Multimodal therapy for painful bladder syndrome/interstitial cystitis.

Most patients who suffer from PBS/IC can now be simply and effectively treated. The first step to successful management is accurate and timely diagnosis, which has become easier with available and validated screening and diagnostic tools such as PUF and PST. Once PBS/IC is correctly diagnosed, prompt treatment should address the main components of the disease, a dysfunctional urothelium, mast cell activation and neural upregulation. Multimodal treatment that has shown benefit includes oral PPS plus an antihistamine, such as hydroxyzine, and a TCA, such as amitriptyline. Behavioral interventions and intravesical instillation therapy are adjunctive measures that will promote symptom relief. Intravesical "rescue" solutions using lidocaine and heparin or PPS (dissolved in water or in the instillation solution [off-label use of PPS]) can provide immediate relief while patients develop a response to oral PPS. Patient education and support are critical in managing this complex but treatable disorder.