These symptoms are individual - they can be mild to severe, can flare up depending on different factors (i e. stress, certain types of food or drinks, sex, exercise, menstruation, etc.), and can even disappear for a while.

Causes

The exact cause of BPS/IC is not known, but there are several factors which could cause damage to the protective GAG layer of the bladder, for example:

• Auto-immune reaction, where your immune system attacks the bladder tissue, mistaking it for an aggressor;
• Allergic reaction;
• As a side effect of conditions such as irritable bowel syndrome, fibromyalgia, lupus, and others.

These and other factors could cause damage to the GAG layer, therefore destroying the protective layer of the bladder. When this happens, the underlying tissue, including nerves and muscle fibres, are open to attack from aggressive substances in urine.

Diagnosis

For physicians, this difficult chronic disease is a therapeutic challenge. Since the cause is not yet known, BPS/IC is diagnosed by exclusion. This means that your doctor will first exclude all other possible conditions. This is often easier said than done, as overlapping syndromes often complicate the diagnosis.

In order to confirm the diagnosis, your urology team may need to obtain your:

• Medical history and bladder diary. You will be required to take note of your symptoms, how many times a day you had to pee, record your fluid intake, etc.
• Pelvic exam, which includes an external and internal exam.
• Urine culture test, to exclude a possibility of a UTI. Urine may also be analysed for bladder cancer cells.
• Cystoscopy results - this is a visual bladder examination through a cystoscope, a thin tube with a small camera at one end. The tube is inserted through your urethra into the bladder and allows your doctor or CNS to look for bladder lining damage. They may also measure your bladder capacity, or take a biopsy sample to exclude bladder cancer.

Treatment

As mentioned previously, BPS/IC has no cure. However, there are many therapeutic options which could offer you relief and symptom management:

1. Lifestyle changes and physical therapy

Physical therapist can help you relieve pelvic pain caused by muscle tension or abnormalities. Additionally, there are many lifestyle changes which can help manage the symptoms and even prevent flareups.

2. Oral medications, which include:
   • OTC pain killers (paracetamol, ibuprofen)
   • Prescription pain killers (gabapentin, pregabalin)
   • Antihistamines (loratadine, cetrizine)
   • Muscle relaxants (tolterodine, mirabegron)
   • Antidepressants (amitriptyline)
   • Pentosan polysulfate sodium which can help repair the GAG layer.
3. GAG replenishment therapy through bladder instillations - 0.2% chondroitin sulphate (the active ingredient in Gepan) attaches itself to the damaged parts of the GAG layer. This way it temporarily coats the bladder wall, protecting it from aggressive substances in urine.
4. Nerve stimulation (sacral nerve stimulation, transcutaneous electrical nerve stimulation (TENS))
5. Bladder distention (bladder is stretched by injecting water during cystoscopy)
6. In rare cases and as a final resort, your doctor may recommend surgery, which could mean:
   • Burning off the ulcers in the bladder (fulguration)
   • Cutting the ulcers out of the tissue (resection)
   • Increasing bladder capacity by adding a piece of intestine onto its surface (augmentation)
   • Removing the bladder.

How can Gepan help?

Gepan is clinically proven to be effective and well tolerated treatment for BPS/IC. In one study 92.3% of patients responded to treatment*, while in the other all patients felt relief in symptoms, with the average symptom score being improved by 73%*.

A long-term study published in January 2020, followed BPS patients on Gepan treatment. The patients received one instillation per week for a month, then continued with once-a-month instillations. At the end of the first month, 77% of patients felt improvement; and at the end of the year, 100% of patients felt mild to strong improvement. 

Speak to your doctor about Gepan as treatment option for IC/BPS. You can download a patient information leaflet here, or ask them to contact us here for more information. If you have been taught how to self-instill, you can order Gepan directly from us by emailing us at gepan@purpleorchidhealth.co.uk or give us a call at 0844 415 2420.