Hunner lesions are strongly associated with Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS), a chronic condition characterized by bladder pain and other urinary symptoms. While Hunner lesions represent a visible abnormality in the bladder lining, they occur in only a subset of individuals with IC/BPS. Their presence often indicates a more severe manifestation of the broader bladder pain condition.
What Are Hunner Lesions?
Hunner lesions are distinct, visible areas of inflammation or ulceration on the bladder wall. They typically appear as reddened mucosal patches, sometimes with small blood vessels radiating towards a central scar or fibrin deposit. These lesions can also be described as having a “waterfall bleeding” appearance, especially after bladder distension during examination.
The size of these lesions can vary, but individual ulcer areas are often less than half a centimeter in diameter, though multiple lesions may group together in a larger inflamed area. They are commonly located on the lateral walls of the bladder. Unlike other forms of IC/BPS where the bladder lining may appear normal, Hunner lesions are a physical finding upon examination, signifying a localized inflammatory process. While historically considered rare, affecting 5-10% of IC/BPS patients, some experienced centers now report finding them in up to 50% of cases, suggesting they might be under-diagnosed. The presence of Hunner lesions often suggests a more severe form of IC/BPS, and these patients may be older, with median ages typically ranging from 53 to 65 years.
Recognizing the Signs
The symptoms associated with Hunner lesions often overlap with those of general IC/BPS, but they can be more intense and localized. Patients frequently experience severe bladder pain, which typically worsens as the bladder fills and may only be temporarily relieved by urination. This pain can be felt in the suprapubic region, but also potentially in the perineum.
Urgency and frequency of urination are common, both during the day and at night. Some individuals also report hematuria, which can occur as the lesions may bleed or ooze. These symptoms can significantly disrupt daily life, impacting sleep, work, and social activities. While shared with other forms of IC/BPS, the presence of a Hunner lesion often means symptoms are more persistent or severe, and they may not respond to typical IC therapies.
Diagnosis and Treatment Approaches
Diagnosing Hunner lesions typically involves a procedure called a cystoscopy, where a thin, lighted tube is inserted into the bladder, often under general anesthesia. During this examination, the doctor directly visualizes the bladder lining, looking for the characteristic reddened, inflamed patches, often with a central scar or fibrin clot. A biopsy may be taken from the lesion and surrounding tissue to confirm the diagnosis and rule out other conditions like carcinoma in situ.
Treatment for Hunner lesions primarily focuses on interventions directly targeting the lesions themselves. Fulguration, also known as cauterization, is a common and often effective approach where the lesion is burned off using an electrical current or laser. This process aims to destroy local nerves and reduce inflammation, with over 90% of patients reporting at least a 50% improvement in pain. Another localized treatment involves injecting corticosteroids, such as triamcinolone, directly into or around the lesion to reduce inflammation. Studies have shown significant symptom improvement in patients receiving triamcinolone injections, with results comparable to fulguration.
While not direct lesion treatments, intravesical instillations of hyaluronic acid or chondroitin sulfate are sometimes used alongside these procedures to help heal the bladder lining. These substances are naturally present in the bladder’s protective glycosaminoglycan (GAG) layer. These localized treatments are often combined with broader IC/BPS management strategies like pain management and dietary modifications, the focus for Hunner lesions remains on direct intervention to alleviate symptoms.
Living with Hunner Lesions
Living with Hunner lesions often involves ongoing management, as the condition can be chronic and lesions may recur even after successful treatment. Regular follow-up care, including repeat cystoscopies, is often recommended to monitor for any new or returning lesions. The effect of treatments like fulguration may last for several months, but recurrence is possible, sometimes in different locations.
Lifestyle modifications play a role in managing symptoms and supporting bladder health. This includes dietary changes, such as avoiding foods and beverages that can irritate the bladder, like caffeinated drinks, artificial sugars, and certain fruit juices. Stress management techniques and pelvic floor physical therapy can also be beneficial, particularly if associated muscle tension is present. Working closely with a urologist or an IC specialist is important for personalized care. Seeking support groups can provide emotional and practical assistance in navigating the challenges of chronic pain and bladder conditions.