Hunner’s Ulcers

Hunner’s ulcers are painful, red areas of damage on the wall of your urinary bladder. These spots can cause inflammation and scarring, which can make your bladder stiff. When this happens, your bladder may not be able to hold as much pee (urine) as usual.

Healthcare providers sometimes find Hunner’s ulcers in people with interstitial cystitis/bladder pain syndrome (IC/BPS). IC/BPS is a long-term condition that causes bladder pain, pressure or discomfort. They occur in about 5% to 57% of people with IC/BPS. But it might be higher in people with more severe symptoms. In the U.S., IC/BPS affects:

• About 3 to 8 million women
• About 1 to 4 million men

It may feel embarrassing to talk about bladder symptoms with a provider. But you’re not alone. These symptoms are common. Providers understand how you feel, and they can help. Treatment can reduce pain and improve your quality of life.

Providers may also call Hunner’s ulcers Hunner’s lesions. The condition gets its name from Dr. Guy LeRoy Hunner. He was a gynecologist who first described these bladder changes in the early 1900s.

Are Hunner’s ulcers cancerous?

No, Hunner’s ulcers aren’t cancerous. There isn’t any evidence that having them increases your risk of bladder cancer.

What are the symptoms of Hunner’s ulcers?

Hunner’s ulcers symptoms can vary from person to person. They may include:

• Mild to severe pain, pressure or burning in your bladder or pelvic area
• Needing to pee more often than usual
• Strong, sudden urges to pee, even when your bladder isn’t very full
• Peeing only small amounts at a time
• Waking up more than once to pee

Most people with Hunner’s ulcers feel sudden urges to pee. But it’s not common to leak pee.

What causes Hunner’s ulcers?

Experts don’t know the exact cause. But research suggests there may be a link between Hunner’s ulcers and:

• Long-term bladder inflammation
• Damage to your bladder lining, which may allow irritation and pain
• Changes in your immune system that cause your body to attack bladder tissue

Some studies have explored possible links between Hunner’s ulcers and certain conditions, like:

• BK virus and Epstein-Barr virus infections
• Uterosacral ligament injury via inflammatory cell activation in your bladder

But experts haven’t proven a single cause.

Risk factors

Hunner’s ulcers can occur in anyone of any age. But you’re more likely to have Hunner’s ulcers if you:

• Have interstitial cystitis/bladder pain syndrome
• Are a woman
• Are over 50

How do you know if you have Hunner’s ulcers?

Talk to a healthcare provider if you have symptoms. They’ll review your medical history and ask about your symptoms. They may ask:

• Where do you feel pain?
• How bad is the pain?
• What kinds of drinks do you have each day?
• About how much water and other fluids do you drink?
• How often do you pee during the day?
• Do you feel strong, sudden urges to pee?
• Do you leak pee?
• If you leak pee, how much?
• Do you wake up more than once to pee?

If your provider thinks you have Hunner’s ulcers, they may recommend a cystoscopy with hydrodistension to confirm their diagnosis. During a cystoscopy, your provider will:

• Give you anesthesia to keep you comfortable
• Insert a thin, lighted tube with a camera (cystoscope) through your urethra and up into your bladder
• Gently fill and stretch your bladder with fluid (hydrodistension)
• Look for Hunner’s ulcers on your bladder wall

If they find a Hunner’s ulcer, they may treat it at the same time. In some cases, they may treat it during a separate procedure, often under general anesthesia.

What are the treatment options?

There are several treatments that healthcare providers may use to treat Hunner’s ulcers. Some treatments have a good history of success. Providers may use others only in certain cases. Your provider will help you choose the best option.

Triamcinolone injection

Triamcinolone is a steroid medication that reduces inflammation. A provider injects it directly into the Hunner’s ulcer during cystoscopy.

Steroid injections don’t cause scarring. Providers usually try them first. Possible side effects are typically mild. But they may include:

• Temporary increases in blood pressure
• Increased appetite
• Weight gain
• Mood swings

Fulguration (cauterization)

During fulguration, your provider uses electrical energy or a laser to burn and remove Hunner’s ulcers. They do this during a cystoscopy.

It can help relieve pain. But it may cause scarring, which can make your bladder less flexible over time.

Other possible risks include:

• Bleeding
• Infection
• Temporary swelling that makes it harder to pee

Cyclosporine

Cyclosporine is an oral immunosuppressant medication. Your provider may prescribe it if other treatments don’t work and your symptoms are severe. Because cyclosporine affects your immune system, it requires close monitoring.

Possible risks include:

• High blood pressure
• Kidney problems
• Increased risk of infection
• Tremors or headaches

Serious side effects aren’t common. But they’re possible if you use cyclosporine for a long time.

Hyperbaric oxygen therapy

During hyperbaric oxygen therapy (HBOT), you sit or lie in a pressurized chamber while breathing pure oxygen. This treatment may help damaged tissue heal.

HBOT isn’t a standard treatment for Hunner’s ulcers. Providers usually consider it an experimental option.

Possible risks include:

• Fear of the enclosed space (claustrophobia)
• Ear pressure or ear injuries
• Sinus discomfort

Surgery

Surgery to treat Hunner’s ulcers is rare. Providers only consider it when all other treatments fail. Your provider may recommend:

• Targeted removal of Hunner’s lesions
• Bladder removal

Bladder removal is extremely rare. Providers only use it for severe, disabling cases.

Surgery risks include:

• Bleeding
• Infection
• Blood clots
• Scar tissue that affects how your pee flows

How soon after treatment will I feel better?

It depends on the treatment and your overall health. Some people feel relief within a few weeks. Others need to try more than one option before finding what works best.

Your provider can give you a better idea of what to expect according to your treatment plan.

When should I see my healthcare provider?

Schedule an appointment with a healthcare provider if you have Hunner’s ulcers symptoms. These include ongoing bladder pain, pressure or peeing more than usual. Your provider can evaluate your symptoms, make a diagnosis and recommend treatment options.

Call them right away if your symptoms are severe, getting worse or don’t improve with treatment. Seek medical care immediately if you have:

• Blood in your pee
• Fever
• Severe pain

These symptoms may indicate another condition.

During your appointment, you may find it helpful to ask:

• Will you treat Hunner’s ulcers at the same time you diagnose them, or will I need to schedule another appointment?
• What treatment option do you recommend, and why?
• What side effects or risks should I know about?
• Is it likely that Hunner’s ulcers come back?
• Could certain foods or drinks make my symptoms worse?
• Are there lifestyle changes that could help reduce my symptoms?
• Should I see a urologist who specializes in Hunner’s ulcers or IC/BPS?

What can I expect?

Treatment often improves pain, pressure and other bladder symptoms. In some people, Hunner’s ulcers may completely heal after treatment.

But symptoms can come back. You may need more treatment. Many people find that a combination of treatments over time provides the best relief. Your provider can help you understand what to expect and create a plan that works best for you.

Can Hunner’s ulcers be prevented?

Experts don’t yet know how to prevent them. There’s also no guaranteed way to stop symptoms from coming back after treatment.

But you can help reduce flare-ups and manage your symptoms over time by following your treatment plan and avoiding symptom triggers. Possible triggers may include certain foods, drinks or stress.