Many patients with IC have associated medical problems. As mentioned a great deal today, some IC patients have pelvic floor dysfunction causing most or a good portion of their symptoms. Some patients have associated systemic problems such rheumatoid arthritis, lupus erythematosus, Sjögren syndrome, or other types of immune problems. More and more IC patients are found to have fibromyalgia (multiple regions of muscle and tendon tenderness) and chronic fatigue syndrome. Each of these problems can have a very negative impact upon the IC patients general condition and they must be addressed. Most urologists are not skilled in the treatment of these other disorders and the help of other medical disciplines is necessary. My strong advice to patients who have multiple problems is to get themselves a good primary care physician who can coordinate the care and/or treat many of these diseases. I find that patients very frequently see only specialists. They need a physician to step back and look at the "big picture" - a holistic approach.

I would like to talk about drinking water. There are two different types of patients: those who drink too much and those who are "peeing syrup" out because they dont drink enough. The patients who drink lots of water are usually doing this to dilute the urine. IC patients appear to be very sensitive, in many instances, to the constituents of urine. We know that urea is a significant irritant to the IC patient and is present in the urine all the time. Likewise, metabolic products of the foods that we eat often are found in the urine and can also act as irritants. By drinking more, the IC patient can dilute these chemicals out and hopefully have fewer symptoms. This strategy coupled with a bladder "protectant" such as Elmiron makes theoretical sense. Of course, theres a downside to drinking large quantities of water - youll pee a lot more. So I think that there needs to be a balance established with each patient erring on the side of increasing their fluid intake but not going so far as to become "waterlogged."