Rescue Instillations

Many doctors and clinics have created their own custom rescue instillations. The core pain fighting ingredient is usually an alkalinized local anesthetic, such as lidocaine or marcaine. Why is it alkalinized? The bladder lining has such a strong mucous barrier that normal lidocaine has difficulty crossing through it. However, researchers (such as Richard Henry, MD -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.

Safety Concerns

Risk of overdose is real. Rescue instillations require precise formulations. Too much sodium bicarbonate can result in too much lidocaine passing deeper into the bladder tissues and the blood supply, thus creating a substantial risk for overdose and potentially fatal heart complications and brain damage. We've seen this most recently in fatalities of patients who used a lidocaine cream before having plastic surgery. Patients doing instillations at home should NEVER experiment with the formulas or ingredients provided by their physician. You must follow their instructions carefully.

Patients who are pregnant should be particularly cautious when using rescue instillations. In early 2007, Dr. Deborah Erickson and colleagues released the first paper which discussed the risk of potential fetal abnormalities that can occur with various IC therapies. They discussed, in depth, the use of rescue instillations and strongly suggested that the "safest choice would be to instilll non-alkalinized lidocaine" to avoid the issue of systemic absorption and placental transfer.(1)

(1) Dr. Parsons (UCSD) "Therapeutic Solution"

The instillations are used 3 times a week for two weeks and can also be used to fight flares. Results are exceptionally promising. Dr. Parsons reports that he has seen a 94% positive result for patients after just one treatment. For 50% of patients, that lasted between 4 and 40 hours. At the end of two weeks, 80% of patients had a sustained improvement. (2) Read the published research results & formula here!

Dr. Parsons formula is now being developed by a new company, Urigen, who recently received FDA approval to conduct a Phase IIb clinical trial. Thus, IC patients around the country may have the opportunity to particiate more in these trials! Check the ICN Clinical Trial Center for the latest information.


(2) Dr. Robert Moldwin Anesthetic Solution

(3) Dr. Kristene Whitmore

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. 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:

  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

References

1. Erickson D. MD, Propert K. ScD, "Pregnancy and Interstitial Cystitis/Painful Bladder Syndrome" Urol Clin N. Amer 34 (2007) p. 61-69.

2. Parsons CL, "Successful downregulation of bladder sensory nerves with combination of heparin and alkalinized lidocaine in patients with interstitial cystitis." Urology. 2005 Jan;65(1):45-8.

3. Bladder Cocktail Recipes, ICA Website