Exploring Treatment Options for Overactive Bladder and Interstitial Cystitis

Q: Exploring Treatment Options for Overactive Bladder and Interstitial Cystitis

Hello, Xiaoyu： ELMIRON is a medication used to treat interstitial cystitis; however, your primary symptom seems to be overactive bladder with frequent urination rather than the classic symptoms of interstitial cystitis such as significant bladder pain, reduced bladder capacity, o

Urinary incontinence

Hello, Doctor Huang.
I have overactive bladder syndrome and suspect interstitial cystitis (since I do not experience urinary urgency or pain, only occasional pain in the morning that wakes me up, and no issues during the day).
The symptoms of urgency are more pronounced.
However, during bladder distension testing, bleeding points were observed.
After applying for ELMIRON through the National Health Insurance and taking it for two months, there was no significant improvement, so I stopped.
The doctor suggested Kegel exercises, but I have no sexual experience, so I find it difficult to perform them.
I feel this has become a bottleneck in my treatment.
I would like to ask if there are other treatment options available or better medications?
I came across an article mentioning...
a more expensive treatment method involves implanting a long-lasting electrical device to stimulate the sacral nerves, which masks the nerve impulses transmitted from the peripheral nerves to the central nervous system, allowing for more effective suppression of bladder sensation impulses.

Could you please tell me the medical name for this treatment? What is its success rate? Which hospitals in Taiwan currently offer this procedure? Is it safe? Thank you for your response!

Xiao Yu, 20~29 year old female. Ask Date: 2004/10/11

Dr. Lin Hexing reply Urology

Hello, Xiaoyu: ELMIRON is a medication used to treat interstitial cystitis; however, your primary symptom seems to be overactive bladder with frequent urination rather than the classic symptoms of interstitial cystitis such as significant bladder pain, reduced bladder capacity, or noticeable hematuria.
Since you have not clearly described your detailed symptoms, it is difficult to provide a reasonable diagnosis for your condition.
If it is indeed overactive bladder, the main treatment approach would involve medication and behavioral therapy.

In terms of medication, anticholinergics are the mainstream treatment options, including Ditropan, GENURIN, and Detrusitol, among others, which have shown effectiveness but also come with potential side effects.
Keeping a detailed record of urination can help gradually train the bladder, thereby reducing the frequency of urination symptoms.
Surgical bladder augmentation is generally reserved for severe cases due to various associated complications.
Regarding the "another more expensive treatment method involving the implantation of a long-lasting electrical device to stimulate the sacral nerves, masking the nerve impulses transmitted from the peripheral nerves to the central nervous system, allowing for more effective suppression of bladder sensations," this likely refers to a recent article from the Department of Obstetrics and Gynecology at Taipei Veterans General Hospital.
This is a newly developed treatment for severe urge incontinence that is considered when various medication treatments and behavioral therapies have failed.
It is not a suitable option for all patients.

Reply Date: 2004/10/11

More Info

Overactive bladder (OAB) and interstitial cystitis (IC) are conditions that can significantly impact a person's quality of life. While you have already tried Elmiron (pentosan polysulfate sodium) for two months without noticeable improvement, there are several other treatment options available that may help alleviate your symptoms.

Treatment Options for Overactive Bladder and Interstitial Cystitis
1. Behavioral Therapies:
- Bladder Training: This involves gradually increasing the time between urinations to help train your bladder to hold more urine.

- Dietary Modifications: Certain foods and beverages can irritate the bladder. Common irritants include caffeine, alcohol, spicy foods, and artificial sweeteners. Keeping a food diary can help identify triggers.

2. Medications:
- Anticholinergics: Medications such as oxybutynin, tolterodine, and solifenacin can help reduce bladder spasms and urgency.

- Beta-3 Agonists: Mirabegron is a newer medication that relaxes the bladder and increases its capacity.

- Tricyclic Antidepressants: Some patients find relief with medications like amitriptyline, which can help with pain and urgency.

3. Physical Therapy:
- Pelvic Floor Physical Therapy: Even if you are not comfortable with Kegel exercises, a trained pelvic floor therapist can provide guidance and alternative exercises that may help strengthen the pelvic floor muscles and improve bladder control.

4. Neuromodulation Therapy:
- The treatment you mentioned involving the implantation of a device to stimulate the sacral nerves is known as Sacral Neuromodulation (SNM). This therapy can help modulate the nerve signals to the bladder, potentially reducing symptoms of urgency and frequency. The success rate varies, but studies suggest that many patients experience significant improvement in their symptoms. In Taiwan, several hospitals and urology clinics may offer this treatment, and it is generally considered safe, though like any procedure, it carries some risks.

5. Intravesical Therapy:
- This involves directly instilling medications into the bladder. Options include dimethyl sulfoxide (DMSO) or heparin, which may help reduce inflammation and pain associated with IC.

6. Surgery:
- In severe cases where other treatments have failed, surgical options may be considered. This could include procedures to increase bladder capacity or even bladder augmentation.

Follow-Up and Monitoring
It is crucial to maintain regular follow-ups with your healthcare provider to monitor your symptoms and adjust treatment as necessary. If you feel that your current treatment plan is not effective, do not hesitate to discuss this with your doctor. They may refer you to a specialist in urology or a pain management clinic for further evaluation and treatment options.

Conclusion
While you have encountered a treatment plateau with Elmiron, there are multiple avenues to explore for managing overactive bladder and interstitial cystitis. It is essential to work closely with your healthcare provider to tailor a treatment plan that addresses your specific symptoms and concerns. Additionally, seeking a second opinion or consulting a specialist may provide further insights and options for your condition.

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