A lesion or ulcer is an area of profound inflammation in the bladder wall. It can have several shapes, from round to what look like cracks in the bladder tissue.
The cause of lesions have been one of the great mysteries of IC. There are two dominant theories:
Research has linked it to two potential viral infections of the bladder wall - the polyoma BK virus and the Epstein Barr virus which may help us understand why lesions haven't responded to traditional therapies, are known to recur and are, in general, somewhat challenging to treat. European IC researchers first identified the polyoma BK virus in the urine of patients with Hunner's lesions. Polyoma has long been known to occur in patients who are immune compromised and is associated with the development of hemorrhagic cystitis (aka profuse bleeding from the bladder wall. The Epstein Barr study is the first to imply that viruses normally found outside of the urinary tract can indeed be found there. Our own research on the ICN found that patients with Herpes also noticed more intense IC flares. We need much more research here.
Uterosacral Ligament Damage
In 2021, a case study was published of a woman with severe Hunner's lesion disease who experienced an unexpected cure. During the surgical repair of the prolapse, surgeons discovered that her Cardinal/Uterosacral Ligament, which helps to hold the uterus in place, was weak and her uterus was out of position (aka posterior fornix syndrome). Remarkably, her Hunner's lesions healed completely after the surgery.
This theory was first discussed in 1938 and then again in 1996. They suggest that if these ligaments are loose, gravity may stimulate visceral plexus nerves in the bladder and other sites. These then send nerve impulses to the brain where they activate a variety of inflammatory cells (T cells, mast cells, etc.). Hunner's are "extreme manifestations" of inflammation in the bladder wall. A simple test, the insertion of a speculum into the fornix (by the cervix), can determine if the ligament is lax and, if so, surgery can reinforce and strengthen the ligament.
Lesions respond best to lesion specific therapies, including: fulguration, laser therapy and triamcinolone injections. Hyperbaric oxygen therapy has also been found helpful with some emerging new research about the use of platelet rich plasma. Of course, if the uterosacral ligament is involved, surgery may be necessary. If viral infection is found, antiviral therapy may be suggested. LEARN MORE
Aside from working with your doctor and getting a proper diagnosis, the single most important thing for you to do is to stop drinking or eating any foods or beverages that contain high amounts of acid and caffeine, such as: coffee (Decaf & Regular), black tea, green tea, all sodas, artificial sugars, fruit juices. Learn more about the IC diet here!
YES! Your job is to create an environment in your bladder that will support healing. When you have open wounds, such as lesions, acid on that wound every day will not only prevent it from healing, it will probably make it worse. In our experience, the patients who drink just one cup in the morning often suffer the most intense and prolonged pain because their bladder simply cannot withstand that daily acid assault.
At this time, we know of no holistic method which has reduced or removed Hunner's lesions from the bladder wall. That said, anything that you can do to reduce inflammation in your body is helpful, such as reducing your consumption of sugar, eating healthy, organic foods and drinks, reducing stress can all help you become more healthy. If it is confirmed that lesions are viral in some patients, that would explain why lesions recur. Anti-virals may be a future treatment.