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Management

There are many different treatment options for PBS/IC, often with varying results and a placebo effect in many cases. Therapy includes dietary advice, which patients can gather from clinicians, books, internet sites and support groups.

Oral pharmacological therapy includes analgesia, tricyclic antidepressants and antihistamines. Pentosan polysulfate may be effective but is not licensed for PBS/IC in the United Kingdom and is available only through a special arrangement, for use with patients having given their informed consent. Given these restrictions, it may be difficult to access in certain healthcare settings.

Intravesical therapy is the mainstay of treatment and those patients who do not respond to these treatments often end up being very difficult to treat. Current options include:

• Dimethyl sulfoxide (DMSO)
• Chondroitin sulfate (for example Uracyst)
• Heparin
• Hyaluronate
• Oxybutynin

Chondroitin sulfate and Hyaluronate are licensed in the UK for use in PBS/IC. Some of the other therapies mentioned above are not licensed and may be available on a named-patient basis only.

Sometimes cocktail therapies (which may be effective in some patients) are used, but the rationale for their use is based on anecdotal evidence only as opposed to published clinical trials.