IC Treatment in 2016 - Do You Know The Six Steps Of Treatment for Interstitial Cystitis?
- Nicole Longwell
- Mar 15, 2017
- 3 min read
Updated: Dec 16, 2025
This video provides a comprehensive look at the American Urology Association's (AUA) six-step treatment protocol for Interstitial Cystitis (IC), which guides patients from the least invasive options to the most advanced.
Understanding the 6-Step Treatment Protocol for Interstitial Cystitis
The journey to managing Interstitial Cystitis (IC), or painful bladder syndrome, can be confusing, but the American Urology Association (AUA) offers a clear, evidence-based roadmap. This protocol is structured in six progressive steps, designed to prioritize patient safety and effectiveness by starting with the easiest, most non-invasive interventions first [01:13].
Here is a summary of the AUA's six steps for IC treatment:
Step 1: Foundational Self-Care
This is the non-negotiable basis of IC management. Skipping these simple steps can interfere with healing [03:08].
Hydration: Maintaining proper water intake (six to eight glasses daily) to keep urine diluted and less irritating. The goal is clear, pale yellow urine [02:06].
Diet Modification: Avoiding high-acid foods and beverages like coffee, soda, and citrus is crucial, as they can worsen bladder wounds [02:34].
Relaxation & Stress Management: Muscle tension and stress reduce blood flow to the bladder. Techniques like hot showers, heating pads, or stress management classes can help relax tight pelvic floor muscles [03:54].
Over-the-Counter Supplements: These are inexpensive and can work for many patients without the side effects of prescription drugs. Examples include acid-reducing products (Prelief, Acid Zap) and bladder-healing supplements (Cysto Renew, Desert Harvest Aloe) [04:44].
Step 2: Traditional Medical Treatments
If Step 1 is not fully effective, physicians move to traditional, well-known therapies:
Oral Medications: This includes the only FDA-approved oral drug for IC, Elmiron, as well as hydroxyzine (an antihistamine), and low-dose antidepressants like amitriptyline, which can help calm nerves related to pain [06:13].
Bladder Installations: Solutions containing lidocaine, sodium bicarbonate, and heparin (known as a "rescue" installation) are administered directly into the bladder to numb nerves and coat the bladder wall [07:35].
Pelvic Floor Physical Therapy (PFPT): Crucially, an NIH study found PFPT dramatically outperformed oral medications and bladder treatments in many cases, making a pelvic floor assessment an essential part of treatment [09:03].
Step 3: Advanced Diagnosis and Treatment of Lesions
This step is primarily for the roughly 5% of patients with severe, observable inflammation called Hunter lesions [11:11].
Lesion Treatment: Lesions can be treated with fulguration (cauterizing) or, preferably, steroid injections to calm the inflammation [11:48].
Hydrodistension: This procedure, where the bladder is filled with fluid, is recommended only as a low-pressure, short-duration procedure to minimize trauma to the bladder tissues [14:07].
Step 4: Neuromodulation and Targeted Injections
These are more advanced procedures for patients who haven't responded to previous steps.
Neuromodulation: Aims to re-regulate bladder nerves. Options include non-surgical Posterior Tibial Nerve Stimulation (Urgent PC) or surgical Sacral Neuromodulation [14:50].
Botox: Injections into the bladder wall to turn off overactive nerves. This is typically reserved for patients who are able to self-catheterize due to the risk of temporary inability to urinate [17:49].
Step 5: Experimental Therapy (Cyclosporine)
This step involves potent, systemic medications like Cyclosporine, a strong steroid with severe potential risks, only to be approached after careful consideration and education [18:49].
Step 6: Surgery
The final, and thankfully rare, step for most patients is surgery, which may involve bladder removal for non-repairable bladders [19:30].
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