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Created:
Feb. 2005
Jill Osborne

Revised:
March 1, 2006
Jill Osborne

Rescue Instillations

• Introduction
• Formulas
• Catheters
• Making Instillations More Comfortable

Introduction

The most promising development in the past ten years in treating IC is the development of "rescue" instillations (or cocktails), a customized solution that can be placed in the bladder and immediately help reduce pain and discomfort. Though it requires a catheter (don't let that stop you!), these instillations can be used in the doctors office, at home, and even by children. In fact, Dr. Lowell Parsons (UCSD) recently shared the story of a nine year old girl who had severe bladder pain and incontinent.

"We had a nine year old girl who had four years of bad pain. Her urologists wanted to take her bladder out. Within three weeks of visiting our clinic, she was doing the therapeutic solution herself twice a day. Three months later, almost all of her symptoms were gone and she was no longer wetting her pants."

Rescue instillations are designed to accomplish several goals: (1) to help restore the mucous in the bladder, (2) to help fight pain and inflammation and (3) to help fight infection, if needed.

Formulas

Many doctors and clinics have created their own custom formulas for this purpose. The core pain fighting ingredient is usually an alkalinized local anesthetic, such as lidocaine or marcaine. The bladder lining has such a strong mucous barrier that normal lidocaine has difficulty crossing through it. However, researchers (such as Richard Henry-Canada) noticed that if you alkalinized the anesthetic with a precise amount of sodium bicarbonate, it dramatically improved its ability to pass through the mucous to reache and soothe the irritated nerves and tissues beneath.

Elmiron or Heparin are included in most instillations because they are believed to help restore the bladder mucous and to create protective barrier in the bladder. Many physicians also include a corticosteroid to help control inflammation, as well as an antibiotic if infection is an issue.

Some clinics recommend using instillations several times a week, while other suggest using it weekly. Here are some sample formulas:

Catheters

Patients and physicians alike have reported much better results when using a hydrophilic low friction catheter, that dramatically improves comfort! An example is Astratech's Lo-Fric catheter. Don't forget that you can ask for a smaller, pediatric catheter as well!

Making Instillations More Comfortable

With more than 11,000 patients posting in the ICN Message Boards, we're sure to find posts that are so helpful and encouraging that they deserve a special mention to all our members and subscribers! This year, we will give those posts the award that you see to the right in recognition of there contribution to our support community and share some in our e-newsletters!

On January 30, 2006 ICN user Kadi replied to a posting about how to make rescue instillations more comfortable. She, too, had experienced discomfort while undergoing these treatments. However, with the help of her physician, they made several adjustments that made the procedure much more easy to tolerate. Her suggestions are certainly worthy of discussion with your physician if you are also struggling with discomfort:

I burned with lidocaine/heparin/sodiumbicarbonate/sterile water, til my doctor & I made the following adjustments.

1. Non-latex caths really really helped. I didn't have any indication of latex allergy, but thought it might be worth a try & the nonlatex ones burn much less!
   
2. Surprisingly, increasing the size of cath to 12Fr instead of the pediatric 8Fr helped because it moved less & irritated the urethra less. Also, the liquid passed through it faster, so I had less time with the catheter in. I think for me, leaving the catheter in would be far more irritating.
   
3. I couldn't understand why the DMSO instills I had burned less than these rescue instills. The only explanation I could come up with was that I used Marcaine with the DMSO's, so my doctor agreed to let me try Marcaine instead of Lidocaine, even though he didn't think it would work. BUT it did work, Marcaine is much better for me.
   
4. I only held the instills 20 minutes for the first few months on the treatments (even though my doctor insisted EVERYONE was ok at an hour), then I gradually increased the time to about 50 minutes - and that works fine for me.
   
5. Also discovered that one of the reasons the instills burned at first was because I was refrigerating the sterile water, thinking b/c it had no preservatives, I should. Uh, no, my bladder REALLY didn't like the cold bath I was giving it. When I thought of it and asked the nurse, she was shocked that I'd had it in the fridge, told me to just keep it at room temperature & I was sooo much more comfortable after that.
   
6. I shower before the instill, rinsing really well, but don't use soap, because every single soap I tried irritated the vulva so much, I burned all night. The doctor told me to stop using soap, but to rinse really really well with warm water. The warm shower also relaxes my muscles, so inserting the cath is easier.
   
7. After the instill I rinse well with a bottle of warm water, and then rinse again after voiding the solution. If I have any external burning, I pat dry & use lidocaine gel on the outside only.

Hope you find some things that work for you!
These instills have dramatically reduced my pain, pressure & frequency! - Kadi