Leena Watts
Interstitial cystitis (IC) is a chronic condition that causes bladder pain and discomfort. It can be challenging to treat because the underlying causes are not well understood. Hunner's lesions are a rare and severe form of IC, affecting 5-10% of patients, where painful areas of inflammation develop on the bladder wall. As Hunner's lesions do not respond to traditional oral medications, they require specific treatments such as fulguration, laser therapy, steroid therapy, or surgery. While surgery for Hunner's lesions can be effective, it is not clear if it will reduce the need for ongoing IC diet management.
| Characteristics | Values |
|---|---|
| Prevalence of Hunner's Lesions | 5-10% of IC patients have Hunner's lesions, also known as Hunner's ulcers |
| Nature of Hunner's Lesions | Areas of inflammation and ulcers on the bladder wall that can cause severe pain and bleeding |
| Diagnosis | Cystoscopy, often with hydrodistention |
| Treatment Options | Fulguration, laser therapy, triamcinolone injections, steroid therapy, hyperbaric oxygen therapy, antiviral therapy, surgery (in cases of uterosacral ligament involvement) |
| Dietary Considerations | Avoid foods and beverages high in acid and caffeine |
| Impact on IC Diet Needs | No direct evidence found, but treatment of Hunner's lesions may reduce IC symptoms, including pain and urinary frequency |
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What You'll Learn
Surgery options for Hunner's lesions
Hunner's lesions are small areas of inflammation that form on the bladder wall. They are extremely painful and are a component of bladder pain syndrome (BPS), which affects the lower urinary tract. Women are more predisposed to the condition than men, at a ratio of 4:1.
Hunner's lesions do not generally respond to traditional oral medications and/or bladder instillations. However, there are several surgical options available for treating the lesions:
- Fulguration: This technique uses heat to burn the lesion or ulcer. It can also be performed using a laser or electric current to remove the lesions from the bladder wall. Fulguration can cause bladder wall scarring, which can decrease bladder capacity over time.
- Steroid therapy: Steroid shots can help heal lesions and provide pain relief.
- Laser therapy: This method uses an electric current or laser beam to destroy the local nerves in the area, reducing inflammation.
- HOT therapy: Hyperbaric oxygen therapy (HOT) has been shown to be effective in treating Hunner's lesions. It involves treating patients with high-pressure oxygen in a pressurised chamber.
- Hydrodistention: This procedure can be performed with or without fulguration to treat Hunner's lesions.
- Resection: The surgeon cuts the lesions off the bladder wall.
- Injection: An anti-inflammatory drug called triamcinolone is injected into the lesion.
- Botox injections: Botox can be injected into the bladder to provide extended periods of relief.
- Neurostimulation: This process involves surgically implanting a small wire under the skin above the tailbone to stop pain signals from reaching the nerves.
In addition to these surgical options, there are also non-surgical treatments for Hunner's lesions. These include:
- Lactoferrin: A study in August 2024 found that this glycoprotein, which has antibacterial, antiviral, and antifungal effects, dramatically reduced urinary symptoms and pain in patients with Hunner's lesions.
- Valacyclovir (Valtrex): A study in January 2024 tested the use of this antiviral medication in patients with Hunner's lesions and Epstein-Barr virus.
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Lesion-specific therapies
Hunner's lesions are areas of profound inflammation in the bladder wall. They are characterised as bleeding wounds in the bladder and are considered the most severe form of interstitial cystitis and bladder pain syndrome. Hunner's lesions are estimated to affect 5-10% of patients with IC. They are typically diagnosed through cystoscopy, often utilising hydrodistention.
- Fulguration: This procedure uses heat to burn the lesion or ulcer, destroying the local nerves and reducing the substances that trigger inflammation. While fulguration can provide significant pain relief, it may also cause bladder wall scarring, leading to decreased bladder capacity over time.
- Laser Therapy: This approach employs an electric current or laser beam to remove the lesions from the bladder wall.
- Triamcinolone Injections: An anti-inflammatory drug, triamcinolone, is injected into the centre of the ulcer to reduce inflammation.
- Hyperbaric Oxygen Therapy (HOT): This therapy has been found to be helpful in treating Hunner's lesions, accelerating the healing phase of ulcerative IC/BPS.
- Lactoferrin: As a glycoprotein with antibacterial, antiviral, and antifungal properties, Lactoferrin has shown promising results in reducing Hunner's lesions and associated inflammation.
- Steroid Therapy: Steroid injections have been reported to visibly heal lesions and alleviate pain and urinary symptoms.
- Surgery: In cases where the uterosacral ligament is involved, surgery may be necessary to reinforce and strengthen the ligament.
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The IC diet
Interstitial cystitis (IC) is a condition that causes recurring pelvic pain, pressure, or discomfort in the bladder and pelvic region. It is often associated with urinary frequency and urgency. While there is currently no cure for IC, certain treatments can help manage the condition. One such treatment is the IC diet, which involves making dietary changes to reduce IC flare-ups and improve symptoms.
- Citrus fruits and juices
- Tomatoes and tomato-based products
- Coffee
- Tea
- Carbonated and alcoholic beverages
- Spicy foods
- Chocolate
- Cultured dairy products, such as yogurt
- Processed sandwich meats
- Soy foods
- High-fat foods: Limit added fats like butter, oil, margarine, mayonnaise, and salad dressings. Choose healthier options like olive oil and canola oil, and opt for low-fat or non-fat dairy products.
In addition to avoiding trigger foods, the IC diet also includes incorporating bladder-friendly foods into your diet. Some recommended food choices include:
- Fruits: Avocados, bananas, blueberries, melons, pears, apricots, dates, prunes, and raisins. Opt for whole fruits over juice, and choose unsweetened varieties when possible.
- Vegetables: Asparagus, celery, bell peppers, broccoli, beets, eggplant, peas, mushrooms, and spinach. Choose fresh, frozen, or canned options without added sauces, fats, or salt.
- Grains: Whole grains like oats, whole grain cereal, whole grain crackers, and rice.
- Proteins: Beef, eggs, pork, lamb, poultry, and fish, especially cold-water oily fish like salmon, tuna, mackerel, and sardines.
- Nuts and seeds: Almonds, walnuts, cashews, macadamia nuts, pistachios, and nut/seed butters like peanut butter and almond butter. Consume these in small amounts.
- Dairy: Low-fat or non-fat milk, cream cheese, cheddar cheese, and low-fat yogurt without added sugar or artificial sweeteners.
- Beverages: Water, pear juice, blueberry juice, grain-based coffee substitutes, and herbal teas like chamomile or peppermint tea.
It is important to note that dietary changes may not work for everyone with IC, and a combination of diet and other therapies may be necessary to manage the condition effectively. Additionally, it is always recommended to consult with a healthcare professional before making any significant dietary changes to ensure they are safe and suitable for your individual needs.
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Causes of Hunner's lesions
Hunner's lesions are areas of inflammation that form on the bladder wall, causing severe bladder pain and symptoms. They are found in around 5 to 10% of patients with interstitial cystitis (IC). The cause of Hunner's lesions has long been a mystery, but recent research has identified several possible causes and contributing factors.
One possible cause of Hunner's lesions is viral infection. Research studies from Europe have found active viruses such as polyoma and Epstein-Barr in the urine of patients with lesions, suggesting that these could be chronic viral infections of the bladder wall. These types of viruses are known to cause inflammation and are challenging to treat with traditional therapies. Additionally, patients with Hunner's lesions have been found to have profound inflammation in their biopsy results, which is not typically seen in patients without the lesions.
Another potential cause of Hunner's lesions is neuroinflammation resulting from a weakened uterosacral ligament. This ligament helps to hold the uterus in place, and its weakness can lead to inflammation in the bladder wall. In some cases, surgical repair of a prolapsed uterus has been shown to resolve Hunner's lesions, indicating a potential anatomical cause.
Hunner's lesions may also develop after a urinary tract infection (UTI), vaginitis, or prostatitis. These infections can cause inflammation and irritation in the bladder and surrounding areas, potentially leading to the formation of lesions. Additionally, certain bacterial infections, such as E. coli, have been associated with recurring urinary tract infections and the development of Hunner's lesions.
While the exact causes of Hunner's lesions are still not fully understood, recent research has provided valuable insights into potential viral, anatomical, and infectious contributors. Further studies are needed to confirm these findings and develop more effective treatments for this painful and challenging condition.
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Diagnosing Hunner's lesions
Hunner's lesions are areas of inflammation that form on the bladder wall. They are associated with Interstitial Cystitis (IC) or Bladder Pain Syndrome (BPS). IC can be diagnosed once a person has had symptoms for six weeks. Diagnosis involves a discussion of symptoms, their severity, effects on everyday life, health history, diet, and medications. Pelvic and rectal exams may be conducted, and a post-void residual urine test may be performed to determine the amount of urine left in the bladder after urination.
Hunner's lesions can be diagnosed through a cystoscopy, which involves inserting a cystoscope into the bladder through the urethra to visually examine the bladder wall. Cystoscopy can also be used to treat Hunner's lesions by removing or injecting them with an anti-inflammatory drug.
In 2017, a new urine test was developed by researcher Laura Lamb, which measures urinary cytokine levels and can identify Hunner's lesions. This test may not be widely available yet, so patients should ask their doctors about its availability.
Other diagnostic tests for Hunner's lesions include urinalysis, urethral swabs, blood tests for inflammation, ultrasounds, and MRIs. In some cases, hydrodistention may be used to see or treat Hunner's lesions, but it is not necessary for diagnosis.
Once diagnosed, Hunner's lesions can be treated with various techniques, including fulguration (using heat or a laser beam to destroy the nerves causing inflammation), steroid therapy, laser therapy, and triamcinolone injections. Surgery may also be an option, especially if the uterosacral ligament is involved.
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Frequently asked questions
Hunner's lesions are areas of profound inflammation in the bladder wall. They are extremely painful and are considered to be the most severe form of interstitial cystitis and bladder pain syndrome.
Treatment options for Hunner's lesions include:
- Hyperbaric oxygen therapy
- Laser therapy
- Steroid therapy
- Surgery
- Cystoscopy
- HOT therapy
- Lactoferrin
There is no definitive answer to this question as it depends on individual circumstances. Surgery for Hunner's lesions may provide relief from symptoms associated with IC, but it is not guaranteed that it will eliminate the need for dietary modifications. It is important to consult with a healthcare professional to determine the most appropriate treatment plan.
