Multimodal therapy for interstitial cystitis.

Gynecologists have been challenged by the diversity in treatment approaches and the historical absence of effective therapy for interstitial cystisis (IC). Until recently, the only Food and Drug Administration (FDA)-approved treatment was bladder instillation with dimethyl sulfoxide, a moderately effective and safe, albeit invasive, process. The approval in 1996 of pentosan polysulfate sodium (PPS) provided IC patients with an effective and safe oral regimen that specifically targets and repairs the damaged urothelium. Intravesical administration of heparin sulfate or PPS, while not FDA indicated, has also been shown to provide symptom relief. Patients with moderate to severe disease may require a multimodal therapeutic approach utilizing PPS as the foundation. Oral PPS can be combined with antihistamines, analgesics, antispasmodics or antidepressants to provide enhanced pain and symptom relief. Patients with severe disease or flares may benefit from instillation of an anesthetic therapeutic relief solution composed of heparin or PPS combined with sodium bicarbonate and lidocaine. Nonpharmacologic approaches, such as bladder training, biofeedback and dietary changes, can provide supplemental relief. Acute and chronic pain associated with IC can now be effectively managed using a multimodal approach with PPS as the basis.