What Is Parsons Solution?

Parsons Solution is a bladder instillation therapy designed to provide rapid pain relief for people with interstitial cystitis (IC) or painful bladder syndrome (PBS). Named after Dr C. Lowell Parsons, the urologist who developed and studied this approach, the solution combines two active ingredients: lidocaine (a local anaesthetic) and heparin (a glycosaminoglycan that helps protect the bladder lining).

The basic idea is straightforward: rather than waiting weeks for oral medications to take effect, deliver pain relief directly to where it hurts. The lidocaine numbs the bladder wall immediately, while the heparin coats and protects the damaged lining. It is one of several intravesical medications available for IC/PBS management.

I should be upfront about something. Parsons Solution is not a cure for IC/PBS. Nothing currently cures IC/PBS. But for patients struggling with severe pain, this approach can provide real relief while other longer-term treatments take effect. Some people use it for acute flares; others incorporate it into their regular maintenance routine.

The Science Behind Parsons Solution

To understand why this treatment exists, you need some background on what goes wrong in IC/PBS.

The Damaged GAG Layer

A healthy bladder has a protective lining made of glycosaminoglycans (GAGs), large molecules that form a barrier between the bladder wall and urine. Think of this layer as a shield. When it works properly, the irritating components in urine never touch the sensitive bladder tissue underneath 1.

In IC/PBS, this protective layer becomes damaged or deficient. The shield develops gaps. Potassium, acids, and other substances in urine then penetrate the bladder wall, triggering inflammation and pain. This explains why acidic foods, coffee, and other bladder irritants tend to worsen symptoms in people with IC—their bladder lacks adequate protection from these substances.

How Parsons Solution Addresses This

The two components of Parsons Solution tackle different aspects of the problem:

Lidocaine is an anaesthetic that blocks nerve signals. When instilled into the bladder, it temporarily numbs the pain receptors in the bladder wall. This provides rapid symptom relief, often within minutes of the treatment.

Heparin is a glycosaminoglycan that mimics the natural bladder lining. When applied to the bladder surface, it helps coat and protect the damaged areas. This is similar to how Cystistat and other GAG-replacement therapies work, though heparin has some additional anti-inflammatory properties.

The combination makes intuitive sense: provide immediate pain relief with the lidocaine while the heparin offers protective benefits. Dr Parsons’ research focused on creating optimal conditions for the lidocaine to work effectively, which brings us to an important technical detail.

The Role of Alkalinisation

Standard lidocaine solutions are acidic (pH around 4-6), which can limit how well the anaesthetic penetrates bladder tissue. The bladder’s natural acidic environment can further reduce effectiveness.

Parsons Solution addresses this by alkalinising the mixture—raising the pH to make it more basic. This is typically achieved using sodium bicarbonate. At higher pH levels, more of the lidocaine exists in its non-ionised form, which penetrates tissue more readily 2.

The practical result: alkalinised lidocaine works faster and potentially provides better pain relief than standard lidocaine solutions alone.

What Does the Research Show?

Several studies have examined the lidocaine-heparin combination for IC/PBS.

Key Clinical Findings

A randomised controlled trial by Parsons and colleagues compared the alkalinised lidocaine-heparin solution against placebo in patients with IC/PBS. The study found that the treatment group experienced significantly greater pain reduction, with effects lasting beyond the immediate anaesthetic window. This suggests the combination provides benefits beyond simple numbing 3.

Another study examined pain relief duration. Patients receiving the alkalinised lidocaine-heparin combination reported symptom improvement lasting an average of twelve hours or longer following a single 45-minute instillation. Some patients experienced relief for several days 4.

Limitations of the Evidence

I want to be honest about the research landscape here. Most studies on Parsons Solution are relatively small, and the field lacks the large, long-term trials that would give us definitive answers. IC/PBS research in general suffers from this limitation—the condition is heterogeneous, difficult to define precisely, and affects a relatively small patient population.

What we can say: the available evidence suggests Parsons Solution provides genuine short-term pain relief for many patients. Whether it offers advantages over other bladder instillations like DMSO or other GAG-replacement therapies depends partly on individual response. IC/PBS treatment is notoriously unpredictable. What works brilliantly for one patient may do nothing for another.

The Typical Formulation

The standard Parsons Solution contains:

Lidocaine hydrochloride 200mg (providing local anaesthesia)
Heparin sodium 50,000 units (providing GAG-layer replenishment and anti-inflammatory effects)
Sodium bicarbonate (alkalinising buffer to enhance lidocaine absorption)

These components are combined into a single-dose vial and instilled as a sterile solution. The total volume is typically 10-15ml, which is diluted with saline for instillation.

In the UK, Parsons Solution is available as an unlicensed “Specials” medicine on a named patient basis. This means your urologist can prescribe it, but it is not a standard licensed product—it is prepared specifically for individual patients. Mawdsleys Specialty Pharmaceuticals is one distributor that supplies this formulation in the UK.

What to Expect During Treatment

If your urologist recommends Parsons Solution, understanding the procedure can help reduce anxiety.

The Instillation Process

Treatment is administered in an outpatient clinic or hospital setting:

You empty your bladder before the appointment
A thin catheter is inserted through the urethra into the bladder
The Parsons Solution is slowly instilled
The catheter is removed
You hold the solution in your bladder for approximately 45 minutes (or as long as comfortable)
You urinate to empty the solution when you can no longer retain it

The entire appointment typically takes about an hour, with most of that time spent retaining the solution. Catheter insertion is uncomfortable (there is no getting around that) but it takes only a few moments. Most patients tolerate the procedure well enough to repeat it.

Potential Benefits

The advantages of Parsons Solution include rapid symptom relief (many patients notice improvement within hours rather than weeks), direct delivery to the bladder, and minimal systemic effects since the treatment stays localised. It is an outpatient procedure, so you go home the same day. It can also be combined with oral medications or other IC/PBS therapies without interference.

Potential Side Effects

Side effects are generally mild and relate primarily to the catheterisation procedure:

Temporary burning or stinging during catheter insertion
Urgency or discomfort while holding the solution
Occasional spotting or light bleeding
Temporary increase in frequency after treatment

These effects typically resolve within a day. Serious complications are rare when the procedure is performed properly with sterile technique.

Who Should Not Use Parsons Solution

Contraindications include:

Active urinary tract infection (treat the infection first)
Known allergy to lidocaine, heparin, or other components
Bleeding disorders or concurrent use of anticoagulants (discuss with your doctor—the heparin dose is generally not systemically absorbed, but this needs individual assessment)
Recent bladder surgery or trauma

How Parsons Solution Fits Into IC/PBS Treatment

Parsons Solution is not typically a first-line treatment for newly diagnosed IC/PBS. The usual approach starts with lifestyle modifications and dietary changes, then moves to oral medications if needed. Bladder instillations, including Parsons Solution, are generally considered when these initial approaches provide inadequate relief.

Rescue Therapy for Acute Flares

One common use is as “rescue” treatment during severe symptom flares. When pain becomes overwhelming and you need relief quickly, a Parsons Solution instillation can provide rapid respite while you wait for other treatments to kick in or for the flare to settle on its own.

Regular Maintenance

Some patients use Parsons Solution as part of an ongoing treatment regimen. After an initial series of weekly instillations, the frequency may be reduced to monthly or as-needed based on symptom control. The optimal schedule varies considerably between individuals.

Combination Approaches

Parsons Solution can be used alongside other IC/PBS treatments. For example, a patient might take oral medications (like pentosan polysulfate or amitriptyline), follow dietary restrictions, attend pelvic floor physiotherapy, and receive periodic Parsons Solution instillations. Multi-modal therapy is the norm in IC/PBS management.

Comparing Parsons Solution to Other Bladder Instillations

Several bladder instillation options exist for IC/PBS. How does Parsons Solution compare?

Versus DMSO

DMSO has been around longer and carries FDA approval for IC treatment. It works through anti-inflammatory mechanisms rather than anaesthetic effects. The main practical difference: DMSO causes a distinctive garlic-like odour on the breath that persists for one to three days. Some patients find this unacceptable.

Parsons Solution does not cause breath odour. It may provide faster pain relief due to the lidocaine component. However, DMSO has a longer track record and may offer benefits through different mechanisms.

Versus Hyaluronic Acid Products

Products like Cystistat and Hyacyst aim to replenish the GAG layer with hyaluronic acid. These take longer to work, typically requiring several weekly treatments before patients notice benefit, but they address the underlying protective layer deficiency.

Parsons Solution provides faster symptom relief but through different mechanisms. Some clinicians use both approaches: Parsons Solution for immediate pain control during flares, and hyaluronic acid products for longer-term GAG-layer restoration.

Versus Cystilieve

Cystilieve also contains alkalinised lidocaine but without the heparin component. It focuses purely on pain relief. Parsons Solution adds the potential GAG-layer benefits of heparin. Whether this makes a practical clinical difference is debatable. The evidence does not definitively favour one over the other.

Practical Considerations

Access in the UK

As an unlicensed Specials medicine, Parsons Solution requires a prescription from a specialist (usually a urologist) who orders it specifically for you. Not all UK hospitals stock it, and there may be delays in obtaining supplies. Discuss availability with your clinical team.

Cost

Specials medicines are generally more expensive than licensed products due to their bespoke manufacturing. In the NHS, your consultant can prescribe Parsons Solution if deemed clinically appropriate, and you should not need to pay out of pocket. Private patients should clarify costs with their provider before treatment.

Self-Catheterisation

Some patients learn to perform bladder instillations at home. This requires training in clean intermittent self-catheterisation (CISC) and proper technique to avoid infection. Home treatment can be more convenient, especially for patients who need frequent instillations, but it is not suitable for everyone. Discuss this option with your urologist if interested.

Setting Realistic Expectations

Parsons Solution can be genuinely helpful for IC/PBS pain, but it is worth approaching treatment with realistic expectations.

It is not a cure. IC/PBS remains a chronic condition without a definitive cure. Parsons Solution manages symptoms; it does not eliminate the underlying problem.

Results vary considerably. Some patients find Parsons Solution highly effective; others notice minimal benefit. Predicting who will respond is difficult, and trial and error is standard in IC/PBS treatment.

You may need repeated treatments. Single instillations provide temporary relief. Ongoing symptom control typically requires periodic treatments, possibly indefinitely.

It works best alongside other approaches. Diet modification, stress management, pelvic floor therapy, and other treatments all have roles. Relying on any single therapy for IC/PBS management often leads to disappointment.

Questions to Ask Your Urologist

If Parsons Solution is being considered for your treatment:

How many patients have you treated with this approach, and what outcomes have you seen?
How will we know if it is working?
What is the plan if Parsons Solution does not help adequately?
Would I be a candidate for home self-catheterisation?
How does this fit with my other current treatments?

IC/PBS management benefits from open communication with your healthcare team. Advocate for yourself, track your symptoms, and do not hesitate to discuss concerns or ask for adjustments to your treatment plan.

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
Parsons CL, Zupkas P, Proctor J, et al. Alkalinized lidocaine and heparin provide immediate relief of pain and urgency in patients with interstitial cystitis. J Sex Med. 2012;9(1):207-212. PubMed
Parsons CL. Successful downregulation of bladder sensory nerves with combination of heparin and alkalinized lidocaine in patients with interstitial cystitis. Urology. 2005;65(1):45-48. PubMed
Nickel JC, Moldwin R, Lee S, et al. Intravesical alkalinized lidocaine (PSD597) offers sustained relief from symptoms of interstitial cystitis and painful bladder syndrome. BJU Int. 2009;103(7):910-918. PubMed