Hunner's ulcers, simply put are painful ulcers in your urinary bladder. These ulcers are inextricably linked to another disorder called the painful bladder syndrome or intestinal cystitis. They occur in 10 to 15 percent of people with interstitia cystitis. These, in fact, are red patches or lesions on the bladder wall which can stiffen tissue and cause reduced bladder capacity. Hunner s ulcers bleed, ooze pus and can be of different sizes. The ulcers in the bladder can be extremely painful and uncomfortable.

These are called Hunner s ulcers because they were first described by Dr. Guy LeRoy Hunner, a Johns Hopkins gynecologist, in 1915. Since Hunner s ulcers are seen only in people with intestinal cystitis, it s important to know more about this painful life-altering bladder disorder before we can even understand how to deal with them.

Interstitial cystitis (IC)
IC is also called painful bladder syndrome. Another important thing to know about IC is that it strikes more women than men. IC is a chronic disorder and there s no cure for it. It causes recurring bouts of pain and pressure in the urinary bladder and the pelvic area. This is often accompanied by an urgent and frequent need to urinate. Sufferers may have to rush to the  loo  as much as 40, 50, or 60 times a day.

Diagnosis
Hunner's ulcers can only be accurately diagnosed by doing a cytoscopy which involves inserting a fibre-optic tube through the urethra to look at the bladder wall closely. During this procedure, a tissue sample from the bladder wall is usually also taken to rule out bladder cancer. Cytoscopy is usually done with hydrodistention under local anesthesia. This involves filling the bladder with a liquid for stretching it to provide a closer view of the bladder wall. Usually, a urologist performs this surgery along with a gynaecologist. IC and also Hunner s ulcers are both a diagnosis of exclusion. This means that they re diagnosed only after a number of other conditions have been ruled out.

Hence, the urologist will first take your thorough medical history, followed by a physical exam and a pelvic exam for women patients and perform tests for ruling out infection, and other disorders like bladder stones and cancer, kidney disease, multiple sclerosis, endometriosis, sexually transmitted diseases amongst others. Only after these tests are inconclusive or uncertain and if there is blood in urine, will the urologist go for cystoscopy.

Treatment
There's no cure for IC, but Hunner s ulcers can be cured by burning them off the bladder wall. Called fulguration, the process uses electricity or laser to burn the ulcers on the bladder wall. Resection is also used in which skin from around the Hunner s ulcer is cut for removing both the ulcer and the inflamed tissue around it. The problem is that ulcers may recur in the same location.
So, managing IC becomes critical. Your doctor can try to treat the patient with one treatment or with a combination of treatment depending on the condition of the patient.

Pain medicines are the first line of treatment to manage Hunner s ulcers and IC both, and many patients do go in for this. Patients also find relief by modifying their diet to remove foods and drinks like caffeinated beverages- tea, coffee, colas etc. Sodas, artificial sugars and fruit juices, especially Cranberry juice can trigger intense pain and discomfort, so these are usually contraindicated. Another important aspect is patient education about normal bladder function and tips on self-care and behavioural modifications like stress control to manage Hunner s ulcers.

Hunner's Ulcer In Urinary Bladder - How They Can Be Treated?

An overactive bladder is a condition that is characterized by a problem in the bladder storage function; a problem that eggs one on to urinate frequently. This condition can cause problems in your social and work life. You may isolate yourself from others and feel embarrassed about the situation.

Symptoms
If you have an overactive bladder, you may exhibit symptoms of frequent urination, involuntary leakage of urine and frequent urge to urinate. These symptoms might disrupt your daily life; so it is important to seek advice from a medical practitioner.

Causes
To better understand what causes an overactive bladder, you need to know how the urination process works. Urine is produced by the kidneys, which flows to the bladder. During urination, the urine is excreted from an opening in the bladder and flows out via the urethra. As the kidneys secrete urine, the bladder starts to fill up. During this stage, nerve signals are sent to the brain; signals that trigger your body to urinate. The bladder muscles tighten that pushes the urine out of the body.

An overactive bladder results from the involuntarily contraction of the bladder, which might happen even if the content of urine in the bladder is low. These contractions create the urge to urinate. The various causes of an overactive bladder are:

Excessive fluid intake, if your fluid intake is high, then you may have the tendency to urinate frequently.
Presence of tumors or stones in the bladder can make the bladder overactive as well.
Excessive alcohol or caffeine consumption has the same effect as an excessive intake of fluids has.
Urinary tract infections may interfere with the entire process of urination, thus causing your bladder to swell up and become overactive.
Other diseases and conditions such as constipation and an enlarged prostate can hamper bladder functioning.
Treatment
There are multiple approaches to treat an overactive bladder; your doctor may use one or a combination of multiple methods.

Medications: Medications such as Trospium and Tolterodine help in relaxing the bladder. These medications help treat symptoms of frequent urination.
Bladder injections: Botox is a protein that is injected into the bladder that causes partial paralysis of the bladder muscles. This helps in treating the constant urge to urinate. However, its effects are temporary as they last for 6-9 months.
Lifestyle modifications: Certain lifestyle modifications such as incorporating exercises to strengthen the pelvic muscles, maintaining optimal weight levels and bladder training to control its functioning can help with managing an overactive bladder.
Surgery: If the other treatments do not produce the desired results, then surgery is usually recommended. The aim of the surgery is to enhance the storage capacity of the bladder and reduce bladder pressure.

Frequent Urination - Is It A Symptom of An Overactive Bladder?

What should you do if you have an overactive bladder?

Overactive bladder, also known as OAB, is a condition where sudden involuntary contractions of the urinary bladder's muscular walls cause bladder storage dysfunction. It leads to sudden and frequent urges to urinate (urinary urgency), as well as unintentional leakage or urine (urinary incontinence).

This is a condition that affects both men and women and causes tremendous discomfort in nearly every aspect of daily life. The specific causes of OAB vary from case to case but it is generally attributed to infection of the urinary tract or dysfunction of the nervous system. The symptoms are intensified by unhealthy lifestyle choices such as overindulging in caffeinated drinks, spicy foods, and alcohol.

There are several ways in which you can deal with the problem of OAB, depending on the nature of the case. It is necessary for you to consult a urologist for a detailed diagnosis to formulate the best treatment option.

Following are the most effective remedies to treat an overactive bladder:

1. Lifestyle Modifications

Also known as behavioral therapy, this is the first step in the treatment of OAB. It involves inculcating simple changes into everyday habits such as avoiding food and drinks that irritate the bladder, scheduling (and in some cases, practice delaying) bathroom visits, exercising the pelvic floor and bladder muscles, keeping a record of urinating habits in a 'bladder diary' for better understanding the problem, etc. You can incorporate these habits into everyday activities for an easy alleviation of the problem with absolutely no side effects.

2. Medication and Surgery

There are several different kinds of medicines and drugs that can treat the problem of OAB. The most common types are muscle relaxants that loosen the muscles of the urinary bladder to prevent involuntary contractions, and antibiotics and anti-inflammatory drugs that treat urinary tract infections. Many types of implants are surgically set into the pelvic area to act as electrical nerve stimulators for neuromodulation therapy. Reconstructive bladder surgery is another remedial option.

3. Devices and Products

Urinary urgency and incontinence can be managed through the external use of various devices and products which collect and hold urine or absorb leakages. These include indwelling catheters, condom catheters (for men), urine drainage bags, absorbent pads and adult diapers, and toilet substitutes such as bedpans and bedside urinals.



What Should You Do if You Have an Overactive Bladder?

A bladder infection is a bacterial infection within the bladder. Some people call a bladder infection a urinary tract infection (UTI). This refers to a bacterial infection anywhere in the urinary tract, such as the bladder, kidneys, ureters, or the urethra. While most cases of bladder infection occur suddenly (acute), others may recur over the long term (chronic). Early treatment is key to preventing the spread of the infection.

What causes Bladder Infection?
Bacteria that enter through the urethra and travel into the bladder cause bladder infections. Normally, the body removes the bacteria by flushing them out during urination. Men have added protection with the prostate gland, which secretes protective hormones as a safeguard against bacteria. Still, sometimes bacteria can attach to the walls of the bladder and multiply quickly. This overwhelms the body s ability to destroy them, resulting in a bladder infection.
Bacteria that enter through the urethra and travel into the bladder cause bladder infections. Normally, the body removes the bacteria by flushing them out during urination. Men have added protection with the prostate gland, which secretes protective hormones as a safeguard against bacteria. Still, sometimes bacteria can attach to the walls of the bladder and multiply quickly.

Other factors can increase the risk of bladder infections for both men and women. These include:

Advanced age
Insufficient fluid intake
Surgical procedure within the urinary tract
A urinary catheter
Urinary obstruction, which is a blockage in the bladder or urethra
Urinary tract abnormality, which is caused by birth defects or injuries
Urinary retention, which means difficulty emptying the bladder
Narrowed urethra
Bowel incontinence
Pregnancy
Diabetes
Symptoms for Bladder Infections

Cloudy or bloody urine
Urinating more often than usual
Foul-smelling urine
Pain or burning when urinating
A frequent sensation of having to urinate, which is called urgency
Cramping or pressure in the lower abdomen or lower back
Bladder infections can also cause back pain. This pain is associated with pain in the kidneys. Unlike muscular back pain, you might experience pain on both sides of your back or the middle of your back. Such symptoms mean the bladder infection has likely spread to the kidneys. A kidney infection can also cause a low fever.

Bladder Infections - Decoding one of the Most Common Gynae Problem in Women

Causes of bladder control problems in women

Urinary incontinence is the term used to describe bladder control problems that affect several people. Many think it only occurs among older, menopausal women but it actually isn't uncommon amid young and active women.

Inability to control the bladder accompanied by pain can be symptomatic of various disorders ranging from a minor infection to cancer. Fortunately, bladder cancer is rare, and bladder pain is usually not serious.

The varied causes of urinary incontinence in women are as follows:

1) Urinary Tract Infection - This is the most common cause of urinary incontinence and it affects women more than men due to anatomical factors. It can also happen at any age.

2) Medicinal Side Effect: The inability to control one's bladder may be a result of the administration of certain medicinal substances such as alpha-blockers, antidepressants, sleeping pills and various narcotics.

3) Changes in the Reproductive System - Pregnancy and fluctuations in hormone levels can cause bladder irritation, which leads to urinary incontinence.

4) Impacted Stool - When stool gets tightly packed in the lower end of the digestive system and rectum, bladder control is affected. Chronic constipation and constraint strain on the lower intestines leads to the weakening of bladder muscles and hampers the bladder control.

5) Surgical Side Effects - Temporary loss of control of the bladder is often a result of prior surgery and radiation therapy in the pelvic region.

6) Nerve Damage and Neurological Disorders - Strokes and spinal cord injuries have a heavy impact on bladder control and amount to urinary incontinence. Diseases such as Alzheimer's disease, Parkinson's disease and multiple sclerosis also lead to the same.

7) Health Complications - Disorders such as diabetes and obesity directly affect the bladder and the ability to exercise control over it.

8) Disability and Impaired Mobility - For women who are physically impaired and suffer from problems of arthritis, urinary incontinence is a major problem as they are unable to reach the toilet easily.

9) Bladder Cancer - Even though it is extremely rare, bladder cancer affects a number of women every year and is treated through surgery and chemotherapy.



What Causes Bladder Control Problems in Women?

The bladder is a hollow storage organ that collects urine from the kidneys and stores it until it can be passed out of the body through the urethra during the process of micturition or urination. It has a thin inner lining of cells called urothelial cells and a thick muscular wall, which exerts pressure to push the urine out of the body.

Causes of Bladder Tumors

In most cases, the bladder tumor develops on the inner layer due to a combination of some of the following factors.

1. Hereditary: A strong family history of cancer predisposes a person to cancer.
2. Gender: Men are 3 times more prone for bladder cancer than women.
3. Ethnicity: White people are more prone for bladder cancer black people.
4. Smoking: Smokers develop bladder cancer 2-6 times more frequently than non-smokers. cigarettes contain toxic, carcinogenic substances which reach the kidney and are stored in the bladder, leading to their damage.
5. Occupational hazards: Some workplaces have a higher likelihood of causing bladder cancers, especially dye and rubber industries. The effects can be damaging, and the person may develop cancers years after the exposure has happened.
6. Recurrent bladder infections: In some people, this can also lead to bladder cancer in the long run.

Types of Bladder Tumor

Depending on the extent of the cancerous spread, it can be of two types:

1. Non-muscle-invasive bladder tumors: The tumor spread is limited to the inner part of the bladder (urothelial cells)
2. Muscle-invasive bladder tumor: The tumor has spread to the thick muscular outer layer. This is more advanced and prognosis is poor compared to the noninvasive type.

The most common and diagnostic symptom of bladder cancer is the presence of blood in the urine, known as hematuria. This will be intermittent and happens whenever the tumor bleeding happens. Other symptoms include pain in the lower abdomen and frequent urination.

Diagnosis

From the most noninvasive to the most invasive diagnostic test, these include:

1. Urine microscopy to detect cancer cells in the urine
2. Cystoscopy A tube inserted into the urethra to look into the inner wall of the bladder is highly diagnostic
3. Ultrasound, CT Scan, and biopsy can also be further used to identify severity of the tumor.

Treatment

Once the tumor is diagnosed, treatment would depend on the severity of the tumor. For both invasive and noninvasive tumors, definitive therapy is surgery, known as transurethral resection of the bladder tumor (TURBT). The cancerous bladder tissue is removed through a cystoscope as done for diagnosis. The bladder is then flushed with chemotherapy agent to kill any residual cancer cells in the bladder. This is then followed by BCG vaccine, which is again done 1 to 4 weeks for several months to avoid recurrence. In some cases, radiotherapy may also be included.

Bladder Tumor and Its Common Causes

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