Hunner's Ulcers

Hunner's Ulcers occur in 5 to 10 percent of people who have the disease Interstitial cystitis. They form on the wall of the bladder and, like any ulcer, they can bleed, ooze and vary in size. They were first described by Dr. Guy LeRoy Hunner, 1868–1957, a Baltimore urologist, in a paper delivered to the Boston Medical Society in 1915 [1].

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Diagnoses

Hunner's Ulcers can only be accurately diagnosed via a cystoscopy with hydrodistention. The procedure is performed while the patient is under general anaesthetic and is listed as a day surgery.

Treatment

While patients consider therapies, they may find significant relief by modifying their diet to remove those foods and beverages high in acid AND caffeine, particularly all coffees (even decaf), regular teas, green teas, sodas, artificial sugars and most fruit juices. Cranberry juice, for example, can trigger intense pain and discomfort due to its high acid level.

The ulcers can be removed through fulguration (burned off with the use of electricity or a laser) or resection (cutting around the ulcer, removing both the ulcer and the surrounding inflamed tissue). Some ulcers may recur in the same location.

Many patients choose to live with the ulcers and treat the symptoms associated with them through bladder instillations or/and pain medication/therapy.

Prevention

The drug Elmiron helps to prevent the formation of Hunner's Ulcers by coating the bladder wall, thus making it harder for the acid in urine to irritate the bladder wall lining, which can lead to ulceration.

Notes

1. J. P. MacDermott, G. L. Charpied, H. Tesluk and A. R. Stone. Histological changes in interstitial cystitis. International Urogynecology Journal, Volume 4, Number 4, 1993, 246-249.

Support Organizations

Interstitial Cystitis Network (ICN) - http://www.ic-network.com

Diet Resources

• ICN - Top Five List of Forbidden Foods
• A Taste of the Good Life: A Cookbook For An IC Diet
• Confident Choices - Customizing the IC Diet
• The ICN Special Report on Diet

Other Links

• ICN Patient handbook, includes information on treatments for Hunner's Ulcers
• AAFP information on Interstitial Cystitis. Includes a picture of an IC bladder with Hunner's ulcer(s)