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PubMed This is a summary of 17 peer-reviewed journal articles Updated
Urology

Hunner Lesions vs. Non-Hunner IC: Understanding Your Specific Type

At a Glance

Interstitial cystitis has two main types: Hunner lesion IC (visible inflammatory wounds in the bladder) and non-Hunner IC (caused by nerve sensitivity and tight pelvic floor muscles). Identifying your specific type through a cystoscopy is the most important step in finding effective treatment.

While all people with IC/BPS share the burden of chronic bladder pain, researchers have discovered that the condition is not “one size fits all” [1]. It is now understood that IC/BPS is divided into two distinct clinical types, or phenotypes: Hunner lesion IC (HL-IC) and non-Hunner IC (N-HL/BPS) [2][3].

Understanding which type you have is the single most important step in creating an effective treatment plan [3].

Hunner Lesion IC (HL-IC)

In this phenotype, the cause of the pain is clearly visible inside the bladder. During a cystoscopy (a procedure where a doctor looks inside the bladder with a camera), the doctor will find Hunner lesions—distinct, red, inflamed patches on the bladder wall [2][4].

  • What it is: HL-IC is considered a true inflammatory disease of the bladder itself [2]. The bladder wall shows significant damage, including the loss of its protective lining (urothelial denudation) and a high concentration of inflammatory immune cells [2][5].
  • Who it affects: Patients with this type tend to be older and often report more severe bladder-specific symptoms, such as having to urinate very frequently [4][6].
  • Targeted Treatment: Because the pain comes directly from the lesions, treatments are “bladder-centric” [5]. This includes fulguration (using heat to cauterize the lesions), triamcinolone injections (steroids injected directly into the lesions), or systemic medications like cyclosporine A to calm the overactive immune response [7][8].

Non-Hunner IC (N-HL/BPS)

The majority of patients fall into this category. When a doctor looks inside the bladder of someone with non-Hunner IC, the bladder wall often looks completely normal [2][5].

  • What it is: This type is often less about a “wound” in the bladder and more about a complex interaction between the nerves, the brain, and the surrounding muscles [9]. It is frequently driven by:
    • Neurogenic Inflammation: Nerves in the pelvic area release chemicals (like Substance P) that cause the bladder to feel painful and inflamed even when no injury is visible [10][11].
    • Pelvic Floor Hypertonicity: The muscles supporting the bladder become “locked” in a state of constant tension or spasm [12]. These tight muscles can create the exact same feeling of bladder pressure and urgency as a bladder infection [13][14].
  • Targeted Treatment: Since the bladder wall is not the primary source of the problem, treatment focuses on calming the nervous system and relaxing the muscles [3]. This often includes pelvic floor physical therapy, stress management, and medications that target nerve pain [1][12].

Comparing the Phenotypes

Feature Hunner Lesion IC (HL-IC) Non-Hunner IC (N-HL/BPS)
Visible on Cystoscopy? Yes (Red, inflamed lesions) [2] No (Bladder wall usually looks normal) [5]
Primary Cause of Pain Direct inflammation/wounds in the bladder wall [2] Nerve hypersensitivity and tight pelvic floor muscles [11]
Most Common Treatments Fulguration (cauterizing lesions), Steroid injections, Cyclosporine A [7] Pelvic floor physical therapy, Nerve-pain medications, Stress management [1]
Who It Typically Affects Older patients, often with more severe urinary frequency [6] Younger patients, often overlapping with IBS or fibromyalgia [15]

Why the Distinction Matters

If you have Hunner lesions and only treat your pelvic floor muscles, the source of your pain (the lesions) remains unaddressed [3]. Conversely, if you do not have lesions but receive aggressive bladder-directed treatments, you may be undergoing unnecessary procedures for a problem that is actually rooted in your nerves or muscles [12][16]. Knowing your phenotype allows your care team to stop “guessing” and start treating the actual biological driver of your symptoms [3][17].

Common questions in this guide

How do I know if I have Hunner lesions or non-Hunner IC?
Your doctor can determine your type of interstitial cystitis by performing a cystoscopy. During this procedure, they look inside your bladder with a camera to see if there are visible red, inflamed patches called Hunner lesions.
What causes the pain in non-Hunner IC if my bladder looks normal?
In non-Hunner IC, pain is often caused by nerve hypersensitivity and tight pelvic floor muscles rather than visible bladder damage. Your nerves release chemicals that make the bladder feel inflamed, and muscle spasms can create intense pressure that mimics an infection.
Are treatments different for the two types of interstitial cystitis?
Yes, the treatments are completely different. Hunner lesion IC is usually treated directly with procedures like cauterizing the lesions or injecting steroids. Non-Hunner IC treatments focus on relaxing the pelvic floor muscles through physical therapy and calming the nervous system.
Why is it important to know my specific IC phenotype?
Knowing your exact type ensures you receive treatments that target the actual biological cause of your pain. Treating your pelvic floor won't heal visible bladder lesions, and treating the bladder aggressively won't fix underlying nerve or muscle tension.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Based on my cystoscopy, do I have Hunner lesions or non-Hunner IC/BPS?
  2. 2.If I have Hunner lesions, are we planning to treat them directly with fulguration or triamcinolone injections?
  3. 3.If I don't have lesions, what role do you think neurogenic inflammation or pelvic floor dysfunction plays in my pain?
  4. 4.How does my specific phenotype change the medication plan you are recommending?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (17)
  1. 1

    Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome.

    Clemens JQ, Erickson DR, Varela NP, Lai HH

    The Journal of urology 2022; (208(1)):34-42 doi:10.1097/JU.0000000000002756.

    PMID: 35536143
  2. 2

    Phenotyping of interstitial cystitis/bladder pain syndrome.

    Akiyama Y, Hanno P

    International journal of urology : official journal of the Japanese Urological Association 2019; (26 Suppl 1()):17-19 doi:10.1111/iju.13969.

    PMID: 31144756
  3. 3

    Interstitial cystitis, bladder pain syndrome, hypersensitive bladder, and interstitial cystitis/bladder pain syndrome - clarification of definitions and relationships.

    Homma Y

    International journal of urology : official journal of the Japanese Urological Association 2019; (26 Suppl 1()):20-24 doi:10.1111/iju.13970.

    PMID: 31144731
  4. 4

    Clinical characterization of interstitial cystitis/bladder pain syndrome in women based on the presence or absence of Hunner lesions and glomerulations.

    Watanabe D, Akiyama Y, Niimi A, et al.

    Lower urinary tract symptoms 2021; (13(1)):139-143 doi:10.1111/luts.12344.

    PMID: 32830459
  5. 5

    Clinical guidelines for interstitial cystitis/bladder pain syndrome.

    Homma Y, Akiyama Y, Tomoe H, et al.

    International journal of urology : official journal of the Japanese Urological Association 2020; (27(7)):578-589 doi:10.1111/iju.14234.

    PMID: 32291805
  6. 6

    Morbidity rate and medical utilization in interstitial cystitis/painful bladder syndrome.

    Lee MH, Chang KM, Tsai WC

    International urogynecology journal 2018; (29(7)):1045-1050 doi:10.1007/s00192-018-3574-x.

    PMID: 29532129
  7. 7

    A pilot study on oral cyclosporine A in association with fulguration for the treatment of interstitial cystitis with Hunner's lesions.

    Brière R, Bouchard F, Ismail S, et al.

    Neurourology and urodynamics 2022; (41(6)):1498-1504 doi:10.1002/nau.24997.

    PMID: 35731015
  8. 8

    Clinical efficacy of submucosal injection of triamcinolone acetonide in the treatment of type II/III interstitial cystitis/bladder pain syndrome.

    Jiang T, Zhou X, Chen Z, et al.

    BMC urology 2020; (20(1)):36 doi:10.1186/s12894-020-00597-3.

    PMID: 32228552
  9. 9

    Definition Change and Update of Clinical Guidelines for Interstitial Cystitis and Bladder Pain Syndrome.

    Homma Y, Akiyama Y, Kim JH, et al.

    Lower urinary tract symptoms 2024; (16(5)):e12532 doi:10.1111/luts.12532.

    PMID: 39267358
  10. 10

    The Neuropeptide CGRP Induces Bipolar Syndrome in Group 2 Innate Lymphoid Cells.

    Motomura Y, Kobayashi T, Moro K

    Immunity 2019; (51(4)):598-600 doi:10.1016/j.immuni.2019.09.015.

    PMID: 31618650
  11. 11

    Calcitonin Gene-Related Peptide Negatively Regulates Alarmin-Driven Type 2 Innate Lymphoid Cell Responses.

    Wallrapp A, Burkett PR, Riesenfeld SJ, et al.

    Immunity 2019; (51(4)):709-723.e6 doi:10.1016/j.immuni.2019.09.005.

    PMID: 31604686
  12. 12

    Painful Bladder Syndrome/Interstitial Cystitis and High Tone Pelvic Floor Dysfunction.

    Moody CC, Fashokun TB

    Obstetrics and gynecology clinics of North America 2021; (48(3)):585-597 doi:10.1016/j.ogc.2021.05.010.

    PMID: 34416939
  13. 13

    Approach of Chronic Pelvic Pain with Top Flat Magnetic Stimulation.

    Salsi B, Ganassi G, Lopopolo G, et al.

    Advances in urology 2023; (2023()):9983301 doi:10.1155/2023/9983301.

    PMID: 37745206
  14. 14

    MRI suggests increased tonicity of the levator ani in women with interstitial cystitis/bladder pain syndrome.

    Ackerman AL, Lee UJ, Jellison FC, et al.

    International urogynecology journal 2016; (27(1)):77-83 doi:10.1007/s00192-015-2794-6.

    PMID: 26231233
  15. 15

    Correlates of 1-Year Change in Quality of Life in Patients with Urologic Chronic Pelvic Pain Syndrome: Findings from the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network.

    Clemens JQ, Stephens-Shields AJ, Newcomb C, et al.

    The Journal of urology 2020; (204(4)):754-759 doi:10.1097/JU.0000000000001080.

    PMID: 32294397
  16. 16

    Clinical Approach to Recurrent Voiding Dysfunction, Dysuria, and Pelvic Pain Persisting for at Least 3 Months.

    Kim SJ, Kim KH

    International neurourology journal 2022; (26(3)):179-189 doi:10.5213/inj.2244200.100.

    PMID: 36203251
  17. 17

    Cystoscopic evaluation and clinical phenotyping in interstitial cystitis/bladder pain syndrome

    Acar Ö, Tarcan T

    Journal of the Turkish German Gynecological Association 2019; (20(2)):117-122 doi:10.4274/jtgga.galenos.2018.2018.0102.

    PMID: 30457110

This page explains the two types of interstitial cystitis for educational purposes. Always consult your urologist to undergo proper diagnostic testing and to determine the safest treatment plan for your specific condition.

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