Hemorrhagic Cystitis

What is hemorrhagic cystitis?

Hemorrhagic cystitis is a medical condition that occurs when your urinary bladder lining becomes inflamed and bleeds.

Your bladder is a muscular sac in your pelvis that stores urine before it’s released from your body. Hemorrhagic means bleeding, and cystitis is inflammation of the bladder.

Who might get hemorrhagic cystitis?

Hemorrhagic cystitis occurs in people who experience damage to the bladder lining. It’s usually associated with infection or cancer treatment.

How common is hemorrhagic cystitis?

Hemorrhagic cystitis isn’t common in the general population. But it can affect 10% to 35% or more of people receiving certain cancer treatments.

How do you get hemorrhagic cystitis?

Hemorrhagic cystitis is the result of damage to your bladder lining, including blood vessels located there. The damage may be due to:

• Bacterial or viral infection.
• Bone marrow transplant.
• Chemotherapy, such as cyclophosphamide or ifosfamide.
• Occupation exposure to certain chemicals, such as aniline and toluidine.
• Radiation therapy near the bladder.

What are the symptoms of hemorrhagic cystitis?

The symptoms of hemorrhagic cystitis vary depending on how severe the case is. Signs of hemorrhagic cystitis may include:

• Blood in the urine (hematuria), which can make pee look pink, red or brown.
• Blood clots in the urine.
• Dysuria (painful urination).
• Fever.
• Frequent urges to pee.
• Inability to pee.
• Loss of bladder control.

How is hemorrhagic cystitis diagnosed?

Hemorrhagic cystitis symptoms can be similar to urinary tract infections and bladder stones.

Your healthcare provider may order tests to make a diagnosis:

• Urine tests to look for microscopic blood cells, cancer cells or infection.
• Blood tests to look for infection or other conditions.
• Imaging tests to take pictures of your bladder, such as CT scan, MRI or ultrasound.
• Cystoscopy, a test that uses a thin tool containing a light and camera to look into your bladder.

Your healthcare provider may assign a grade to hemorrhagic cystitis based on your symptoms and test results. The grade indicates how advanced or severe it is:

• Grade I: Minor bleeding that’s visible only under a microscope.
• Grade II: Visible but relatively minor bleeding.
• Grade III: Bleeding with small clots.
• Grade IV: Severe hemorrhagic cystitis that causes clots large enough to block urine flow.

How do you treat hemorrhagic cystitis?

Prompt treatment of hemorrhagic cystitis is important to reduce pain and prevent long-lasting bladder damage.

Treatment options vary widely, depending on the cause and severity of each case. Hemorrhagic cystitis treatment may include:

• Bladder drainage through a catheter (tube) into a bag outside your body.
• Changes to medications, such as an alternative chemotherapy or a lower dose.
• Clot evacuation via catheter or cystoscopy to remove clots from your bladder.
• Continuous bladder irrigation, which injects fluids into your bladder to flush it out.
• Embolization, which blocks bleeding blood vessels.
• Hyperbaric oxygen therapy.
• Intravesical therapy, injection of medications into your bladder, such as sodium hyaluronidase and aminocaproic acid.
• IV fluids injected into a vein in your hand or arm to increase urine and flush the bladder.
• Medications for infections, such as antibiotics to treat bacterial infections or antivirals to fight viruses.

Rarely do people with hemorrhagic cystitis require blood transfusion to replace heavy blood loss or a cystectomy (surgery to remove your bladder).

How can I reduce my risk of hemorrhagic cystitis?

If you’re receiving treatment for cancer, ask your healthcare providers about ways to protect your bladder and prevent hemorrhagic cystitis. Strategies include:

• Drinking more fluids, including cranberry juice, which can boost bladder health.
• Emptying your bladder more often.
• Having your urine checked regularly for traces of blood.
• Limiting the area of radiation.
• Receiving mesna.
• Receiving continuous bladder irrigation regularly during cancer treatment.

Is hemorrhagic cystitis fatal?

The outlook depends on the cause and severity of hemorrhagic cystitis. The condition usually responds well to treatment and doesn’t lead to long-term problems, especially infection-related cases. Rarely, severe cases can be fatal.

Most people with cancer who develop hemorrhagic cystitis can continue cancer treatment.

When should I seek medical attention for hemorrhagic cystitis?

You should seek medical attention quickly if you have any signs of hemorrhagic cystitis. It’s particularly urgent if you have blood clots in your urine or can’t pass urine.

A note from Cleveland Clinic

Hemorrhagic cystitis occurs when your urinary bladder lining becomes inflamed and bleeds. It’s a common complication of cancer treatment and may also occur as a result of infection and occupational exposure to chemicals. If you have blood in your urine or any problems peeing, talk to a healthcare provider.