Interstitial Cystitis Treatment in Singapore

Interstitial cystitis (IC) is a chronic bladder condition characterised by bladder pressure, bladder pain, and sometimes pelvic pain. Unlike bacterial cystitis, IC is not caused by infection and doesn’t respond to antibiotics. The bladder wall becomes inflamed and irritated, leading to scarring and stiffening that reduces bladder capacity.

This condition primarily affects the bladder’s ability to store urine comfortably. Patients experience pain that typically worsens as the bladder fills and may temporarily improve after urination. The severity can range from mild discomfort to severe pain that significantly impacts daily activities.

IC affects both men and women, though it’s more commonly diagnosed in women. The condition may coexist with other chronic pain syndromes such as irritable bowel syndrome, fibromyalgia, or chronic fatigue syndrome. While there’s no cure for IC, various treatment approaches can effectively manage symptoms and help patients regain control over their lives.

Ideal Candidates

• Adults experiencing bladder pain or pressure for more than six weeks
• Patients with frequent urination (more than 8 times daily) accompanied by urgency
• Individuals whose symptoms persist despite treatment for urinary tract infections
• Those experiencing pain during or after sexual intercourse related to bladder symptoms
• Patients with negative urine cultures ruling out bacterial infection
• Individuals whose quality of life is significantly impacted by bladder symptoms

Contraindications

• Active urinary tract infection requiring antibiotic treatment first
• Bladder cancer or other malignancies affecting the urinary system
• Severe kidney disease that may complicate certain treatments
• Pregnancy may limit some treatment options
• Certain medications that interact with IC treatments

Proper diagnosis is essential before beginning treatment. Our urologists conduct thorough evaluations including medical history, physical examination, urine tests, and potentially cystoscopy to rule out other conditions and confirm IC diagnosis.

Oral Medications

Oral medications form the foundation of IC treatment. Pentosan polysulfate sodium (Elmiron) is specifically approved for IC and works by restoring the bladder’s protective lining. Antihistamines like hydroxyzine can reduce urgency and frequency by blocking histamine release in the bladder. Tricyclic antidepressants such as amitriptyline help by blocking pain signals and reducing bladder spasms.

Bladder Instillations

Bladder instillations involve placing medication directly into the bladder through a catheter. Dimethyl sulfoxide (DMSO) is commonly used and can reduce inflammation and pain. Heparin instillations help restore the bladder’s protective coating. Some patients receive cocktail instillations combining multiple medications for enhanced effectiveness.

Neuromodulation Therapy

Sacral neuromodulation uses a small device implanted near the tailbone to send electrical pulses to nerves controlling bladder function. Percutaneous tibial nerve stimulation (PTNS) is a less invasive option involving weekly sessions where a needle electrode near the ankle stimulates nerves affecting bladder control.

Technology & Equipment Used

Modern diagnostic tools include high-definition cystoscopes for visual bladder examination and urodynamic testing equipment to assess bladder function. Treatment delivery systems include specialised catheters for instillations and neuromodulation devices with programmable settings for personalised therapy.

Pre-Treatment Preparation

Before beginning treatment, patients undergo comprehensive evaluation including symptom questionnaires, voiding diaries, and urine analysis. Dietary modifications may be recommended to identify trigger foods. Patients should list all current medications and supplements. Some treatments require baseline kidney function tests or pregnancy testing for women of childbearing age.

During the Procedure

For oral medications, patients receive detailed instructions on dosing schedules and potential side effects. Bladder instillations are performed in-clinic, taking about 15-30 minutes. Patients lie comfortably while a thin catheter is inserted to drain the bladder before instilling medication. The solution typically remains in the bladder for 15-60 minutes. Neuromodulation procedures vary from simple office visits for PTNS to minor surgical procedures for implants.

Immediate Post-Treatment

After bladder instillations, patients may experience temporary burning or urgency. These symptoms usually resolve within hours. Oral medications may take several weeks to show effectiveness. Patients receiving neuromodulation can usually resume normal activities immediately for PTNS or within days for implanted devices. Regular follow-up appointments monitor treatment response and adjust therapy as needed.

First 24-48 Hours

Following bladder instillations, increase fluid intake to flush the bladder unless otherwise instructed. Mild discomfort or increased frequency is normal and should gradually improve. Avoid strenuous activities immediately after procedures. Monitor for signs of infection such as fever, severe pain, or bloody urine.

First Week

Continue prescribed medications as directed, even if symptoms haven’t improved yet. Maintain a symptom diary to track progress. Follow dietary recommendations avoiding known bladder irritants. For those with implanted devices, keep incision sites clean and dry. Attend scheduled follow-up appointments for treatment adjustments.

Long-term Recovery

IC management is typically ongoing rather than curative. Patients often need treatment adjustments over time. Regular monitoring helps optimise therapy effectiveness. Many patients find combining treatments provides better symptom control. Lifestyle modifications including stress management and dietary changes enhance treatment outcomes.

Effective IC treatment can significantly reduce bladder pain and pressure, allowing patients to engage in daily activities more comfortably. Many experience decreased urinary frequency and urgency, leading to better sleep quality and reduced anxiety about bathroom access. Treatment often improves intimate relationships by reducing pain during intercourse.

Patients frequently report enhanced work productivity and social engagement as symptoms become manageable. The ability to travel, exercise, and participate in recreational activities often returns with proper treatment. Many find their overall quality of life dramatically improves as they regain control over bladder symptoms.

Psychological benefits include reduced depression and anxiety associated with chronic pain. Patients often experience renewed hope and optimism as they discover effective management strategies. The comprehensive approach to IC treatment addresses both physical symptoms and emotional well-being.

Common Side Effects

Oral medications may cause mild stomach upset, hair loss, or headaches that often improve with continued use. Bladder instillations can temporarily increase burning or urgency immediately after treatment. Some patients experience bladder spasms during the first few instillations. PTNS may cause minor discomfort at the needle insertion site.

Rare Complications

Serious medication allergies, though uncommon, require immediate medical attention. Bladder instillations rarely cause infection or bladder perforation. Implanted devices may experience technical malfunction or require repositioning. Some patients don’t respond to initial treatments and need alternative approaches.

Our experienced urologists minimise risks through careful patient selection, proper technique, and close monitoring. Most complications are minor and manageable with appropriate intervention.