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Practitioner protocol
Bladder (Vesicourethral) Ozone Instillation Protocol
Preparation, concentration and precautions for bladder irrigation with ozonized water, performed by a clinician.
Quick answer: Bladder instillation irrigates the bladder with 500 mL of ozonized water at 20–30 µg/mL, made by bubbling for 10 minutes at 200 mL/min. It must be done by a trained clinician.
Warning
For trained practitioners only
Bladder instillation should only be done by a practitioner who has been trained in it. You can reach Dr. Mandy Dell, DCN, on the MediSkill team through her website for questions.
What are the basics of bladder ozone instillation?
- This is a sterile procedure performed by a trained clinician through a urinary catheter. It is not a home method.
- Madrid advises against putting ozone gas straight into the bladder. It recommends irrigating with ozonized double-distilled water instead.
- The bladder lining is very sensitive to the oxidizing effect of ozone, especially in interstitial cystitis. The lining is covered by a layer of glycosaminoglycans that protects the tissue underneath from urine, so the aim is to avoid harming it.
- Preparation: ozonize 500 mL of double-distilled water at 20 to 30 µg/mL for 10 minutes at a flow of 200 mL/min.
- Keep all aseptic and antiseptic measures.
- Madrid does not state a volume to instill per session, a session frequency or a maximum. These are set by the treating clinician, so those tiles are left blank.
Source: Madrid Declaration on Ozone Therapy, 4th edition (ISCO3, 2025), section 7 (vesicourethral irrigation). Paraphrased.
What dose and schedule are used for bladder ozone instillation?
| Fluid | Volume | Gas concentration | Bubbling time | Flow |
|---|---|---|---|---|
| Double-distilled water | 500 mL | 20–30 µg/mL | 10 min | 200 mL/min |
Madrid gives no session schedule for the bladder. For ozonized water in general, Madrid notes the final dissolved concentration is about one quarter of the gas concentration bubbled, at 20 °C.
What are the best tips when using bladder ozone instillation?
- Dissolved ozone fades quickly: Madrid gives a half-life of about 9 hours at 20 °C. Prepare it for the session.
- Use a glass cylinder and ozone-resistant tubing, with a destructor for gas that is not dissolved.
- Tell the urologist treating the patient. The patient should not stop current bladder medication on their own (from our interstitial cystitis article).
- For urinary concerns at home, our protocols use vaginal and rectal insufflation, not the bladder.
What are the precautions for bladder ozone instillation, and who should avoid it?
- Do not instill ozone gas directly into the bladder. Madrid recommends ozonized water.
- Avoid trauma and keep the procedure sterile. Interstitial cystitis bladders are especially sensitive.
- Do not inhale the gas while preparing the water. Work in a ventilated space.
Contraindications
Check with your healthcare provider before starting, especially if you are pregnant, have a heart or bleeding condition, or take blood thinners.
More detail
Equipment
- Medical ozone generator with medical-grade oxygen
- Glass cylinder, about three-quarters full of double-distilled water, with ozone-resistant tubing and a destructor
- Sterile urinary catheter and irrigation supplies
What the studies used
There is no controlled trial of bladder ozone in our study set. The best data are small cohorts and case series, which used gas, not water. Study doses are listed as printed and are not Madrid dosing.
- In 16 women with interstitial cystitis, 6 bladder sessions of ozone gas (41 µg/mL, 60 mL, held 15 minutes, twice a week for 3 weeks) took the median symptom index from 17 to 0.5 at 180 days. There was no comparison group (Pires 2023).
- In 4 nursing-home residents with recurrent urinary infections, bladder gas (50 to 100 mL at 10 to 25 µg/mL) after irrigation with ozonated water, alongside antibiotics, was followed by symptom remission in all four (Dominguez 2018, Revista Espanola de Ozonoterapia).
- In a single case of a resistant E. coli urinary infection, bladder water ozonated at 80 µg/mL for 10 minutes was given twice a week with MAH, and the urine culture turned negative (Logan 2018, Revista Espanola de Ozonoterapia).
Learn more
Background, benefits and research: Ozone therapy for interstitial cystitis and bladder pain syndrome, full article. Comparing routes: Comparing home ozone therapies.
Related protocols: Prostate Ozone Injection Protocol, Ozonated Saline IV Drip (O3SS) Protocol, IV Ozone Protocol: Major Autohemotherapy (MaH).
Other protocols
For licensed practitioners. Educational reference only, not medical advice. Follow your scope of practice and local regulations.