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Quick Reference Guide for Clinicians
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Diagnosis and Management of Interstitial Cystitis/Painful Bladder Syndrome

(Published May 2008)

Diet and Self-Care

Diet

  • Avoiding certain foods, beverages, vitamins, and additives may help control symptoms and avoid flare-ups.
  • Not every patient is affected by all of these substances, and the degree of response varies from patient to patient.
  • Working with a knowledgeable nutritionist on an elimination diet (removing potential trigger substances and then reintroducing them one at a time) may be helpful.
  • Patients who are sensitive to a particular substance will notice symptoms 30 minutes to 6 hours after ingesting it.1

Self-care

Some substances that may trigger IC/PBS symptom flares:2
  • Coffee
  • Tea
  • Soda
  • Alcoholic beverages
  • Caffeinated beverages
  • Citrus fruits and juices
  • Artificial sweeteners
  • Spicy foods (e.g., hot peppers)
  • Tomatoes
  • Food additives and preservatives

This list was compiled from responses to a questionnaire by patients who have IC/PBS, published by Shorter and colleagues, supplemented by anecdotal reports from patients provided by expert committee members.

  • An important component of IC/PBS management
  • Can help patients better manage symptoms
  • Can help address secondary causes of pelvic pain that can exacerbate symptoms
  • Encourages patients to take an active role in managing IC/PBS
  • Randomized controlled data are not available, but faculty reviewers of this Quick Reference Guide believe that patients may find these strategies helpful.

Specific self-care strategies

  • Gentle exercise, such as low-impact aerobics, walking, yoga, and Tai Chi
  • Stress reduction techniques, such as relaxation techniques, meditation, visualization, self-hypnosis, massage, and psychotherapy
  • Pain relief strategies, such as a warm sitz bath or use or a cold pack or hot water bottle on the perineum or suprapubically
  • Comfortable and nonrestrictive clothing
  • Alternative therapies, such as acupressure, acupuncture, and biofeedback
  • Physical therapy—transvaginal massage using the Thiele technique, which has been shown to improve IC/PBS symptoms and decrease tone of pelvic floor muscles3
  • Bladder retraining programs that include suppression of urgency—a protocol of progressive, small increases in the intervals between voiding with the goal of reducing urinary frequency (appropriate only for patients who are free of pain)
  • Experimenting with different positions during sexual intercourse or using lubricants, if dyspareunia is an issue
  • Controlled fluid intake—but not fluid restriction—may help patients (if symptoms increase when urine is concentrated, it is suggested that patients increase fluid intake, but not more than about 2 liters per 24 hours; some clinicians suggest that patients “drink to thirst”)

References

  1. Moldwin RM, Sant GR. Interstitial cystitis: a pathophysiology and treatment update. Clin Obstet Gynecol. 2002;45:259-72.
  2. Shorter B, Lesser M, Moldwin RM, Kushner L. Effect of comestibles on symptoms of interstitial cystitis. J Urol. 2007;178:145-52.
  3. Oyama IA, Rejba A, Lukban JC, et al. Modified Thiele massage as therapeutic intervention for female patients with interstitial cystitis and high-tone pelvic floor dysfunction. Urology. 2004;64(5):862-5.