When all else has failed and the patient with interstitial cystitis is still miserable with frequency and pelvic/perineal pain, you, as the treating physician, basically has 2 options. Option 1 is to refer them out to the "specialist." This my get the patients out of your hair, but it does not do the patient a service. The better approach is option 2: the IC cocktail instillation.
I use a compunded mixture of 2% lidocaine, 10,000 U Heparin, and 8.4% Sodium Bicarb. After confirming that the symptoms are not due to a UTI, I instill the mixture--a total of 12cc--by gravity into the bladder. I then have the patient hold the mixture in the bladder for 15 to 20 minutes, then void it out.
The most difficult part of the entire process is finding a pharmacy that can compound the above mixture. I use a pharmacy in NJ called Wedgewood. I think the are terrific and recommend them.
The majority of IC patients who are refractory to other forms of treatment, such as elavil, atarax, and elmiron, will repsond to the instillations.
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