Radiation Cystitis

What is radiation cystitis?

Radiation cystitis is inflammation that occurs in your urinary bladder after radiation therapy to treat cancer in your pelvic area. This may include:

• Bladder cancer
• Colorectal (colon) cancer
• Prostate cancer
• Uterine cancer
• Ovarian cancer

Radiation cystitis can be an uncomfortable side effect of radiation therapy. If you have symptoms like difficulty peeing or peeing more frequently, let your provider know so they can recommend ways to help.

What are the types of radiation cystitis?

• Acute radiation cystitis: This type develops suddenly. It may develop in the time between radiation therapy sessions or shortly after completely finishing radiation therapy.
• Delayed (late) radiation cystitis: This type takes longer to develop. It can occur six months or even longer after completing radiation therapy. Sometimes symptoms develop years later.

What is another name for radiation cystitis?

Another name for radiation cystitis is radiation-induced cystitis.

How common is radiation cystitis?

Anywhere between 23% and 80% of people who receive radiation treatment in their pelvic area develop radiation cystitis. There’s such a big range because there are different types of radiation therapy, and you may need more or less radiation therapy depending on your cancer stage and where the cancer is in your body. A healthcare provider will give you a better idea of what to expect according to your unique situation.

What are the symptoms of radiation cystitis?

Radiation cystitis symptoms may range from mild to severe. The severity usually depends on how much radiation therapy you need — that is, the amount or duration.

Mild radiation cystitis symptoms may include:

• Peeing more than usual (frequent urination)
• Waking up more than once to pee (nocturia)
• Urgent, uncontrollable need to pee (urge incontinence)
• Pain or burning when you pee (dysuria)
• Bladder muscle spasms

Over time, these symptoms may improve on their own without treatment.

Severe radiation cystitis symptoms may include:

• Long-term loss of bladder control (urinary incontinence)
• Bladder can’t hold as much pee (reduced bladder capacity)
• Blood in your pee (hematuria)
• A sore (ulcer or lesion) in your bladder wall (Hunner’s ulcer)
• An opening or tunnel between two body parts that don’t usually connect (fistula)
• Bladder tissue deteriorates (necrosis)

Is radiation cystitis progressive?

For some people, radiation cystitis can be progressive. You may not have any radiation cystitis symptoms while going through radiation therapy. But they develop months or even years after you complete radiation therapy.

What causes radiation cystitis?

Radiation therapy causes radiation cystitis. Before you start treatment, a healthcare provider will review the benefits of radiation therapy and weigh them against the potential risks so you can make an informed decision.

What causes late radiation cystitis?

Late radiation cystitis develops because radiation therapy causes scar-like tissue to build up in your bladder (fibrosis).

How long after radiation can you get radiation cystitis?

Late radiation cystitis may develop anywhere between six months and 20 years after completing radiation therapy.

Who does radiation cystitis affect?

Radiation cystitis can affect anyone who gets radiation therapy to treat cancer in their pelvic area. But people with penises are more likely to develop it because radiation therapy is a common treatment option for prostate cancer. Prostate cancer is the second-most common cancer that affects people with penises.

How is radiation cystitis diagnosed?

A healthcare provider will review your medical history, ask questions about your symptoms and perform a physical exam. Radiation cystitis shares many of the same symptoms as other common conditions that can affect your bladder, including urinary tract infections (UTIs) and bladder stones. So, to help make an accurate diagnosis and rule out other conditions, they may recommend testing.

What tests will be done to diagnose radiation cystitis?

Radiation cystitis testing may include:

• Urinalysis (pee test): A provider examines a sample of your pee for the presence of blood or bacteria.
• Blood tests: A provider takes a blood sample to look for signs of infection.
• Cystoscopy: A provider inserts a thin, lighted device with a camera at the end (cystoscope) into your urethra and up to your bladder to visually examine your bladder.

How do you treat radiation cystitis?

It depends on the severity of your radiation cystitis. Mild radiation cystitis may eventually improve on its own without treatment. You can help alleviate some of your discomfort with the following:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) to help reduce inflammation
• Analgesics (painkillers) to help reduce pain
• Antispasmodics to help relieve bladder spasms

For more severe symptoms, a healthcare provider may recommend:

• Bladder irrigation (bladder wash): A healthcare provider inserts a urinary catheter through your urethra and up to your bladder to deliver numbing medications.
• Sodium hyaluronate injection: A provider injects sodium hyaluronate directly into your bladder, usually through a urinary catheter. It coats your bladder walls to help relieve pain.
• Hyperbaric oxygen therapy (HBOT): During HBOT, you enter a pressurized chamber that fills with 100% oxygen. The oxygen helps your damaged bladder tissue heal. The extra air pressure helps your body absorb more oxygen.
• Urinary reconstruction and diversion: A surgeon creates a new way for your body to store and remove pee from your body.
• Cystectomy: A surgeon removes your bladder. They’ll also create a new way for your body to store pee and remove it from your body. A cystectomy to treat radiation cystitis is rare. A provider will only recommend it if your symptoms are severe and don’t respond to other treatments.

How soon after treatment will I feel better?

It depends on how much radiation therapy you require, the severity of your symptoms and your body’s response to treatment. Your healthcare provider will give you a better idea of what to expect according to your unique situation.

Can radiation cystitis be prevented?

Experts aren’t sure if there is any way to prevent radiation cystitis. The medication pentosan polysulfate may help prevent bladder irritation. But more research is necessary.

What can I expect if I have radiation cystitis?

For many people, radiation cystitis is a long-term condition. Your symptoms may be mild or severe, and they may go away and come back or last a long time. Talk to your healthcare provider about your outlook and the best treatment options.

How long can radiation cystitis last?

It varies. For some people, radiation cystitis symptoms may last a few weeks or months and then go away and never come back. For others, symptoms may last a long time. Or they may show up months or even years after you complete radiation therapy.

What foods are good for radiation cystitis?

You can help reduce discomfort or pain by drinking plenty of water. It’s a good idea to drink between eight and 10 glasses each day.

The following foods may be less likely to cause discomfort or pain if you have radiation cystitis:

• Fruits, like bananas, pears, raisins and blueberries
• Vegetables, like broccoli, spinach, avocados and beets
• Whole grains, like rice and oats
• Nuts, including peanuts, cashews and almonds

What drinks should I avoid if I have radiation cystitis?

Avoid drinks that irritate your bladder. These include:

• Acidic juices, including cranberry juice, tomato juice and orange juice
• Caffeine, including coffee and tea
• Alcohol
• Carbonated beverages, including seltzer water and soda pop

It’s also a good idea to avoid spicy or acidic foods.

When should I see a healthcare provider?

Call a healthcare provider if you have symptoms of radiation cystitis. You should also reach out to your provider if they diagnose you with radiation cystitis and your symptoms don’t go away after treatment.

What questions should I ask a healthcare provider?

• What are the chances that I will develop radiation cystitis?
• What kind of radiation cystitis do I have?
• Why does late radiation cystitis take so long to develop?
• Is my case mild or severe?
• What treatment do you recommend?
• Will treatment cure my radiation cystitis, or will symptoms come back?
• What foods or drinks should I avoid?
• Should I see a dietitian?