Intravesical enemas – when and why are they used?

Content author: physician. Arthur Abbazov, urologist, andrologist · Editorial work: Editorial team of Wyspa Medycyny Przyjaznej · Medical review: lek. Arthur Abbazov · Date of creation: 07.08.2026 · Date of review: 07.08.2026 · Updated: 07.08.2026

The article is of educational nature and does not replace a urological consultation or qualification for the procedure. Fever with chills and pain in the lumbar region, urinary retention, severe hematuria with clots and deterioration of the general condition require urgent medical attention. Recurrent urinary tract infections always require determining the cause, not just treating subsequent episodes.

The most important information at a glance

• Intravesical infusion is the administration of the preparation directly into the bladder through a catheter, retaining it for a specified period of time.
• The aim is to rebuild the protective layer that lines the bladder from the inside, called the glycosaminoglycan layer.
• When this layer is damaged, urine irritates the bladder wall - hence pain, urgency and frequent urination despite normal cultures.
• The most common indications are recurrent cystitis and painful bladder syndrome.
• This is not an antibiotic or treatment for infection - infusions do not replace antibacterial treatment.
• Infusions rebuilding the protective layer should not be confused with intravesical oncological treatment; these are completely different procedures.
• The procedure is performed on an outpatient basis, takes a short time, and the patient returns to normal activity after it.
• The standard is a series of infusions, initially more frequent, then at longer intervals.
• The condition for qualification is prior diagnosis - infusions do not exempt you from determining the cause of the ailment.
• The effect varies and builds gradually; not every patient will experience this.

Find out more about the specialist

Doctor. Arthur Abbazov is a urologist and andrologist at Wyspa Medycyny Przyjaznej in Gdańsk. He deals with the diagnosis and treatment of diseases of the urogenital system, including recurrent urinary tract infections and chronic bladder problems. With these diagnoses, the most important thing is to determine why the symptoms return - because this determines whether the infusions make sense. He also conducts consultations in Russian.

Meet the doctor. Arthur Abbazova

A layer that few people have heard about

To understand the meaning of infusions, you need to start with how the bladder is built from the inside - because this explains the mechanism of ailments that remain inexplicable for many patients.

The inside of the bladder is lined with a transitional epithelium called the urothelium. Above it there is a thin protective layer made of glycosaminoglycans - polysaccharide compounds, among which hyaluronic acid plays an important role. This layer acts as a waterproof coating: it separates chemically aggressive urine from the living cells of the bladder wall.

When the coating is damaged - by recurrent infections, oncological treatments, procedures, catheterization or chronic inflammation - urine begins to directly irritate the bladder wall. This triggers an inflammatory reaction, stimulation of nerve endings and symptoms that the patient knows all too well: urgency, urinary frequency, pain and burning.

And here comes the situation that frustrates patients the most: the symptoms resemble cystitis, but urine cultures are normal. Further antibiotics do not help because there is nothing to treat - the problem is not the bacteria, but the damaged barrier. Intravesical infusions address this mechanism.

Be careful with the nomenclature - two different types of infusions

This distinction is important because patients looking for information about "bladder infusions" come across two completely different topics and often confuse them.

This article applies only to the first column. Intravesical oncological treatment is a separate field, carried out according to separate principles and in different conditions.

When are infusions considered?

Enemas are not the first choice treatment for every cystitis. They are considered in situations where the symptoms are chronic or recurrent and standard treatment is no longer sufficient.

• Recurrent cystitis - when episodes repeat despite proper treatment of subsequent infections.
• Painful bladder syndrome - chronic bladder pain with urgency and urinary frequency, with normal urine cultures.
• Radiation cystitis - after radiotherapy of the pelvic area.
• Complaints after oncological treatment of the bladder — as a soothing procedure, agreed together with the treating center.
• Chronic symptoms after urological procedures or after long-term use of a catheter.
• Persistent symptoms despite exclusion of infection - when the patient has urgency and pain, and tests do not show bacteria.

However, the condition is common to all these situations: diagnostics first. Recurrent infections may have an obvious cause - urolithiasis, urine retention, prostate enlargement in men, anatomical defects, diabetes, and in women, changes related to estrogen deficiency. Bullous symptoms may also accompany changes in the bladder requiring endoscopic evaluation. Infusions used without explaining the cause alleviate the symptom and postpone the diagnosis.

What the procedure looks like step by step

The most noticeable moment is the insertion of the catheter - in most patients it is a short discomfort, not pain. An anesthetic gel is used, and the procedure itself takes a while. Changing the body position while stopping the preparation is of practical importance: it allows it to evenly cover the entire surface of the bladder.

Treatment is carried out in a series. Infusions are first performed more frequently, and then at longer and longer intervals - the number of treatments and the schedule are determined individually by the doctor, based on the diagnosis, severity of symptoms and response to previous treatment. There is no one regimen that fits all.

What you can and shouldn't expect

This part of the conversation determines whether the patient considers the treatment successful - so it's worth setting expectations before the first treatment, not after the third.

What you can expect: gradual reduction in pain, less frequent urination, lower frequency of urination, improved quality of life and - in some patients - less frequent recurrences of infections.

What you should not expect: an effect after the first treatment, an immediate disappearance of symptoms, an antibacterial effect in an ongoing infection or a solution to the problem caused by urolithiasis, residual urine or subvesical obstruction.

An honest note about the evidence: Bladder restructuring methods have been used for years and listed among treatment options for selected indications, but the strength of the scientific evidence is not the same for all applications, and studies differ in their protocols and the way they evaluate the effect. The response to treatment is individual and not every patient will experience it. A fair qualification is about saying it straight, not about promising a certain result.

Contraindications and possible side effects

Situations requiring postponement or exclusion of the procedure include, among others:

• active, symptomatic urinary tract infection,
• fever and symptoms of systemic infection,
• difficulties in catheterization, for example in case of urethral narrowing,
• recent injury or procedure in the urinary tract,
• hypersensitivity to the ingredients of the preparation,
• hematuria of unknown cause,
• pregnancy and breastfeeding - individual decision, after assessing the indications,
• unexplained symptoms requiring diagnostics first.

Possible side effects include transient burning and discomfort when urinating, increased urgency in the first hours after the procedure, slight hematuria related to catheterization and, less commonly, urinary tract infection caused by the procedure itself. Symptoms are usually short-lived. Fever with chills after the procedure requires contact with a doctor.

What else is important in the case of recurrent inflammation

Infusions are one of the elements of the treatment, but they are rarely sufficient on their own. In the case of recurrent infections, it is worth taking care of:

• adequate hydration and regular emptying of the bladder,
• not holding urine and urinating after intercourse,
• treatment of constipation that promotes retention and infections,
• correction of diabetes, if any,
• assessment of the causes of urine retention, including the condition of the prostate in men,
• in postmenopausal women - discussion with a gynecologist of the local treatment of atrophic lesions,
• consideration of other methods of preventing recurrences, selected by the doctor,
• imaging or endoscopic diagnostics in case of atypical course.

It is worth talking about antibiotics separately. Repeated treatments without determining the cause of relapses lead to increasing resistance and do not solve the problem. The goal of management is to reduce the number of episodes, not to treat subsequent episodes more efficiently.

The most common myths

• "An infusion is an antibiotic administered topically." No. Preparations that rebuild the protective layer do not have antibacterial effects.
• "It's the same as infusions for treating bladder cancer." No. These are completely different preparations, indications and treatment conditions.
• "One treatment is enough." No. The treatment is carried out in a series and the effect builds gradually.
• "If the culture is negative, I'm fine." No. Symptoms of a damaged protective layer occur despite proper cultures.
• "Infusions will replace diagnostics." No. Recurrent infections require determining the cause before starting treatment.
• "The procedure is painful." Usually no. The most noticeable sensation is the insertion of the catheter, which takes a while and is performed with an anesthetic gel.
• "This method is only for women." No. The indications apply to patients of both sexes.
• "The effect is permanent once and for all." No. Some patients need supportive treatments.

Bladder symptoms return despite treatment, but the cultures are normal?

This is a situation in which it is worth checking another mechanism of the symptoms. The consultation allows you to determine the cause and assess whether intravesical infusions are justified in your case.

Intravesical infusions at the Island of Friendly Medicine in Gdańsk

At the Island of Friendly Medicine doctor. Arthur Abbazov consults patients with recurrent cystitis and chronic urinary tract problems. The visit includes an interview, examination, assessment of current treatment and results, and determining whether further diagnostics are needed before starting treatment.

The treatments are performed on an outpatient basis, under sterile conditions, using a preparation based on hyaluronic acid intended for intravesical administration. The number of infusions, the intervals between them and the time of stopping the preparation are determined by the doctor individually. The current scope of treatments, availability of dates, prices and rules of preparation for the visit should be confirmed during registration.

Find out more about the medicine. Arthur Abbazov Urology consultation Urology

What to ask a urologist?

• Has the cause of recurring symptoms been determined in my case?
• Do I need additional tests before starting the infusions?
• Why is this method justified in my situation?
• How many infusions does the treatment plan provide and at what intervals?
• How long should I keep the preparation in my bladder?
• How long will it take to assess the effect and how will I know the improvement?
• Will I need maintenance treatments?
• What side effects are possible and what to do if they occur?
• Can I work and function normally on the day of the procedure?
• What else can I do to reduce relapses?
• Should I continue my current treatment?
• What will we do if treatment does not bring improvement?

FAQ - Intravesical infusions

What is an intravesical infusion?

This is the administration of the preparation directly into the urinary bladder through a thin catheter, with its retention for a specified period of time. The drug works locally, on the bladder lining, rather than systemically.

Why are they used?

To rebuild the protective layer that lines the bladder. When it is damaged, urine irritates the bladder wall, causing pain, urgency and urinary frequency - even with normal urine cultures.

Is it an antibiotic?

No. Preparations that rebuild the protective layer do not have antibacterial properties and do not replace the treatment of the infection. Active, symptomatic infection is a contraindication to infusion.

Who is eligible for the procedure?

Most often, patients with recurrent cystitis, painful bladder syndrome, radiation cystitis or chronic symptoms after urological treatment. The condition is prior diagnosis.

Does the procedure hurt?

Usually no. The most noticeable sensation is the introduction of the catheter, which takes a short time and is performed using an anesthetic gel. After the procedure, you may experience a temporary burning sensation when urinating.

How long does the entire procedure take?

The administration itself takes a few minutes. In addition, the time it takes to retain it in the bladder is indicated by the doctor. The procedure is outpatient and does not require a stay in the facility after its completion.

How many infusions are needed?

Treatment is carried out in a series - initially more frequently, then at longer intervals. The number of treatments and the schedule are determined individually by the doctor; there is no one regimen for all patients.

When will I see the effect?

Improvement is achieved gradually, during a series of treatments, not after the first infusion. The response to treatment is individual and not every patient will experience it.

Can I function normally after the procedure?

Yes, usually the same day unless your doctor tells you otherwise. Increased urge and discomfort when urinating may occur for several hours.

Is it safe?

The procedure is minimally invasive, but involves catheterization, which means there is a risk of urethral irritation and urinary tract infection. Fever with chills after the procedure requires contact with a doctor.

Will infusions replace the diagnosis of recurrent infections?

No. Recurrences may result from urolithiasis, residual urine, subvesical obstruction, diabetes or lesions requiring endoscopic evaluation. Symptomatic treatment without determining the cause delays the diagnosis.

Who performs infusions at WMP?

On the WMP website, MD. Arthur Abbazov is described as a urologist and andrologist engaged in the diagnosis and treatment of diseases of the urogenital system. The scope of treatments and availability of dates are confirmed by registration.

Sources

• Island of Friendly Medicine, MD. Arthur Abbazov: https://www.wyspamedycynyPrzyjaznej.pl/pl/artur-abazzov
• Wyspa Medycyny Przyjaznej, urology consultation: https://www.wyspamedycynyPrzyjaznej.pl/pl/konsultacja-urologiczna
• Island of Friendly Medicine, urology: https://www.wyspamedycynyPrzyjaznej.pl/pl/urologia
• European Association of Urology, Urological Infections Guidelines: https://uroweb.org/guidelines/urological-infections
• European Association of Urology, Chronic Pelvic Pain Guidelines: https://uroweb.org/guidelines/chronic-pelvic-pain
• European Association of Urology, Non-muscle-invasive Bladder Cancer Guidelines: https://uroweb.org/guidelines/non-muscle-invasive-bladder-cancer
• NHS, Urinary tract infections (UTIs): https://www.nhs.uk/conditions/urinary-tract-infections-utis/
• NHS, Bladder pain syndrome (interstitial cystitis): https://www.nhs.uk/conditions/interstitial-cystitis/
• NICE Clinical Knowledge Summaries, Urinary tract infection (lower) - women: https://cks.nice.org.uk/topics/urinary-tract-infection-lower-women/
• NICE, Urinary tract infection (recurrent): antimicrobial prescribing (NG112): https://www.nice.org.uk/guidance/ng112