The American Urological Association (AUA) listed their first Guidelines for the Diagnosis and Treatment of Interstitial Cystitis in 2011. They reviewed hundreds of studies and recommendations from leaders in the field. A few years later, in 2014, they further updated their findings on the condition.
Unfortunately, with how recently these treatment guidelines have been published, many urologists may not be familiar with all of the recommendations. At PelvicSanity, we created a one-page summary of the AUA Guidelines for IC that you can print out and use to guide your conversation with your urologist.
"No single treatment has been found effective for the majority of patients, and the fact that acceptable symptom control may require trials of multiple therapeutic options (including combination therapy) before it is achieved."
The experts at the AUA acknowledge that there is no single medication, treatment, or therapy that consistently works for the majority of patients. As we know, a multi-disciplinary, holistic approach yields the best results. This means that you should be wary if your urologist only suggests a single treatment - often, this is either the oral medication Elimiron(R) or bladder instillations. However, the Guidelines clearly state that a combination of treatments is most effective, and your urologist should be open to consider other treatment options.
"Treatment strategies should proceed using more conservative therapies first, with less conservative therapies employed if symptom control is inadequate for acceptable quality of life."
The AUA breaks the treatment options into 'Lines' of treatment, and recommend their physicians recommend treatments to patients in order. The first 'Line' of treatment is education about the condition - there are great resources at the Interstitial Cystitis Association and articles at PelvicSanity, while The Interstitial Cystitis Solution provides a comprehensive overview of the condition.
The first 'Line' of medical treatments (the 2nd line overall) includes pelvic floor physical therapy for IC, bladder instillations, oral medications, and pain management.
"When sufficient evidence existed, the body of evidence for a particular treatment was assigned a strength rating of A (high), B (moderate), or C (low)."
When reading the AUA Guidelines, there are two major things you should be looking for as a patient. The first is what 'Line' the treatment is in. That shows you how early in the treatment process the experts recommend trying the therapy. For example, bladder instillations (Line 2) would be recommended before trying neurostimulation (Line 3).
The other thing to look at is the evidence grade listed by the treatment. The AUA rates the evidence of effectiveness as either an A, B, or C. The better the grade, the more proof of efficacy. Pelvic floor physical therapy for IC is the only treatment given an 'A' evidence grade by the AUA, as it's been proven helpful in multiple randomized, controlled clinical trials.
Conclusion
These Guidelines for IC from the AUA can be a great way to start a conversation with your urologist about other treatment options. Don't get stuck trying a single treatment - Elmiron(R), bladder instillations, or pain medication - for months, because patients with IC see the best results with a combination of different treatments.
Additional Resources
Dr. Nicole Cozean is the founder of PelvicSanity physical therapy, Orange County's premier pelvic floor physical therapy clinic. One of only 270 PTs to be board-certified in the pelvic floor, and the first PT to serve on the ICA Board of Directors, Nicole is the author of the acclaimed and best-selling book The Interstitial Cystitis Solution (2016). She is an adjunct professor at her alma mater, Chapman University. The PelvicSanity blog focuses on presenting practical, positive information to help patients beyond the walls of Nicole's clinic.