D is the correct answer

Interstitial cystitis, or painful bladder syndrome, is a cause of chronic bladder pain that can severely impact the quality of life. The exact pathophysiology of this disorder is not well understood. The hallmark of interstitial cystitis is bladder discomfort and pain. A typical feature of the disorder is the discomfort with filling and the relief with voiding. Bladder pain is frequently elicited on physical exam as well. The diagnosis is primarily that of exclusion. Urine laboratory testing aims to rule out the presence of infection. First-line treatment includes behavioral modifications such as fluid management, avoidance of certain foods or beverages, and bladder training. Second-line therapy includes physical therapy and pharmacologic treatment, including amitriptyline, antihistamines (e.g., cimetidine, hydroxyzine), and sodium pentosan polysulfate. Sodium pentosan polysulfate is an oral drug that is approved by the FDA for interstitial cystitis. Third-line therapy includes hydrodistention of the bladder by cystoscopy. Hunner lesions, areas of mucosal inflammation identified by cracking and bleeding, should be treated with fulgartion or infection of triamcinolone. Finally, additional options for refractory symptoms include intradetrusor administration of botulinum toxin A and neuromodulation.

Ciprofloxacin (A) is appropriate in the setting of an acute episode of cystitis. Mirabegron (B) is a beta 3 agonist used for the treatment of overactive bladder but is not an effective treatment for pain associated with interstitial cystitis. Oxybutynin (C) is an anticholinergic drug that is used for patients with urge incontinence. Although the patient in the clinical vignette has urgency symptoms, oxybutynin is not indicated in the absence of incontinence.