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.
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.
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.
A problem pertaining to the storage function of the bladder that results in bouts of sudden, often uncontrollable urge to urinate is referred to as an overactive bladder. This condition which is marked by unconditioned or involuntary loss of urine can sometimes be quite difficult to stop. People who experience such a condition often feel humiliated and as such tend to limit their social and work life. Despite such, only a few are conscious that a brief evaluation can help them manage and overcome an overactive bladder.
Mechanism of Urination
During urination, the urine proceeds from the bladder and flows into the urethra which is located at the tip of the penis in men and above the vagina in women. As the bladder fills, the nerve signals in the brain prompts urination by coordinating the relaxation and contraction of the urinary sphincter muscles.
Causes and Symptoms of an Overactive Bladder
Primarily caused due to involuntary contraction and relaxation of sphincter muscles, several conditions can lead to overactive bladder.
Some of them are:
1. Parkinson's disease, Alzheimer's and other neurological disorders
2. Poor kidney function due to diabetes
3. Medications that lead to increased production of urine
4. Bladder abnormalities like tumors or stones
6. Excessive consumption of caffeine or alcohol
Some of the common signs of an overactive bladder are:
1. Bouts of sudden, uncontrollable urge to urinate
2. Awakening at night frequently to urinate
3. Urinating more than eight times a day
The risk of an overactive bladder gradually increases with age. Conditions such as diabetes and an enlarged prostate results in the increased likelihood of an overactive bladder. People who have previously faced strokes and heart attacks experience cognitive decline which often times lead to the development of an overactive bladder.
Urinary incontinence as well as a host of associated factors can be detrimental to your life. Emotional distress, interrupted sleep cycles and depression are some of the observed complications of this condition.
Thus if you experience or entertain suspicion of an overactive bladder, you should consider visiting a general physician who might refer you to a specialist, if need be.