What your doctor can do
Antibiotics.
Your doctor can prescribe an antibiotic (such as nitrofurantoin
or trimethoprim) if bacterial cystitis seems likely. Cure rates
with antibiotics are about 85 –95%.
Checking your urine for bacteria. Your doctor can check your
urine for bacteria, but may not do this for an ordinary single
attack of cystitis. It is only if you keep getting cystitis that
you definitely need a urine check. Ideally, the doctor needs
a urine sample when you are having an attack, and one that is
not too dilute, which is problematic if you have started drinking
lots of water. A way round this difficulty is for you to collect
a special sample container from the surgery at the beginning
of an attack so that you can pass some urine into it first thing
next morning (because early morning urine is more concentrated).
Phone your doctor’s surgery and ask for their advice.
Interstitial cystitis. If no bacteria are
present and your doctor thinks you have interstitial cystitis,
there are several possible treatments (Journal of Urology 2003;170:816 –7).
They do not cure the condition, but can keep symptoms under control.
There is a lot of interest in this condition, and many new treatments
are being investigated, so the future is hopeful.
- Amitriptyline and similar drugs are often used. These drug
are commonly used antidepressants, but they also have a pain-blocking
effect. In interstitial cystitis, they are used as a pain blocker,
not because your doctor thinks you are depressed or imagining
your symptoms.
- Antihistamine medications (similar to hayfever treatments)
have been tried, on the basis that interstitial cystitis might
be a type of allergy.
- Pentosan polysulfate is used in the USA, but is not available
in the UK. It contains the glucosaminoglycans chemicals that
some researchers think are deficient in the bladders of women
with interstitial cystitis. Scientific studies to assess whether
it works have given contradictory results.
- ‘Hydrodistension’ is stretching of the bladder
with water. This is a specialist treatment and you would need
an anaesthetic. No one knows how it works, but it helps 60%
of people. The improvement lasts for several months.
DMSO (dimethyl sulfoxide) can be squirted into the bladder to reduce
pain and inflammation. It works in about 50% of people. For this
treatment, you will need to be referred to a specialist. There
have been worries that DMSO could affect the eyes and liver.
