Hunner’s Ulcers: Symptoms, Causes, and Treatment Options

Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026

Quick Answer

Hunner's ulcers are inflammatory sores or lesions on the urinary bladder wall, found in 5% to 57% of people diagnosed with IC/BPS. They cause pelvic pain, sudden urges to pee and frequent urination. They are confirmed by cystoscopy, often while stretching the bladder with fluid, and treated with triamcinolone steroid injections or by burning the ulcers (fulguration). [1] [3]

What the research says

• Hunner lesions mark a distinct IC/BPS phenotype that responds well to treating the lesions. A systematic review and meta-analysis of 59 articles found that people with Hunner lesions were older (by 6.7 years on average), urinated more often (3.2 more times per day), had more nocturia (1.0 more per night) and a smaller bladder capacity (113 mL less) than people without lesions. Pain scores did not differ. Patients with lesions responded well to fulguration or triamcinolone injection, and better to oral cyclosporine A than patients without lesions. (Lai et al., J Urol, 2020)

• Two ways of removing the lesions worked equally well. In a randomized trial of 126 patients with Hunner lesions, recurrence-free time was about 12 months in both groups (12.2 months after resection vs 11.5 months after coagulation, p = 0.735), and symptoms and pain improved significantly in both. Bladder injury occurred in 7.9% of the resection group and 3.4% of the coagulation group. This was a single-center trial. (Ko et al., Eur Urol, 2020)

What are Hunner’s ulcers and how do they affect the bladder?

Hunner’s ulcers, also known as Hunner’s lesions, are areas of damage and inflammation on the inner lining of the urinary bladder. Unlike typical ulcers found in the stomach, these are specific to the bladder wall and are characterized by their red, irritated appearance. When these ulcers develop, they can cause the bladder wall to become stiff due to scarring and chronic inflammation. This stiffness prevents the bladder from expanding normally, which significantly reduces the amount of urine it can hold comfortably. [1]

These lesions are named after Dr. Guy LeRoy Hunner, the gynecologist who first described them in the early 20th century. While they are not cancerous and do not increase the risk of bladder cancer, they are a significant source of chronic discomfort. [1] They are most commonly identified in individuals already living with Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS), a long-term condition marked by bladder pressure and pelvic pain.

What are the most common symptoms of Hunner’s ulcers?

The symptoms of Hunner’s ulcers can vary significantly between individuals, but they generally center around bladder discomfort and changes in urinary habits. Most patients experience a combination of the following: [1]

• Chronic pelvic pain: This may feel like pressure, burning, or sharp pain in the bladder or pelvic region, ranging from mild to severe.

• Urinary urgency: A strong, sudden need to urinate, even when the bladder is not full.

• Increased frequency: Needing to pee much more often than usual throughout the day.

• Nocturia: Waking up multiple times during the night to use the bathroom.

• Small volume urination: Passing only small amounts of urine at a time due to bladder sensitivity or stiffness.

It is important to note that while the urge to pee is frequent and sudden, leaking urine (incontinence) is not a common symptom of Hunner’s ulcers. [1]

What causes Hunner’s ulcers to develop?

Medical experts have not yet identified a single, definitive cause for Hunner’s ulcers. However, several factors are believed to play a role in their development. Research suggests that long-term inflammation and damage to the protective lining of the bladder may allow irritants in the urine to reach the bladder wall, causing sores to form. There is also evidence suggesting that changes in the immune system might lead the body to mistakenly attack its own bladder tissue. [1]

Some studies have explored links to viral infections, such as the Epstein-Barr virus or the BK virus. Additionally, injuries to the uterosacral ligament, a structure that supports the uterus and bladder, have been investigated as a possible trigger for the inflammatory cells that lead to these ulcers. [1] [4] These links remain hypotheses rather than proven causes.

Who is at risk?

While anyone can develop Hunner’s ulcers, they are most frequently diagnosed in: [1]

• Individuals with a history of IC/BPS.

• Women (who are more likely to have IC/BPS in general).

• Adults over the age of 50.

How are Hunner’s ulcers diagnosed and treated?

Diagnosis typically begins with a review of your medical history and a discussion of your symptoms. If a healthcare provider suspects Hunner’s ulcers, the primary way to confirm the diagnosis is through a cystoscopy with hydrodistension. During this procedure, a thin tube with a camera (cystoscope) is inserted through the urethra to view the inside of the bladder while it is gently stretched with fluid. This allows the provider to see the characteristic red lesions on the bladder wall. [1]

In one single-center database of 359 patients with documented cystoscopic findings, 12.3% had Hunner lesions, and the share was higher in people aged 50 or older than in younger people (14.9% vs 7.8%). [2]

Treatment options

Once diagnosed, several treatments can help manage the pain and inflammation: [1]

Treatment	How it works	Key considerations
Steroid injections	Triamcinolone is injected directly into the ulcer.	Reduces inflammation without causing scarring; often the first choice.
Fulguration	Electrical energy or a laser burns away the ulcer.	Can relieve pain in many people but may cause bladder scarring over time, and symptoms can return.
Cyclosporine	An oral medication that suppresses the immune system.	Used for severe cases; requires close monitoring of blood pressure and kidneys.
Experimental therapies	Includes hyperbaric oxygen therapy (HBOT).	Involves breathing pure oxygen to promote tissue healing; not a standard treatment. [5]
Surgery	Removal of lesions or, in extreme cases, the bladder.	Very rare; reserved for cases where all other treatments have failed.

Conclusion

Hunner’s ulcers are a challenging but manageable condition. While they can cause significant pain and disrupt daily life, modern diagnostic tools and treatments offer effective ways to find relief. By working closely with a healthcare provider to identify triggers and follow a tailored treatment plan, most individuals can achieve a significant improvement in their symptoms and overall well-being.

Stay informed. For more resources on managing bladder health and chronic pain, visit Rinnit.com.

Frequently Asked Questions

Are Hunner’s ulcers the same as interstitial cystitis?

No, but they are related. Hunner’s ulcers are a specific type of bladder lesion found in some people with interstitial cystitis (IC/BPS).

Can Hunner’s ulcers be cured?

While treatment can make the ulcers heal and symptoms disappear, they can sometimes recur, requiring ongoing management.

Is there a specific diet for Hunner’s ulcers?

Many patients find that avoiding certain triggers, such as acidic foods, caffeine, or alcohol, can help reduce flare-ups.

Does having Hunner’s ulcers mean I have a higher risk of bladder cancer?

No, there is no evidence that Hunner’s ulcers are cancerous or lead to bladder cancer.

How long does it take for treatments to work?

Some people feel relief within a few weeks, though it may take longer depending on the specific treatment used.

What is a cystoscopy?

A cystoscopy is a procedure where a doctor uses a small camera to look inside your bladder to identify sores or other issues.

Can stress make Hunner’s ulcers worse?

Stress is a possible trigger that can cause symptoms to flare up in many individuals.

Are steroid injections painful?

The procedure is typically done under anesthesia or with numbing agents to ensure you are comfortable.

What happens if I don’t treat Hunner’s ulcers?

Untreated ulcers can lead to chronic pain, increased bladder stiffness, and a significant decrease in quality of life.

Can I exercise with Hunner’s ulcers?

Yes, but you may need to adjust your routine during flare-ups. Gentle exercise is often recommended.

Are Hunner’s ulcers a common condition?

Hunner’s ulcers are found in about 5% to 57% of people with IC/BPS, making them relatively common within that specific group.

Can men get Hunner’s ulcers?

Yes, while more common in women, men can also be diagnosed with Hunner’s ulcers.

Will I need surgery for my ulcers?

Surgery is very rare and is only considered if all other non-invasive treatments fail.

What are the side effects of fulguration?

Possible risks include bleeding, temporary swelling, infection, or scarring of the bladder wall.

Should I see a specialist for this condition?

Yes, a urologist who specializes in bladder disorders or IC/BPS is usually the best provider for diagnosis and treatment.

Related Reading

Interstitial Cystitis: Symptoms, Causes, and Treatment explains the bladder condition in which Hunner's lesions are found.

Interstitial Cystitis: Understanding Bladder Pain Syndrome describes bladder pain syndrome symptoms, triggers, and long-term management.

Cystoscopy: Purpose, Procedure, Recovery and Risks explains the bladder camera test used to find Hunner's lesions.

Cystitis: Symptoms, Causes, and Treatment covers the main causes of bladder inflammation and how each is treated.

References

1. Cleveland Clinic. Hunner’s Ulcers. Cleveland Clinic. Last updated February 10, 2026. https://my.clevelandclinic.org/health/diseases/hunners-ulcers

2. Doiron RC, Tolls V, Irvine-Bird K, et al. Clinical Phenotyping Does Not Differentiate Hunner Lesion Subtype of Interstitial Cystitis/Bladder Pain Syndrome: A Relook at the Role of Cystoscopy. J Urol. 2016;196(4):1136-40. PMID 27117441. https://doi.org/10.1016/j.juro.2016.04.067

3. Whitmore KE, Fall M, Sengiku A, et al. Hunner lesion versus non-Hunner lesion interstitial cystitis/bladder pain syndrome. Int J Urol. 2019;26 Suppl 1:26-34. PMID 31144757. https://doi.org/10.1111/iju.13971

4. Petros PE, Wenk MJ, Liedl B, et al. The Posterior Fornix Syndrome Is an Important Differential Diagnosis for Interstitial Cystitis/Bladder Pain Syndrome. Urol Int. 2025;110(3):306-316. PMID 40759091. https://doi.org/10.1159/000547785

5. Tanaka T, Minami A, Uchida J, et al. Potential of hyperbaric oxygen in urological diseases. Int J Urol. 2019;26(9):860-867. PMID 31083787. https://doi.org/10.1111/iju.14015

6. Lai HH, Pickersgill NA, Vetter JM. Hunner Lesion Phenotype in Interstitial Cystitis/Bladder Pain Syndrome: A Systematic Review and Meta-Analysis. J Urol. 2020;204(3):518-523. PMID 32223699. https://doi.org/10.1097/JU.0000000000001031

7. Ko KJ, Cho WJ, Lee YS, et al. Comparison of the Efficacy Between Transurethral Coagulation and Transurethral Resection of Hunner Lesion in Interstitial Cystitis/Bladder Pain Syndrome Patients: A Prospective Randomized Controlled Trial. Eur Urol. 2020;77(5):644-651. PMID 31959549. https://doi.org/10.1016/j.eururo.2020.01.002

8. Interstitial Cystitis Network. Interstitial Cystitis & Bladder Pain Syndrome - Symptoms, Treatment, Diet. Interstitial Cystitis Network. Accessed October 15, 2026. https://www.icnetwork.org/

This article is for general educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have about a medical condition.