oxybutynin ER 10 mg
    Yoga


    tried and failed
    Cardura, Hytrin, Flomax, Prosed DS, Vesicare, Pyridium, Cystoprotek (caused GI problems), Lyrica, Pamelor

    "We can't wait until the storm is over. We need to learn to dance in the rain."

  13. #13
    ICN Member DaniMSC's Avatar
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    Botox?

    Maybe i missed it but the article didn't mention anything about botox treatments, which I have been reading a lot about and one of the urologists I saw here in Spain mentioned he could do if instillations didn't work for me...

  14. #14
    ICN Member cmclien's Avatar
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    Its there under 5th line treatments along with cyclosporine A
    Cindi


    Gelnique for frequency/urgency - works great
    Macrobid after sex
    Prilosec, continuous birth control pills
    synthroid .088mg, mucinex-d, restasis

    Supplements: Desert Harvest Aloe vera, Cysta-q, prelief, magnesium and calcium, Vit D, flaxseed oil

    Diag Mild IC Jan 11 but have had symptoms for 25 years. Also have GERD, TMJ, IBS-C, chronic dry eye syndrome, hashimotos thyroiditis, non-allergic rhinitis.

    IC Diet Link: http://www.ic-network.com/diet/2009icdietlist.pdf
    AUA 2011 Guidelines to diagnosing and treating IC overview- http://www.ic-network.com/forum/showthread.php?p=571592
    AUA 2011 Guidelines to diagnosing and treating IC PDF: http://www.auanet.org/content/guidel...ent_ic-bps.pdf
    Great treatment flowchart on page 19 of the pdf

  15. #15
    ICN Member Jereme's Avatar
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    Botox is listed as a fifth line treatment. See botulinum toxin. Good luck with that. It will likely be FDA approved for overactive bladder soon from what i've read.
    What helps
    Elmiron 200 mg bid
    Wellbutrin XL anxiety and depression
    Oxybutynin ER 10 mg
    Yoga


    tried and failed
    Cardura, Hytrin, Flomax, Prosed DS, Vesicare, Pyridium, Cystoprotek (caused GI problems), Lyrica, Pamelor

    "We can't wait until the storm is over. We need to learn to dance in the rain."

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