There are steps you can take to cope with BPS and manage the disease yourself – self-care practices and behaviour modifications, stress management and coping techniques, including an elimination diet that may help to identify any strong triggers for your symptoms. Many patients report that stress leads to an increase in their symptoms; as such, managing stress may be crucial to managing BPS symptoms.1
Reference
- Rothrock NE, et al. Urology. 2001;57(3):422–7
Behavioural therapy
There are various types of psychotherapy (behavioural therapy) that can help you to manage the symptoms of BPS.
Seeing a pain psychologist can help you identify past and present life stressors and provide you with ways to cope with these stressors to limit a flare up in your BPS symptoms
Emotionally expressive therapy may also help to address painful experiences that occurred prior to onset of your symptoms
Cognitive behavioural therapy can help you to develop coping strategies for dealing with painful and uncomfortable symptoms
Interpersonal therapy can help you to work through any issues relating to intimacy that arise as a result of your BPS
Stress reduction
Reducing stress has been shown to really help some people with the symptoms of BPS. Anything that helps you relax, such as exercise or regular warm baths, may help to improve your ability to cope with pain and other symptoms.1 Recent evidence suggests that mindfulness-based techniques, such as meditation, can also help.2
References
- NHS UK. Interstitial cystitis.
Available at: https://www.nhs.uk/conditions/interstitial-cystitis/. Accessed March 2020 - Kanter G, et al. Int Urogynecol J. 2016;27(11):1705–11
Complementary and supportive therapy
- Bladder retraining: gradually learning to be able to hold more urine in your bladder before needing to go to the toilet1
- Complementary therapies such as acupuncture, guided imagery and reiki may help you to better manage the symptoms associated with BPS.2 These therapies relieve stress, focus on mind and body connection, and can generally help people cope with BPS
References
- Interstitial Cystitis Association. Bladder retraining.
Available at: https://www.ichelp.org/diagnosis-treatment/management-of-ic-pain/bladder-retraining/. Accessed March 2020 - Interstitial Cystitis Association. Complementary therapies.
Available at: https://www.ichelp.org/diagnosis-treatment/complementary-therapies/. Accessed March 2020
- Physiotherapy can help with the symptoms associated with BPS, such as tenderness/pain in the pelvic floor area 1,2
- Physiotherapy may focus on massage to relieve painful symptoms that occur as a result of BPS
- Assessment by a trained physiotherapist is recommended before undertaking any ongoing physical therapy
References
- Han E, et al. Ther Adv Urol. 2018;10(7):197–211
- Interstitial Cystitis Association. Physical therapy.
Available at: https://www.ichelp.org/diagnosis-treatment/treatments/physicaltherapy/. Accessed March 2020
- You shouldn’t make any drastic changes to your diet before seeking medical advice. However, if you notice that certain foods or drinks make your symptoms worse, avoiding these may help
- There are two broad diets recommended for people with BPS – the low acid diet and the low histamine diet
Generally, foods that are high in acid are not well tolerated by patients with BPS. Reducing acid as part of your diet may help to relieve some symptoms.
Histamine is believed to play a role in BPS, therefore by lowering your histamine levels you may experience a reduction in the pain you are experiencing.
Histamine is a compound released by certain cells in the body, such as mast cells. This may be triggered in people after they eat or drink something that they are sensitive to, for example some people get a red flush on their cheeks after drinking red wine.
Elimination diet
- Not all foods affect everyone in the same way. By following an ‘elimination diet’ it’s simple to discover which foods, if any, affect your bladder
- In this case, you would stop eating all of the foods that could irritate your bladder from the lists available, for example from www.ichelp.org, for 1 to 2 weeks. If your bladder symptoms improve, then it is likely that at least one of those foods was irritating your bladder. After 1–2 weeks, try eating one of the foods from the elimination list. If the food doesn’t bother your bladder within 24 hours, it is not likely to be the cause of your bladder irritation
- Following this approach, you can add one of the foods back into your diet one day at a time
- This way you will be able to determine if a certain food or drink causes an increase in your symptoms and eliminate it from your diet
Bladder Health UK click here
Histamine Intolerance Awareness click here
Interstitial Cystitis Association click here
- Over-the-counter paracetamol
- Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
- Stronger painkillers available on prescription, such as codeine
- Pain modulators, which alter how your body responds to pain, such as amitriptyline and gabapentin (an anticonvulsant).
Understanding pain modulators:
Amitriptyline is a tricyclic antidepressant that can help relieve pain by reducing the release of neurochemicals that lead to bladder pain and inflammation.2 It is also a very potent antihistamine and helps people cope better with stress and anxiety.3
Gabapentin has been shown to be effective in treating the pain associated with BPS by altering the activity of neurotransmitters that send messages to your brain about pain.4
References
- NHS UK. Interstitial cystitis.
Available at: https://www.nhs.uk/conditions/interstitial-cystitis/. Accessed March 2020 - British Pain Society. Information for adult patients prescribed amitriptyline for the treatment of pain.
Available at: https://www.britishpainsociety.org/static/uploads/resources/files/FPM_Amitriptyline.pdf. Accessed March 2020 - Richelson E. Mayo Clin Proc. 1979;54(10):669-74
- British Pain Society. Information for adult patients prescribed gabapentin for the treatment of pain.
Available at: https://www.britishpainsociety.org/static/uploads/resources/files/FPM-Gabapentin_0.pdf. Accessed March 2020
Antihistamines may help by blocking the effect of a substance called histamine on cells in the bladder.
These include hydroxyzine and cimetidine, which can be prescribed for BPS.1
If your healthcare team have found evidence of tiny bleeds and/or lesions or ulcers on the lining of your bladder, they may suggest pentosan polysulfate sodium.2
This medicine may help repair the bladder mucosal lining and over time may reduce the pain and the need to go to the toilet so often.
Rather than taking a pill, intravesical medications are in a liquid form that is given via a small tube called a catheter, which is inserted directly into your bladder.
Intravesical instillations contain one or more drugs that may help BPS symptoms. The liquid is left in the bladder for a certain period of time before you empty your bladder. The instillation
your healthcare team use may vary; common ones include:1,3
- Sodium hyaluronate
- Chondroitin sulphate
- Chondroitin sulphate with sodium hyaluronate
- Heparin and lignocaine
Botulinum toxin may also be effective in relieving the symptoms associated with BPS, particularly pain, frequency and urgency.
Botulinum toxin is given via injection into the bladder.4
Many studies also reported patients having less symptoms after injections in trigger points in their pelvic floor.5
References
- NHS UK. Interstitial cystitis.
Available at: https://www.nhs.uk/conditions/interstitial-cystitis/. Accessed March 2020 - elmiron® Hard Capsule
Available at: https://www.consilienthealth.co.uk/product-variant/elmiron-hard-capsule-100mg-caps-bottle-90/. Accessed April 2021 - Interstitial Cystitis Association. Bladder instillations.
Available at: https://www.ichelp.org/diagnosis-treatment/treatments/bladder-instillations/. Accessed March 2020 - Jhang JF. Toxins (Basel). 2019;11(11):E641
- Purwar B & Khullar V. Women’s Health (Lond). 2016;12(3):293-296
Surgery and other procedures may sometimes be an option if you have abnormal areas (lesions) in your bladder, or if other, less invasive treatments, do not work.
- Cauterisation – ulcers inside the bladder are cauterised (burned off) using electricity or with a laser
- Bladder distension – the bladder is stretched with fluid, which can aid diagnosis and may temporarily relieve your symptoms
- Neuromodulation – an implant that stimulates your nerves with electrical pulses is placed in your body to relieve pain and reduce sudden urges to pass urine
- Augmentation – although not common, some centres may consider this option where the bladder is enlarged using part of the small intestine. The removal of any inflamed areas of the bladder is usually part of this procedure
Reference
- NHS UK. Interstitial cystitis.
Available at: https://www.nhs.uk/conditions/interstitial-cystitis/. Accessed March 2020
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