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PubMed This is a summary of 18 peer-reviewed journal articles Updated
Urology · Interstitial Cystitis / Bladder Pain Syndrome

Navigating Treatment Options for IC/BPS

At a Glance

Treatment for IC/BPS is highly personalized and no longer follows a rigid step-by-step process. Doctors now tailor therapies to your specific symptoms, using a mix of stress management, pelvic floor physical therapy, oral medications, and targeted bladder procedures to provide relief.

Treating Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) is not a “one-size-fits-all” process. In the past, the American Urological Association (AUA) recommended a rigid “stepped-care” (six-tier) system where patients had to fail basic treatments before trying advanced ones. In 2022, the AUA explicitly abandoned this rigid system [1].

Today, treatment is non-linear. It is based on shared decision-making between you and your doctor, and tailored to your specific phenotype (such as whether you have Hunner lesions) [1][2]. You do not have to blindly move up a ladder; instead, your doctor should select therapies from the following categories based on what is driving your unique symptoms [3].

Behavioral and Non-Pharmacologic Therapies

Every treatment plan should incorporate these foundational strategies, which empower you to manage symptoms day-to-day [1]:

  • Education and Stress Management: Using techniques like mindfulness or Cognitive Behavioral Therapy (CBT) to lower the impact of stress on bladder flares [4][5].
  • Physical Therapy: Specifically, manual pelvic floor physical therapy to relax tight muscles. Note: You should avoid “Kegels,” which can make IC/BPS pain worse [6].
  • Dietary Adjustments: Identifying and avoiding personal “trigger foods” that irritate your bladder [1].

Oral Medications

If lifestyle changes and physical therapy aren’t enough, oral medications are often introduced [1]:

  • Amitriptyline: An antidepressant that, at low doses, effectively targets nerve pain [1].
  • Hydroxyzine: An antihistamine that targets the overactive mast cells in the bladder [1].
  • Pentosan Polysulfate Sodium (Elmiron): A medication designed to help restore the bladder’s protective GAG layer [1].

CRITICAL SAFETY NOTE: Pentosan Polysulfate (Elmiron)
Long-term use of Elmiron is linked to a unique form of vision damage called pigmentary maculopathy. This risk increases with higher doses and longer duration of use. If you take this medication, the AUA and manufacturers recommend regular retinal eye exams, including Optical Coherence Tomography (OCT) and Fundus Autofluorescence (FAF), to monitor for changes [7][8].

Bladder Instillations and Procedures

These therapies act directly on the bladder [1]:

  • Bladder Instillations: Medications like DMSO, heparin, or lidocaine are put directly into the bladder via a catheter to temporarily soothe the lining [1].
  • Hydrodistension: Stretching the bladder with water under anesthesia to help provide temporary pain relief and identify lesions [9].
  • Hunner Lesion Treatment: If visible lesions are found, your doctor may use fulguration (cauterizing with heat) or inject steroids (triamcinolone) directly into them [10][11].

Advanced Options

These are reserved for cases that have not responded to earlier treatments (refractory IC/BPS) [12]:

  • Botox (OnabotulinumtoxinA): Injections into the bladder wall to relax the muscle and block pain signals [13]. Effects typically last 3 to 9 months. There is a risk of temporary urinary retention (inability to urinate), which may require you to temporarily use a catheter.
  • Cyclosporine A: A powerful immune-suppressing drug [14]. Because it can cause kidney toxicity and high blood pressure, your doctor must perform regular blood tests and blood pressure checks [15].
  • Neuromodulation: A small device (like a pacemaker for the bladder) is implanted to help control nerve signals [16].

Major Surgery

A tiny fraction of patients ever need major surgery [17]. Surgery (such as removing the bladder or diverting urine) is the absolute last resort and is only considered for incredibly rare, end-stage cases that have not responded to years of other treatments [18][12].

Common questions in this guide

How is IC/BPS treated today?
Treatment for IC/BPS is no longer a rigid, stepped process. Instead, your doctor will work with you to select therapies—like pelvic floor physical therapy, oral medications, or bladder instillations—based on your specific symptoms and underlying causes.
Are Kegel exercises good for interstitial cystitis?
No, you should avoid Kegel exercises if you have IC/BPS. Kegels strengthen and tighten pelvic floor muscles, which can actually worsen your pain. Instead, manual pelvic floor physical therapy is recommended to help relax tight muscles.
What are the eye risks associated with taking Elmiron?
Long-term use of Elmiron is linked to a unique form of vision damage called pigmentary maculopathy. The risk increases with higher doses and longer use. If you take this medication, you must get regular retinal eye exams to monitor your eye health.
What are the side effects of Botox for the bladder?
Botox injections can effectively relax the bladder muscle and block pain signals for three to nine months. However, there is a risk of temporary urinary retention, meaning you might temporarily need to use a catheter to empty your bladder.
Will I need major surgery for IC/BPS?
Major surgery, such as removing the bladder or diverting urine, is considered an absolute last resort. It is extremely rare and only used for end-stage cases that have not responded to years of other treatments.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Which category of treatment do you think is best suited for my specific phenotype right now?
  2. 2.Since I am taking/considering Elmiron (pentosan polysulfate), can you help me coordinate the required baseline and follow-up eye exams with an ophthalmologist?
  3. 3.If we try Botox injections, how often will I need to repeat the procedure, and what is the risk that I will need to use a catheter temporarily?
  4. 4.For Cyclosporine A, what is the schedule for monitoring my blood pressure and kidney function?
  5. 5.How long should we try a conservative treatment before deciding it isn't working and moving to another option?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (18)
  1. 1

    Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome.

    Clemens JQ, Erickson DR, Varela NP, Lai HH

    The Journal of urology 2022; (208(1)):34-42 doi:10.1097/JU.0000000000002756.

    PMID: 35536143
  2. 2

    Cystoscopic evaluation and clinical phenotyping in interstitial cystitis/bladder pain syndrome

    Acar Ö, Tarcan T

    Journal of the Turkish German Gynecological Association 2019; (20(2)):117-122 doi:10.4274/jtgga.galenos.2018.2018.0102.

    PMID: 30457110
  3. 3

    Clinical Approach to Recurrent Voiding Dysfunction, Dysuria, and Pelvic Pain Persisting for at Least 3 Months.

    Kim SJ, Kim KH

    International neurourology journal 2022; (26(3)):179-189 doi:10.5213/inj.2244200.100.

    PMID: 36203251
  4. 4

    Multimodal Treatment with Cognitive Behavioral Therapeutic Intervention Plus Bladder Treatment Is More Effective than Monotherapy for Patients with Interstitial Cystitis/Bladder Pain Syndrome-A Randomized Clinical Trial.

    Yu WR, Jhang JF, Chen BY, et al.

    Journal of clinical medicine 2022; (11(20)) doi:10.3390/jcm11206221.

    PMID: 36294541
  5. 5

    The effect of mindfulness-based stress reduction on the urinary microbiome in interstitial cystitis.

    Shatkin-Margolis A, White J, Jedlicka AE, et al.

    International urogynecology journal 2022; (33(3)):665-671 doi:10.1007/s00192-021-04812-z.

    PMID: 33991218
  6. 6

    MRI suggests increased tonicity of the levator ani in women with interstitial cystitis/bladder pain syndrome.

    Ackerman AL, Lee UJ, Jellison FC, et al.

    International urogynecology journal 2016; (27(1)):77-83 doi:10.1007/s00192-015-2794-6.

    PMID: 26231233
  7. 7

    Phenotypic Spectrum of Pentosan Polysulfate Sodium-Associated Maculopathy: A Multicenter Study.

    Hanif AM, Armenti ST, Taylor SC, et al.

    JAMA ophthalmology 2019; (137(11)):1275-1282 doi:10.1001/jamaophthalmol.2019.3392.

    PMID: 31486843
  8. 8

    Age-Related Macular Degeneration Masquerade: A Review of Pentosan Polysulfate Maculopathy and Implications for Clinical Practice.

    Mukhopadhyay C, Boyce TM, Gehrs KM, et al.

    Asia-Pacific journal of ophthalmology (Philadelphia, Pa.) 2022; (11(2)):100-110 doi:10.1097/APO.0000000000000504.

    PMID: 35533330
  9. 9

    Low-pressure hydrodistension induces bladder glomerulations in female patients with interstitial cystitis/bladder pain syndrome.

    Hsu LN, Tsai YS, Tong YC

    Neurourology and urodynamics 2022; (41(1)):296-305 doi:10.1002/nau.24818.

    PMID: 34633704
  10. 10

    Predictive Factors for a Satisfactory Treatment Outcome with Intravesical Botulinum Toxin A Injection in Patients with Interstitial Cystitis/Bladder Pain Syndrome.

    Wang HJ, Yu WR, Ong HL, Kuo HC

    Toxins 2019; (11(11)) doi:10.3390/toxins11110676.

    PMID: 31752328
  11. 11

    Clinical guidelines for interstitial cystitis/bladder pain syndrome.

    Homma Y, Akiyama Y, Tomoe H, et al.

    International journal of urology : official journal of the Japanese Urological Association 2020; (27(7)):578-589 doi:10.1111/iju.14234.

    PMID: 32291805
  12. 12

    Managing Interstitial Cystitis/Bladder Pain Syndrome in Older Adults.

    Gracely A, Cameron AP

    Drugs & aging 2021; (38(1)):1-16 doi:10.1007/s40266-020-00810-w.

    PMID: 33094445
  13. 13

    Use of Botulinum Toxin in Urologic Diseases.

    Chermansky CJ, Chancellor MB

    Urology 2016; (91()):21-32.

    PMID: 26777748
  14. 14

    Efficacy, Side Effects, and Monitoring of Oral Cyclosporine in Interstitial Cystitis-Bladder Pain Syndrome.

    Crescenze IM, Tucky B, Li J, et al.

    Urology 2017; (107()):49-54 doi:10.1016/j.urology.2017.05.016.

    PMID: 28528859
  15. 15

    Risk factors for increased serum creatinine level in patients with psoriasis treated with cyclosporine in a real-world practice.

    Hong JR, Lee YW, Choe YB, Ahn KJ

    Dermatologic therapy 2019; (32(3)):e12875 doi:10.1111/dth.12875.

    PMID: 30884082
  16. 16

    Results of Sacral Neuromodulation Therapy for Urinary Voiding Dysfunction: Five-Year Experience of a Retrospective, Multicenter Study in China.

    Zhang P, Wang JY, Zhang Y, et al.

    Neuromodulation : journal of the International Neuromodulation Society 2019; (22(6)):730-737 doi:10.1111/ner.12902.

    PMID: 30609180
  17. 17

    Impact of Cystectomy With Urinary Diversion Upon Tracked Receipt of Opioid Prescriptions Among Patients With Interstitial Cystitis/Bladder Pain Syndrome.

    Koslov DS, Vilson F, Colaco M, et al.

    Urology 2018; (114()):83-86 doi:10.1016/j.urology.2017.11.009.

    PMID: 29158174
  18. 18

    Promising Experimental Treatment in Animal Models and Human Studies of Interstitial Cystitis/Bladder Pain Syndrome.

    Hu JC, Tzeng HT, Lee WC, et al.

    International journal of molecular sciences 2024; (25(15)) doi:10.3390/ijms25158015.

    PMID: 39125584

This page provides educational information about IC/BPS treatment options. Always consult your urologist to develop a personalized treatment plan tailored to your specific symptoms.

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