Bladder instillation is a medical treatment that delivers therapeutic agents directly into the bladder using a catheter. This localized approach allows high concentrations of medication to act directly on the bladder wall, often the source of chronic pain and inflammation. By bypassing the digestive system, this method treats the affected tissue while reducing systemic side effects associated with oral medications. The procedure primarily manages symptoms from chronic, non-infectious conditions causing persistent discomfort and urinary dysfunction. Patients typically undergo a series of treatments to achieve relief from symptoms such as urgency and frequency.
Conditions Treated by Bladder Instillation
Bladder instillation is a focused treatment often recommended when first-line therapies, such as diet changes or oral medications, have not successfully controlled symptoms. The most common indication is Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS), a chronic condition characterized by recurring pelvic discomfort and problems with urination. The underlying issue in many chronic bladder conditions is believed to be a defect in the protective lining of the bladder wall.
This natural barrier is known as the glycosaminoglycan (GAG) layer, which shields the underlying tissue from the acidic components in urine. When this GAG layer becomes compromised, urine can irritate the sensory nerves and cause inflammation, leading to the characteristic pain, urgency, and frequency experienced by patients. Bladder instillation aims to repair or shield this damaged lining.
Other conditions that benefit include radiation cystitis, which is inflammation caused by previous radiation therapy to the pelvic area. Chronic, non-bacterial forms of cystitis, where inflammation occurs without an active infection, may also respond well to this treatment. The localized delivery of medication allows the therapeutic agents to concentrate exactly where the pathology is occurring, offering relief for symptoms that severely impact quality of life.
How the Medications Work to Soothe the Bladder
The efficacy of bladder instillation relies on the agents delivered directly to the bladder lining. One frequently used agent is Dimethyl Sulfoxide (DMSO), the only solution specifically approved by the Food and Drug Administration (FDA) for treating IC/BPS. DMSO functions as an anti-inflammatory agent, reducing swelling and irritation within the bladder tissue.
DMSO is also thought to act as an analgesic, helping to relieve pain by interfering with nerve signals, and may help to relax the smooth muscles of the bladder wall. Because DMSO is a solvent, some practitioners use it in combination with other medications, believing it enhances the absorption of those agents into the bladder lining. A less common side effect of DMSO is a temporary, garlic-like taste and odor that can be noticed on the breath and skin for up to three days after treatment.
Heparin, a different agent often included in instillation mixtures, works to restore the integrity of the damaged GAG layer. This is achieved because heparin is a sulfonated GAG itself, and it is thought to replenish the protective coating on the bladder surface. Restoring this layer helps to prevent irritants in the urine from penetrating the underlying sensitive tissue, which reduces inflammation over time.
Another common component is lidocaine, a local anesthetic that provides immediate, though temporary, pain relief. Lidocaine works by directly numbing the nerve endings in the bladder wall, offering a quick reduction in discomfort and urgency. Lidocaine is often mixed with sodium bicarbonate to create an “alkalinized” solution, which is thought to improve the drug’s ability to penetrate the bladder tissue and increase its therapeutic effect.
What to Expect During and After the Procedure
The bladder instillation procedure is an outpatient treatment performed in a clinic setting and typically takes about 15 to 30 minutes. Before the instillation begins, the patient will be asked to empty their bladder completely. A clinician will then gently insert a catheter through the urethra and into the bladder, often using a numbing gel to minimize discomfort.
The catheter is used to drain any residual urine before the prescribed medication is slowly infused into the bladder. Once the medication is delivered, the catheter is removed, and the patient is instructed to hold the solution in the bladder for a specified amount of time. This retention time usually ranges from 15 to 30 minutes, allowing the therapeutic agents time to coat and penetrate the bladder lining.
After the retention period is over, the patient simply voids the solution into a toilet and can then leave the clinic. Patients may feel a mild pressure or a temporary increase in urgency during the instillation due to the fluid volume or the presence of the catheter. Following the procedure, it is common to experience temporary bladder irritation, which can feel like a slight burning sensation or increased frequency, similar to original symptoms.
These side effects are usually mild and resolve within 24 to 48 hours; over-the-counter pain relievers can often manage the discomfort. The initial treatment course is typically scheduled once a week for six to eight weeks, though this varies by patient and medication. If the initial course is successful, maintenance treatments may be scheduled less frequently, such as once a month, to sustain the symptom relief.