Bladder instillation, also known as a bladder wash or bath, is a medical procedure that involves introducing liquid medication directly into the bladder through a thin tube called a catheter. The primary purpose of this treatment is to deliver therapeutic agents directly to the bladder lining, allowing for localized action and minimizing systemic side effects. It addresses various bladder conditions by targeting affected tissue with concentrated medication.
Understanding Bladder Instillation
Bladder instillation is often prescribed for conditions that affect the bladder’s inner lining, where direct medication delivery can be highly effective. A common reason for this treatment is interstitial cystitis (IC) or bladder pain syndrome, a chronic condition characterized by bladder and pelvic discomfort, urinary urgency, and frequent urination. The bladder’s natural protective barrier, the glycosaminoglycan (GAG) layer, can be damaged in these conditions, allowing irritants in urine to cause inflammation.
This direct administration method is also used for recurrent urinary tract infections (UTIs), radiation cystitis (bladder inflammation due to radiation therapy), and cases of limited bladder capacity that lead to frequent urination. By delivering medication straight to the bladder lining, the treatment aims to reduce inflammation, alleviate pain, and potentially help restore the protective GAG layer.
Performing the Procedure
The bladder instillation procedure begins with the patient lying down comfortably. A healthcare professional will clean the urethral opening and may apply a numbing gel to minimize discomfort during catheter insertion. A thin, flexible catheter is then gently inserted through the urethra into the bladder to drain any remaining urine.
Once the bladder is empty, the pre-measured medication solution is slowly instilled through the catheter. The catheter is then removed or sometimes clamped, and the medication is left to “dwell” in the bladder for a specific period, typically 15 minutes to two hours. Patients may be asked to change positions during this dwell time to ensure the medication coats the entire inner lining of the bladder. Common medications used include dimethyl sulfoxide (DMSO), which is FDA-approved for IC and can reduce irritation and relax bladder muscles, and heparin, which may help repair bladder lining damage. Other solutions may contain lidocaine for pain relief, hyaluronic acid, or a combination of various compounds like sodium bicarbonate. For bladder cancer, chemotherapy drugs like Mitomycin C or immunotherapy agents like Bacillus Calmette-Guérin (BCG) may be instilled.
Preparing and Recovering
Before a bladder instillation, patients are advised to empty their bladder. Some healthcare providers may suggest limiting fluid intake for a few hours prior to the appointment to ensure the bladder is as empty as possible, allowing for better retention of the instilled solution. Patients should inform the healthcare provider of any allergies or current medications, as some may need adjustment.
During the procedure, patients might experience a sensation of pressure or mild discomfort as the catheter is inserted. After the medication is instilled and the catheter is removed, patients are asked to hold the solution in their bladder for the specified dwell time, then empty their bladder.
Following the procedure, common side effects include increased urinary urgency, a burning sensation during urination, or mild bladder irritation. The urine might also have a different smell or appearance for a few days, especially with DMSO, which can cause a temporary garlic-like odor. These symptoms are temporary and should subside within a day or so.
Treatments are often administered weekly for a course of 6 to 8 weeks, followed by maintenance treatments every few weeks or months, depending on the individual’s response. Patients should contact their healthcare provider if they experience signs of a urinary tract infection, such as persistent pain, fever, or inability to urinate.