Tag Archive | "BPS"

Guidelines Introduced for Interstitial Cystitis/Bladder Pain Syndrome

For the first time ever, a clinical guideline on the diagnosis and treatment of interstitial cystitis/bladder pain syndrome (IC/BPS) has been established.

The full text of the evidence-based guideline, issued by American Urological Association, is available on AUA’s website.  An executive summary will be published in an upcoming issue of the Journal of Urology.

“IC/BPS affects a significant number of patients whose quality of life is severely diminished by this complicated, frustrating condition,” said Philip Hanno, MD, who chaired the multidisciplinary panel that developed the guideline.

“This population has historically been both under-recognized and under-served, and it is our hope that this guideline provides physicians with a much-needed road map to help treat these patients,” he noted.

A previous attempt had been made in 1999 to develop a guideline for IC/BPS, “but after doing a literature search, we realized we didn’t have enough data to put a guideline together,” explained Dr. Hanno.  Now enough research is available.

“Over time,” Dr. Hanno explained, “interest in the disorder exploded, and the prevalence seemed to be increasing because of better epidemiology studies, and we felt that there was a lot of mismanagement of the symptom complex and failure to recognize it.  We felt it was really important to put together a guideline for clinicians, and luckily at this time there was enough data to do it.”

Here are the key recommendations:

  1. The basic assessment should include a careful history, physical examination, and laboratory examination to rule in characteristic IC/BPS symptoms (including sensations of pain, pressure and discomfort perceived by the patient to be related to the bladder, and absence of infection, as well as marked urinary urgency and frequency), and rule out easily mistakable disorders (such as overactive bladder or, specifically in men, chronic prostatitis).
  2. Baseline voiding symptoms and pain levels should be obtained to measure subsequent treatment efficacy.
  3. Cystoscopy and/or urodynamic studies should be considered as an aid to diagnosis only for complex presentations; these tests are not necessary for making the diagnosis in uncomplicated presentations.  Although there are no existing cystoscopic or urodynamic findings specific for IC/BPS, the guideline states that these tests can be valuable in identifying lesions or alterations (Hunner’s lesions) in the bladder in patients with symptoms, and in ruling out other entities such as bladder cancer or urethral diverticula.

One major concern of Dr. Hanno’s is that IC/BPS is often misdiagnosed as overactive bladder or prostatitis in men, which delays correct diagnosis and treatment.  “Some patients are treated as if they have recurrent urinary tract infections, and they will be on antibiotics for months or years without proper diagnosis, or on anticholinergics for years if it is diagnosed as overactive bladder and they don’t get better.  Identifying IC/BPS early and treating it early can certainly impact a patient’s quality of life,” Dr. Hanno said.

Currently, no cure exists for IC/BPS, and oftentimes no single treatment works well over time for the individual patient.  Despite the fact that the best treatment remains unclear, the following points are given for guidance for overall management of IC/BPS:

  1. Strategies should start with the most conservative treatments first before moving to less conservative therapies.
  2. Initial treatment type and level should be related to symptom severity, clinical judgment, and patient preferences.   Patients should be counseled with regard to reasonable expectations for treatment outcomes.
  3. Some patients may benefit from multiple, concurrent treatments; baseline symptom measurement and regular assessment are critical to document the efficacy of combined vs. single treatments.
  4. Ineffective treatments should be stopped once a clinically meaningful interval has elapsed.
  5. Pain management and its effect on a patient’s quality of life should be regularly assessed and considered.  If pain management is inadequate, then consideration should be given to a multidisciplinary approach, and the patient referred appropriately.
  6. If no improvement in symptoms occurs after multiple treatment approaches, the diagnosis of IC/BPS should be reconsidered.

The authors of the guideline indicate that patient education is the first-line treatment:

  1. “Patients should be educated about normal bladder function, what is known and unknown about IC/BPS, the benefits vs. risks/burdens of available treatment alternatives, the fact that no single treatment has been found effective for most patients, and the fact that acceptable symptom control may require trials of multiple therapeutic options (including combination therapy) before it is achieved,” the authors write.
  2. Patients should be counseled on how certain self-care practices, behavioral modifications, and coping techniques such as stress management may help manage their IC/BPS symptoms.
  3. The guideline also outlines second-, third-, fourth-, fifth-, and sixth-line treatment options and includes an algorithm outlining a hierarchy of physical and medical therapies, as well as surgical options for IC/BPS.  “There is a lot of leeway in the guidelines, so people have the ability to do what they think is right,” Dr. Hanno said.

The guideline discusses several treatments that should not be offered because of lack of efficacy and/or unacceptable adverse effects.  These treatments are:

  1. Long-term oral antibiotics
  2. Intravesical instillation of bacillus Calmette-Guerin outside of a study setting
  3. Intravesical instillation of resiniferatoxin
  4. High-pressure, long-duration hydrodistension
  5. Systemic (oral) long-term glucocorticoid administration

“This guideline will improve the ability of primary care physicians and specialty physicians (urologists, gynecologists) to diagnose IC/BPS, and then it will aid them in treatment options, as well as avoid certain treatments that have been proven to not be worthwhile,” Dr. Hanno notes.

“It’s directed at all physicians,” he emphasized, noting that “primary care physicians need to recognize this condition and then make the appropriate referrals to physicians who have some expertise in managing it.”

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Overly Restrictive Diets May Not be Necessary for Interstitial Cystitis Sufferers

The results of a recent survey revealed that the diets of interstitial cystitis/bladder pain syndrome (IC/BPS) patients may not have to be so restrictive.

The aim of the study was to survey IC/BPS patients using an online questionnaire to determine which foods, drinks, supplements/spices, and general food categories truly lead to symptom flare ups.

In order to conduct the study, the Interstitial Cystitis Association posted an online study for ICA’s members to participate.  Members were asked their experiences/effects after consuming 344 different foods, drinks, supplements, condiments/spices, and general food categories.  Mainly, the researchers were interested in the effects on urinary frequency, urgency, and/or pelvic pain symptoms.  Members were asked to score the resulting symptoms due to the consumption of the noted foods using the Likert scale of 0 to 5.  Questions on ethnicity, education, symptom duration, seasonal allergies, irritable bowel syndrome, and specific diets were also included.

Out of the 598 complete responses to the questionnaire, 95.8% relayed that certain foods and beverages do affect their IC/BPS symptoms; however, most items on the list had no effect on the symptoms.

Some items that made symptoms worse were citrus fruits, tomatoes, coffee, tea, carbonated and alcoholic beverages, spicy foods, artificial sweeteners, and vitamin C.

Only two items on the list were reported to help alleviate the symptoms:  calcium glycerophosphate (Prelief) and sodium bicarbonate (baking soda).

Although it is recommended that patients with IC/BPS avoid citrus fruits, tomatoes, coffee, tea, carbonated and alcoholic beverages, spicy foods, artificial sweeteners, and vitamin C, the study’s results suggest that interstitial cystitis diets do not have to be overly restrictive.  Further, the use of calcium glycerophosphate or sodium bicarbonate before consumption of the known irritants may also help reduce the symptoms of IC/BPS.

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