Hemorrhagic Cystitis

What Is Hemorrhagic Cystitis?

Hemorrhagic cystitis is the sudden onset of hematuria combined with bladder pain and irritative bladder symptoms.

Hematuria is blood in the urine. The amount of blood can range from a minute amount that occurs occasionally to frank bright red blood that occurs continuously. There are a variety of causes of hematuria.

Oncology patients are at risk for developing hemorrhagic cystitis. The onset can be variable. Hemorrhagic cystitis can occur during treatment, immediately following treatment, or the onset may be delayed for months following treatment.

While hemorrhagic cystitis can be a very serious condition leading to significant bleeding (hemorrhage) or life-threatening infection (urosepsis), the majority of patients can be treated successfully.

Who Is At Risk To Develop Hemorrhagic Cystitis?

Oncology patients are at risk for developing this, but there can be other reasons it occurs. Risks include:

• Chemotherapy medications Cyclophasphamide and Ifosfamide
• Bladder cancer
• Pelvic radiation therapy
• Radiation therapy given with chemotherapy
• AIDs
• Other chemicals (for example, dyes, insecticides, and recreational drugs)
• Antibiotics
• Viruses (for example, papovarius and adenovirus)
• Persistent urinary tract infections
• Thrombocytopenia (low platelet count)
• Bone marrow transplant (due to higher dosages of chemotherapy)
• Other chemotherapeutic agents, while not usually associated with bladder toxicity, might also put a patient at risk.

Why Does Hemorrhagic Cystitis Occur?

For patients receiving chemotherapy (Cyclophasphamide and Ifosfamide), these drugs are broken down by the body into substances (acrolein) which when excreted from the body through the bladder can cause symptoms such as irritation to the lining of the bladder. This irritation can be severe and cause ulceration resulting in significant bleeding.

Hemorrhagic Cystitis Symptoms:

• Hematuria (slight pink to frank bright red blood), with or without blood clots.
• Dysuria (painful urination)
• Burning with urination
• Urinary frequency
• Urinary urgency
• Urinary incontinence (involuntary loss of urine)
• Nocturia (awakening at night to urinate, considered a disturbance in voiding if it occurs two or more times in a night)
• Vague abdominal (or suprapubic) pain
• Fatigue (due to anemia)
• Bladder infection

In Addition to the Bleeding With Hemorrhagic Cystitis, What Other Bladder Problems Might Occur?

• Bladder wall scarring
• Decrease in size (atrophy) of the bladder
• Severe systemic infection (urosepsis)
• Urinary obstruction

Treatment of Hemorrhagic Cystitis Symptoms:

Treatment of hemorrhagic cystitis usually varies and there is no established protocol to treat hemorrhagic cystitis. Often it may resolve on its own.

• Stop the treatment causing the bladder problems.
• Analgesics pain medication.
• Antibiotics if concern of underlying infection or as preventive measure.
• Blood transfusion if anemia results from bleeding.
• Instillation of medications into the bladder to stop bleeding.

Prevention of Hemorrhagic Cystitis:

There are options that can be tried:

• Continuous bladder irrigation with normal saline
• Aggressive fluid intake by mouth or by intravenous (IV) infusion (to flush metabolites from the bladder)
• Alkalinization of urine by diuretics (Foley or patient void frequently)
• IV diuretics for patients with low urine output
• Use of Mesna (a compound that protects the bladder lining by binding to the metabolite acrolein in the bladder to form an inactive product that is readily excreted by the bladder). The use of this does not compromise the antitumor activity of the chemotherapy.

When to Contact Your Doctor or Health Care Provider:

• Fever of 100.5° F (38° C) or higher, chills (possible signs of infection)
• Blood in the urine
• Symptoms of bladder irritation: blood in the urine, frequency, difficulty or burning when urinating, pain.

Common Bladder Problems: Cystitis | Hemorrhagic Cystitis

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website about bladder problems and other medical conditions is meant to be helpful and educational, but is not a substitute for medical advice.