Very rarely do we find ourselves in a position to speak on the topic of Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) with a clinician that has over 625 publications, whose research spans several decades, and has positively contributed to the understanding of these common and challenging syndromes impacting the lives of so many people.

Last week, Marnie Glavin, the founder of Pelvic Health Support, interviewed Dr. Curtis Nickel, Professor Emeritus, regarding his experience researching and treating IC/BPS. Dr. Nickel is a global key opinion leader in the space of inflammatory disease and infection of the urinary tract. Furthermore, he has been a member of the department of Urology at Queens University since 1984.

Having started with a background in microbiology and beginning to see patients with Chronic Prostatitis and IC/BPS early in his career, Dr. Nickel’s original belief was that these patients’ symptoms were the result of an infection. With this belief, he set out a goal to discover the microorganism(s) that caused these disorders. In the process, he has studied hundreds, if not thousands of patients.

The results of this research were fascinating. Infection may be implicated in some IC/BPS patients and likely exacerbates it in others. There is definitely a percentage of IC/BPS patients with an infection phenotype. As for the rest, Dr. Nickel has worked to establish a total of nine patient phenotypes (table 1) to categorize IC/BPS for the purpose of treatment. By doing so, “the correct ingredients for a personalized management recipe” can be chosen.

In December of 2022, the Canadian Urological Association Journal published Dr. Nickel’s article Managing Interstitial Cystitis/Bladder Pain Syndrome in female patients: Clinical Recipes for success. The article details his work to not only describe these 9 patient phenotypes, but also to provide treatment recommendations specific to each one, being cognizant of the fact that most have multiple phenotypes and will require a multi-therapy approach. Dr. Nickel hopes that clinicians will use this article as a tool for use in their practice, to better understand these patients and to support better outcomes for patients struggling to find relief from the pain and discomfort of IC/BPS.

Intravesical Therapy

One treatment method for IC/BPS is intravesical therapy. This refers to the placement of solutions, that being natural substances or medication, directly into the bladder. Dr. Nickel has said that over 50% of his patients will end up having some type of tailored or directed, personalized program which will include at least one form of intravesical therapy.

The contents of these therapies vary by patient, their treatment history, and ultimately, their clinical phenotype (table 2).

For more on Dr. Nickel’s story in developing treatment methods for IC/BPS patients, visit the Pelvic Health Support YouTube page to watch the interview and Q&A.

Hyaluronic Acid, a natural substance for IC/BPS Treatment 

When analyzing Dr. Nickel’s Phenotypes and recipes for each, one can see that hyaluronic acid plays a key role in 5 out of the 9 treatment processes.

With IC/BPS, the bladder lining is often damaged or inflamed, which can lead to a loss of the protective layer (GAG layer) that lines the bladder. This can result in increased exposure of the underlying tissues to irritants in the urine, leading to pain, discomfort, and inflammation.

Hyaluronic acid may be beneficial for people with IC/BPS because it can help to restore the protective layer of mucus in the bladder lining. It works by binding to water molecules and forming a gel-like substance that helps to maintain tissue hydration and lubrication. This can help to protect the bladder lining from irritants.

The Canadian Urological Association has recommended Hyaluronic Acid as a grade C option for treatment of IC/BPS. In addition, the European Urological Association has recommended Hyaluronic Acid as an option to treat recurrent urinary tract infections.

INSTYLAN: Hyaluronic Acid Bladder Instillations in the comfort of your home

INSTYLAN is a hyaluronic acid solution with packaging that enables instillation at home through a catheter. The packaging also encompasses an additional port, allowing for the addition of other drugs, such as heparin, and chondroitin sulfate based on physicians’ recommendations (up to 50 ml). In doing so, INSTYLAN provides capability to treat 5 of the 9 phenotypes established by Dr. Nickel.

For more information on INSTYLAN, visit the web site or call 1-877-563-7422.