Hemorrhagic Cystitis (Bleeding from the Bladder)

What is hemorrhagic cystitis?

Hemorrhagic cystitis is when the lining of your bladder becomes inflamed (irritated or swollen) and starts bleeding. This causes blood in your urine (pee) and pain when you urinate. If you have blood in your urine, it needs to be treated right away.

What causes hemorrhagic cystitis?

If you have cancer, hemorrhagic cystitis can be caused by:

• Some chemotherapy medications such as cyclophosphamide or ifosfamide that may damage your bladder.
• DIC, a clotting disorder that leads to bleeding.
• Having had radiation therapy to your pelvis in the past. It can be a late effect (happening years after treatment).
• Bacterial, viral, fungal, and parasitic infections.

What are the symptoms of hemorrhagic cystitis?

• Your urine may turn pink, red, or brown, depending on how much you are bleeding. Sometimes the blood can only be seen using a microscope.
• Pain when you urinate.
• Needing to urinate more often.
• Fever.
• Blood clots in your urine
• You may lose control of your bladder.

How is it treated?

Protecting your bladder when you are getting some types of chemotherapy such as cyclophosphamide or ifosfamide is very important.

• You may be told to drink more fluids or empty your bladder more often.
• You may be given intravenous (IV, into a vein) fluids and medications that protect your bladder.

Your care team may check your urine for traces of blood. If you have hemorrhagic cystitis, treatment may be:

• Intravenous (IV) fluids.
• Bladder irrigation (fluids flushed into your bladder).
• Having a catheter placed (a tube placed through your urethra and into your bladder to drain urine from your bladder into a bag outside your body).
• Hyperbaric oxygen therapy (HBOT). With HBOT, you breathe in 100% (pure) oxygen while in a special space called a hyperbaric chamber. HBOT is mainly used to treat hemorrhagic cystitis that is caused by radiation.
• Surgery is sometimes needed if the hemorrhagic cystitis does not get better. Your provider will talk with you about the surgery you may need.

When should I call my care team?

If you are taking cyclophosphamide and ifosfamide, your urine will be checked for blood. If you have recently gotten these medications and you see pink, red, or brown in your urine, call your care team right away. If you have blood in your urine, pain when you urinate, or feel the need to go to the bathroom more often, call your care team right away.