What Is iAluRil?

iAluRil is a medical device that delivers two glycosaminoglycans—hyaluronic acid and chondroitin sulphate—directly into the bladder to treat conditions caused by damage to the bladder’s protective lining. It is manufactured by IBSA and used for interstitial cystitis (IC), painful bladder syndrome (PBS), radiation cystitis (bladder damage from pelvic radiotherapy), and recurrent urinary tract infections.

What sets iAluRil apart from other bladder instillations is that it combines two GAG (glycosaminoglycan) components in a single product. Many other treatments, like Cystistat or Hyacyst, contain only hyaluronic acid. Gepan contains only chondroitin sulphate. iAluRil includes both, based on the reasoning that the natural bladder lining contains multiple GAG types, so replacing more than one might provide better coverage.

I should be clear from the start: iAluRil is not a cure for IC or chronic cystitis. It is a symptom management treatment that temporarily replenishes a protective layer on the bladder wall. Some patients experience significant improvement, others notice moderate benefit, and some see little difference. This variability is typical of IC treatments generally.

How the GAG Layer Works

To understand why treatments like iAluRil exist, you need to know what goes wrong in conditions like IC and chronic cystitis.

The Bladder’s Natural Defence

The inner surface of a healthy bladder is coated with a layer of glycosaminoglycans, commonly called the GAG layer. This coating includes several substances: hyaluronic acid, chondroitin sulphate, heparan sulphate, and others. Together, they form a protective barrier between the bladder tissue and urine.

This matters because urine contains various compounds that would irritate the underlying bladder wall if they made direct contact—potassium, waste products, and other potentially harmful substances. The GAG layer prevents this contact, functioning as a biological shield.

When Protection Breaks Down

In patients with IC, PBS, or certain types of chronic cystitis, researchers believe this protective layer becomes damaged or deficient 1. Without adequate protection, irritating substances from urine can penetrate the bladder wall and trigger inflammation and pain—the characteristic urgency, frequency, burning, and discomfort that make these conditions so difficult to live with.

The Logic of GAG Replacement

If the problem is a damaged protective layer, the logical solution is to replace it. This is the principle behind intravesical (inside-the-bladder) therapies like iAluRil. By instilling GAG components directly into the bladder, clinicians hope to temporarily restore the protective coating and create conditions that allow the underlying tissue to heal.

I should note that this remains partly theoretical. We cannot easily measure the GAG layer in living patients, so proving definitively that it is deficient in any individual is difficult. The treatment approach is based on reasonable theory, clinical observation, and accumulating research evidence rather than complete mechanistic certainty.

Why Combine Hyaluronic Acid and Chondroitin Sulphate?

iAluRil contains 800mg of hyaluronic acid and 1g of chondroitin sulphate in a 50ml solution. The rationale for combining these two components is straightforward: since the natural GAG layer contains multiple types of glycosaminoglycans, replacing more than one might provide more complete protection than replacing just one.

Hyaluronic acid is a large molecule that holds water and contributes to the gel-like consistency of the protective layer. It is also found naturally in joint fluid, skin, and eyes.

Chondroitin sulphate is another GAG component that contributes to the bladder lining’s protective properties. It is also used in joint health supplements, often combined with glucosamine.

Whether combining them actually works better than either alone is an important question. Some research suggests it might.

What Does the Evidence Show?

The clinical evidence for combination hyaluronic acid plus chondroitin sulphate therapy is reasonably encouraging, though most studies are relatively small and long-term data remain limited.

Combination Therapy Studies

A key study examined 126 patients with refractory IC/PBS who received intravesical hyaluronic acid plus chondroitin sulphate. At 12 weeks, 87% of patients experienced clear symptom improvement. At 12-month follow-up with maintenance therapy, 62% maintained this improvement 2. These are promising numbers, though the study lacked a placebo control group.

Another multicentre study evaluated combination treatment in women with recurrent UTIs. Patients who received hyaluronic acid plus chondroitin sulphate instillations experienced significantly fewer UTI episodes compared to their pre-treatment baseline. The treatment appeared to reduce the frequency of infections by helping restore the bladder’s natural defences 3.

Evidence for Radiation Cystitis

For patients with bladder damage following pelvic radiotherapy, GAG-replacement therapy can also be helpful. A study examining intravesical treatment for radiation cystitis found that 79% of patients reported meaningful symptom improvement, particularly reduced urgency and pain 4.

How This Compares to Single-Agent Treatments

Is combination therapy actually better than hyaluronic acid or chondroitin sulphate alone? The honest answer is that we do not have definitive head-to-head comparisons. Response rates in studies of single-agent treatments (like Cystistat or Gepan) typically fall in the 60-75% range, which overlaps with combination therapy results.

The theoretical advantage of combination therapy is providing more complete GAG-layer replacement. Whether this translates to clinically meaningful benefit for individual patients is harder to prove. Some clinicians prefer combination products, while others find single-agent treatments work adequately.

My reading of the evidence: The available research suggests combination therapy helps a meaningful proportion of patients. Response rates of 60-87% in various studies are genuinely encouraging. The treatment appears well tolerated with few side effects. However, the studies are generally small, lack placebo controls in many cases, and long-term data are limited. I would say the evidence is supportive but not conclusive.

How Treatment Is Administered

Understanding the practical aspects of iAluRil treatment helps set appropriate expectations.

The Instillation Procedure

iAluRil is administered by a healthcare professional—typically a urologist or specialist nurse—in an outpatient clinic. The procedure is relatively straightforward:

You empty your bladder before the appointment
A thin catheter is inserted through the urethra into the bladder
The sterile iAluRil solution is slowly instilled
The catheter is removed
You retain the solution for as long as comfortable—minimum 30 minutes, though longer is better
You urinate to empty the bladder when you can no longer hold it

The instillation itself takes only a few minutes. Most patients tolerate it reasonably well, though catheter insertion can be uncomfortable for some people, particularly those with severe IC symptoms.

Self-Catheterisation Option

Some patients learn to perform instillations at home after receiving training from their healthcare team. This can be more convenient than frequent clinic visits, especially during the intensive initial treatment phase. Self-catheterisation requires good dexterity, reasonable comfort with the procedure, and proper sterile technique to avoid introducing infection. Your specialist can advise whether this is appropriate for your situation.

Treatment Schedule

The typical protocol involves two phases.

Initial intensive phase: Weekly instillations for four to six weeks. This regular treatment schedule allows the GAG layer to build up consistently on the bladder lining. Some protocols extend to eight weeks depending on response.

Maintenance phase: After the initial course, treatments are spaced further apart based on individual response. Many patients move to fortnightly instillations, then monthly, eventually extending to every two or three months if symptoms remain well controlled.

One thing worth knowing: do not expect immediate results. Many patients need four, five, or even six treatments before noticing meaningful improvement. The protective layer needs time to establish, and the underlying bladder tissue needs time to settle down. If you abandon treatment after two sessions because you feel no different, you may be stopping too soon.

How Long Does Treatment Continue?

There is no set endpoint for iAluRil therapy. Some patients achieve stable remission and can discontinue treatment entirely. Others require ongoing maintenance instillations for years—sometimes indefinitely—to keep symptoms controlled. If symptoms return after stopping, treatment can usually be resumed.

The goal is finding the minimum treatment frequency that maintains adequate symptom control for you specifically. This varies considerably between patients.

Side Effects and Safety

iAluRil has a good safety profile. Both hyaluronic acid and chondroitin sulphate occur naturally in the body, and the treatment remains local to the bladder rather than circulating systemically.

Common Experiences

The most frequently reported issues relate to the catheterisation procedure rather than the iAluRil solution itself:

Mild discomfort or burning during catheter insertion
Temporary urgency or stinging immediately after instillation
Occasional minor spotting of blood in urine following the procedure

These effects typically resolve within a day or two.

Less Common Reactions

Rarely, some patients experience a temporary worsening of symptoms shortly after instillation. This paradoxical flare usually settles within 24-48 hours. If severe symptoms persist beyond this, contact your healthcare team.

Allergic reactions to hyaluronic acid or chondroitin sulphate are very rare but theoretically possible.

Who Should Not Use iAluRil?

iAluRil is contraindicated in patients with:

Active urinary tract infection (treatment should be delayed until the infection resolves)
Known hypersensitivity to hyaluronic acid, chondroitin sulphate, or any product component
Significant bladder injury or recent bladder surgery where instillation could cause complications

There are no known significant drug interactions, and iAluRil can generally be used alongside other IC medications.

Comparing iAluRil to Other Treatments

If you are considering iAluRil, understanding how it compares to alternatives can help inform discussions with your specialist.

Versus Single-Agent GAG Therapies

Products like Cystistat (hyaluronic acid alone) or Gepan (chondroitin sulphate alone) work by the same GAG-replacement principle but contain only one active component. The theoretical advantage of iAluRil is providing more complete GAG-layer replacement by including both. Whether this translates to better outcomes in practice is uncertain—studies have not directly compared them head-to-head in large populations.

Versus DMSO

DMSO (dimethyl sulfoxide) works differently, primarily through anti-inflammatory and muscle relaxant effects. It is the only FDA-approved intravesical treatment for IC and has a longer track record. However, DMSO causes a distinctive garlic-like odour on the breath and skin that persists for days after treatment—a significant quality-of-life issue for many patients. It can also temporarily worsen bladder irritation and requires periodic eye examinations during prolonged use. GAG-replacement therapies like iAluRil do not have these problems.

Versus Lidocaine-Based Treatments

Products like Cystilieve work by directly anaesthetising the bladder, providing more immediate pain relief but addressing symptoms differently. They are sometimes used for acute flares or in combination with GAG therapies rather than as primary maintenance treatment.

Versus Oral Medications

Oral treatments like pentosan polysulfate sodium (Elmiron) work systemically and typically require months to show effect. Intravesical treatments deliver the active ingredients directly to the bladder and may show results more quickly in responsive patients. The trade-off is that instillations require clinic visits (or self-catheterisation), whereas oral medications can be taken at home.

A practical note: IC/PBS treatment often involves trial and error. What works well for one patient may do nothing for another. Many patients try multiple approaches before finding their optimal management strategy. Being open to experimentation while giving each treatment a fair trial is often necessary.

Obtaining Treatment

iAluRil is classified as a medical device rather than a pharmaceutical drug, which affects how it is regulated and supplied. It requires administration by qualified healthcare professionals, so you cannot simply purchase it for home use (unless you have been trained in self-catheterisation).

In the UK

iAluRil is available through NHS urology departments for patients meeting clinical criteria. Availability varies by region depending on local commissioning decisions. Private treatment is also an option for those who prefer it or face NHS waiting times.

The Referral Pathway

To access iAluRil, you typically need:

A diagnosis of IC, PBS, radiation cystitis, or recurrent UTIs from a urologist
Documentation that first-line treatments have been tried without adequate relief
Assessment confirming intravesical therapy is appropriate for your situation

Your GP can refer you to a urologist if you are experiencing chronic bladder symptoms that have not responded to initial treatments.

Practical Tips for Patients

Based on clinical experience and patient feedback, here are some practical suggestions.

Empty your bladder just before the procedure. An empty bladder allows maximum contact time between the solution and your bladder lining.

During the retention period, some patients find it helpful to change positions—sitting, lying on each side, lying on their back—to help the solution coat all areas of the bladder. There is no rigorous evidence this makes a significant difference, but it seems reasonable.

After treatment, drink normally but avoid excessive fluid intake in the first few hours. Overdrinking will dilute and flush out the treatment faster than necessary.

Keep a bladder diary recording symptoms, urgency episodes, and pain levels. This helps you and your clinician objectively assess whether the treatment is working and fine-tune your maintenance schedule. Without tracking, it can be difficult to distinguish gradual improvement from wishful thinking.

Questions to Discuss With Your Urologist

If iAluRil is being considered, here are questions worth raising:

How many patients have you treated with combination hyaluronic acid/chondroitin sulphate instillations, and what outcomes have you typically seen?
Would combination therapy have advantages over single-agent products for my specific situation?
How long should I trial the treatment before we reassess whether it is working?
Would I be a suitable candidate for self-catheterisation at home?
If iAluRil does not help enough, what would you suggest trying next?

Is iAluRil Worth Trying?

For patients with IC, PBS, radiation cystitis, or recurrent UTIs who have not found adequate relief from oral medications and lifestyle modifications, iAluRil represents a reasonable option.

The evidence suggests combination GAG therapy helps roughly two-thirds to three-quarters of patients who try it. The safety profile is excellent—no systemic side effects, no garlic odour, just the temporary inconvenience of catheterisation. These are genuine advantages over some alternatives.

But I would encourage realistic expectations. You will probably need multiple treatments before knowing whether it works for you specifically. You may need ongoing maintenance treatment for years. The procedure requires clinic visits (or learning self-catheterisation). And roughly one in four patients does not benefit meaningfully.

For the right patient—someone who has tried simpler approaches without success and is willing to commit to a proper treatment trial—iAluRil is worth discussing with your urologist. Give it at least five or six sessions before deciding whether it is helping.

References

Parsons CL. The role of the urinary epithelium in the pathogenesis of interstitial cystitis/prostatitis/urethritis. Urology. 2007;69(4 Suppl):9-16. PubMed
Cervigni M, Natale F, Nasta L, et al. A combined intravesical therapy with hyaluronic acid and chondroitin for refractory painful bladder syndrome/interstitial cystitis. Int Urogynecol J. 2012;23(9):1193-1199. PubMed
Damiano R, Quarto G, Bava I, et al. Prevention of recurrent urinary tract infections by intravesical administration of hyaluronic acid and chondroitin sulphate: a placebo-controlled randomised trial. Eur Urol. 2011;59(4):645-651. PubMed
Shao Y, Lu GL, Shen ZJ. Comparison of intravesical hyaluronic acid instillation and hyperbaric oxygen in the treatment of radiation-induced hemorrhagic cystitis. BJU Int. 2012;109(5):691-694. PubMed