DIMETHYL SULFOXIDE (DMSO): This is the most common treatment used. DMSO is a liquid anti-inflammatory agent that is instilled in the bladder (through a catheter) once a week or so. The patient holds the medication in her/his bladder for up to a half an hour (although you can ask the nurse to leave the catheter in and clamp it off). This drug leaves a strong garlic-like odour on the skin and breath for about 24 hours after treatment. An odour-free type of DMSO called DMSO-2 is being developed.

Studies have shown that 50 to 90 percent of women with mild to moderate interstitial cystitis get improvement with DMSO. Fifty to 70 percent of women with severe IC get good to excellent results with DMSO.

For some, Dr. Gillespie instills a "cocktail" of DMSO, sodium bicarbonate, and steroids directly into the bladder, under general anesthetic every week for six weeks or until the bladder starts to heal. In severe cases of IC, she also uses the drug angiostat, which stops the tiny blood vessels in the bladder from overgrowing.

Dr. Whitmore uses a cocktail including all the above ingredients, but substitutes a local anesthetic for DMSO. This mixture seems to offer relief to half the people who have tried it. Studies are under way to further evaluate this treatment.

DIET: For some women, a restricted diet, low in acid as well as low in tryptophan and tyrosine may eliminate most of the burning sensation. If chronic yeast infection is present, a short-term diet with no sugar, fruit, yeasted bread, or dairy may be optimal. Food allergies can be tested through an elimination diet. Foods to which a person is sensitive can sometimes trigger a bladder attack.

It is very important to avoid artificial sweeteners like cyclamates or aspartame (nutrasweet). These not only irritate the bladder, they cause sugar cravings and fluctuations of blood sugar levels.

MOOD-ALTERING DRUGS: If diet alone does not control the burning sensations, some women have been helped by very low doses of elavil (an anti-depressant medication) in the range of ten to 40mg a day, usually taken at bedtime.

ANTIHISTAMINES: While over the counter anti-histamines (H1 blockers) may help, more effective are H2 blockers, drugs normally used to treat ulcers, like tagamet, zantac, and pepsid.

TENS UNIT: "Transcutaneous electrical nerve stimulation" involves using electrical stimulation of acupuncture points to reduce pain. A minimum of a four to six week trial should be tried.

ELMIRON or sodium pentosanpolysulfate is an expensive oral medication that is believed to coat the bladder and protect it from irritants. This drug may take up to three months before improvement is noticed. In April, 1993, elmiron was approved for the Canadian market and is available by prescription.

The major side effects are diarrhea and gastrointestinal problems. The drug is still undergoing trials in the United States where it is expected to be approved in 1993-4. Preliminary studies show that this drug helps between 25 and 50 percent of those who tried the medication. More research is under way.

Dr. Ramon Perez-Marrero believes that elmiron is like heparin (a drug that decreases blood clotting) that you can take by mouth. Since heparin is far cheaper, Dr. Perez-Marrero feels it might make more sense to put heparin into the bladder. In his experience with severe IC, instillation of heparin into the bladder helped 40 to 50 percent of people with severe IC. Dr. Perez-Marrero also warns that elmiron use may lead to the development of osteoporosis, but heparin will not.

NALMEFENE: This new drug is believed to help IC by stopping the release of histamine and other substances which may be released within the bladder wall. Histamine is produced by cells in allergic or inflammatory reactions. A well designed study of this drug is now taking place at McMaster University.

BLADDER DISTENTION: This consists of filling the bladder with water for varying amounts of time, from a few minutes to several hours. According to Dr. Whitmore, "About 30 to 50 percent of people who undergo this procedure experience a lessening of symptoms for up to six months or longer."

LASER TREATMENT: Women with severe IC with pain and bleeding from ulcers in the bladder wall, may obtain some relief from having these ulcers burned with a laser. This must be done by an experienced surgeon as there is a danger of burning through the bladder wall.