Hunner's ulcers or Hunner's lesions occur in 5 to 10 percent of people who have the bladder disease
interstitial cystitis
Interstitial cystitis (IC), a type of bladder pain syndrome (BPS), is chronic pain in the bladder and pelvic floor of unknown cause. It is the urologic chronic pelvic pain syndrome of women. Symptoms include feeling the need to urinate right awa ...
. They form on the wall of the
bladder
The urinary bladder, or simply bladder, is a hollow organ in humans and other vertebrates that stores urine from the kidneys before disposal by urination. In humans the bladder is a distensible organ that sits on the pelvic floor. Urine enters ...
and, like any ulcer, they can bleed, ooze, and may vary in size. They were first described by
Guy LeRoy Hunner, a Johns Hopkins gynecologist, in a paper delivered to the Boston Medical Society in 1915.
Diagnosis
Hunner's ulcers can only be accurately diagnosed via a
cystoscopy
Cystoscopy is endoscopy of the urinary bladder via the urethra. It is carried out with a cystoscope.
The urethra is the tube that carries urine from the bladder to the outside of the body.
The cystoscope has lenses like a telescope or microscope ...
, and at the same time can be treated with
hydrodistention. The procedure is performed by a urologist either as an in office procedure or while the patient is under
general anaesthesia
General anaesthesia (UK) or general anesthesia (US) is a medically induced loss of consciousness that renders the patient unarousable even with painful stimuli. This effect is achieved by administering either intravenous or inhalational general ...
as a day surgery.
Prevention
The drug
Elmiron helps, for some patients, to prevent the formation of Hunner's ulcers by coating the bladder wall, thus making it harder for the acid in urine to irritate the bladder wall lining, which can lead to ulceration. Elmiron is a controversial medication within the interstitial cystitis community, with its efficacy questioned by many. Elmiron has also led to long term eye damage from use.
Treatment
The ulcers can be removed through
fulguration
Radiofrequency ablation (RFA), also called fulguration, is a medical procedure in which part of the electrical conduction system of the heart, tumor or other dysfunctional tissue is ablated using the heat generated from medium frequency alternat ...
(burned off with the use of electricity or a laser) or
resection (cutting around the ulcer, removing both the ulcer and the surrounding inflamed tissue). Some ulcers may recur in the same location.
Many patients choose to live with the ulcers and treat the symptoms associated with them through
bladder instillations and/or pain medication/therapy.
Patients with interstitial cystitis may find relief by modifying their diet to remove foods and beverages that trigger symptoms: caffeinated beverages, particularly coffee (regular and decaf), tea, green tea, soda, artificial sugars and fruit juices. Cranberry juice may also trigger intense pain and discomfort. However, studies about the impact of specific foods and drinks on Hunner's ulcer symptoms are limited.
See also
*
Glomerulation Glomerulation refers to bladder hemorrhages which are thought to be associated with some types of interstitial cystitis (IC).
The presence of glomerulations, also known as petechial hemorrhages, in the bladder suggests that the bladder wall has bee ...
Notes
External links
{{Urinary tract disease
Urinary bladder disorders
Urologic pelvic pain syndrome