Hunner's Lesion Treatments
Self-Help
The American Urology Association encourages patients to embrace self-help strategies, such as diet modification. Foods high in acid and caffeine can trigger severe pain and discomfort, including: coffees (regular & decaf), black teas, green teas, citrus fruit juices (orange, lemon, lime), cranberry, artificial sugars and vitamins which contain Vitamin C and B6. LEARN MORE
OTC Supplements
In August of 2024, a new possible treatment for Hunner's lesions emerged with the publication of a study of Lactoferrin, a glycoprotein that plays a critical in our immune system and has antibacterial, antiviral and antifungal effects.(1) The results were very encouraging, showing a dramatic decrease in urinary symptoms and pain in the 31 patients who participated, the majority of whom (28 out of 31) experienced no flares after treatment. They found a dramatic reduction Hunner’s lesions and inflammation in the bladder.(2) No side effects were noted in the study. This follows a study in 2022 which found it effective at reducing e-coli driven recurring UTI.(3) Lactoferrin is available as an over the counter supplement, making this an affordable first option for patients to consider.
Antiviral Therapy
In January 2024, researchers in China released the first study testing the use of the antiviral medication valacyclovir (Valtrex) in patients with IC.(4) All four patients with Hunner's lesions were found to have the Epstein-Barr virus and 18 out of 24 patients without lesions had active Polyoma JC viral infections. All four patients with Hunner's responded to treatment, and two were free of pain after treatment completion. The majority of patients with Polyoma infections showed improvement in their symptoms as well. This supports the most recent research implicating viral infection in some Hunner's lesion patients.
Fulguration & Laser Therapy
Fulguration uses heat to burn the area of the lesion or ulcer while laser therapy uses an electric current or laser beam. This then destroys the local nerves in the area which causes a decrease in the substances which trigger the inflammation.
More than 90% of patients report atleast a 50% improvement in pain after the procedure with some lasting for years.(5) For other patients, however, the lesion can recur in the area, resulting in pain can returning within three to nine months. Additional treatment may be required. Fulguration can also cause bladder wall scarring that could decrease bladder capacity over time.
Fulguration or laser therapy are always performed under general or spinal anesthesia. An anesthetic solution is often placed in the bladder at the end of the procedure to numb the bladder and reduce post-operative pain.
Triamcinolone Injection
Researchers have found that the submucosal injection of triamcinolone into the center and periphery of Hunner’s ulcers to improve patient symptoms and discomfort. One study found that 70% of those patients who received triamcinolone treatment had a significant improvement in their symptoms.(6) Additional studies found the results comparable to those found in fulguration studies.(7) This procedure does not leave scarring on the bladder wall thus is usually tried before more aggressive cauterization.
Hyperbaric Oxygen Therapy (HOT)
Hyperbaric oxygen therapy (aka decompression therapy) is most well known for saving the lives of scuba divers. The patient is placed in a pressurized chamber where they breathe 100% oxygen for a period of time. The increased pressure allows the lungs to absorb more oxygen than they would at normal pressure. The blood stream then delivers the oxygen throughout the body where it can help fight infection, stimulate growth factors and stem cells and enhance healing.
Several studies have shown that HOT therapy can be helpful for IC/BPS.(8-14) Researchers in Japan treated two patients with 20 sessions of hyperbaric therapy, reporting that Hunner’s lesions disappeared completely AND pain and frequency were improved. That same time followed 11 patients (eight with lesions and 3 without) who had not responded to therapies. They received treatment for 60 minutes per day, 5 times per week for 2 to 4 weeks. After ten sessions, seven patients showed significant improvements in their symptoms. The researchers suggest that HOT therapy accelerates the healing phase of ulcerative IC/BPS. An American study found yet more success with 83% of patients reporting improvement in their lesions and 66% showing long term success at six months.
It is now available at specialty centers throughout the USA provided that your urologist is familiar with the technology and willing to try it.
Surgical Resection Of The Nerves
On rare occasions, urologists may choose to remove the lesion from the bladder wall via a resection procedure. The challenge with resection is that it is major surgery that can leave a smaller, less flexible bladder wall. Bladder capacity is reduced as well. The American Urology Association does not recommend surgical resection for the treatment of ulcers/lesions.
References
- Wang J, et al. Lactoferrin, a Great Wall of host-defence? Biometals. 2023 Jun;36(3):385-390. doi: 10.1007/s10534-023-00502-z. Epub 2023 Apr 25.
- Conte AL, et al. Effect of bovine lactoferrin on recurrent urinary tract infections: in vitro and in vivo evidences. Biometals. 2023 Jun;36(3):491-507. Epub 2022 Jun 29.
- Rosa L, et al. LACTOFERRIN IN THE TREATMENT OF INTERSTITIAL CYSTITIS: A RETROSPECTIVE PILOT STUDY. Biochem Cell Biol. 2024 Aug 1. Epub ahead of print. PMID: 39088844.
- Kuo H-C, et al. Urinary Viral Spectrum in Patients with Interstitial Cystitis/Bladder Pain Syndrome and the Clinical Efficacy of Valacyclovir Treatment. Biomedicines. 2024; 12(3):522. https://doi.org/10.3390/biomedicines12030522
- Hillelsohn J, et al. Fulguration for Hunner ulcers: long-term clinical outcomes. J Urol. 2012 Dec;188(6):2238-41.
- Cox M, et al. Assessment of patient outcomes following submucosal injection of triamcinolone for treatment of Hunner’s ulcer subtype interstitial cystitis. Can J Urol. 2009 Apr;16(2):4536-40.
- Oliver J, et al. Triamcinolone Injection vs. Fulguration for the treatment of Hunner’s Ulcer Type Interstitial Cystitis. ICS Annual Meeting Poster #555
- Osborne J. Hyperbaric Oxygen Therapy: A treatment used for decompression sickness may also help with lesions. The IC Optimist. Late Winter – Early Spring 2019. P14-15.
- van Ophoven A, et al. Hyperbaric oxygen for the treatment of interstitial cystitis: long-term results of a prospective pilot study. Eur Urol. 2004 Jul;46(1):108-13.
- van Ophoven A, et al. Safety and efficacy of hyperbaric oxygen therapy for the treatment of interstitial cystitis: a randomized, sham controlled, double-blind trial. J Urol. 2006 Oct;176(4 Pt 1):1442-6.
- Tanaka T, et al. Hyperbaric oxygen therapy for interstitial cystitis resistant to conventional treatments. Int J Urol. 2007 Jun;14(6):563-5.
- Tanaka T, et al. Hyperbaric oxygen therapy for painful bladder syndrome/interstitial cystitis resistant to conventional treatments: long-term results of a case series in Japan. BMC Urol. 2011 May 24;11:11.
- Gallego-Vilar D, et al. Maintenance of the response to dimethyl sulfoxide treatment using hyperbaric oxygen in interstitial cystitis/painful bladder syndrome: a prospective, randomized, comparative study. Urol Int. 2013;90(4):411-6.
- Wenzler DL, et al. Treatment of ulcerative compared to non-ulcerative interstitial cystitis with hyperbaric oxygen: a pilot study.
Author: Jill Osborne
Revised: 09/12/24