Hemorrhagic Cystitis (Bleeding from the Bladder)

Author: Marisa Healy, BSN, RN
Last Reviewed: May 10, 2023

What is hemorrhagic cystitis?

Hemorrhagic cystitis is when the lining of your bladder becomes inflamed (irritated/swollen) and starts bleeding. This causes blood in your urine (pee) and pain with urination. Blood in the urine should 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 pelvic radiation in the past. It can be a late effect (happening years after treatment).
  • Other causes are 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 receiving 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 include:

  • Intravenous fluids.
  • Bladder irrigation (fluids flushed into your bladder).
  • Having a catheter placed (a tube is placed through the urethra and into the 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.
  • In some cases where hemorrhagic cystitis does not get better, surgery may be needed. Your provider will talk with you about the surgery you may need.

When should I call my care team?

When receiving cyclophosphamide and ifosfamide, your urine will be checked for blood. If you have recently been given these medications and you see pink, red, or brown-tinged 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.

Alesawi, Anwar M.; El-Hakim, Assaad; Zorn, Kevin C.; Saad, Fred. Radiation-induced hemorrhagic cystitis. Current Opinion in Supportive and Palliative Care 8(3):p 235-240, September 2014. | DOI: 10.1097/SPC.0000000000000073

Linder, B.L., Chao, N.J., & Gounder, M.M. (April 14, 2021). Chemotherapy and radiation-related hemorrhagic cystitis in cancer patients.

Mayo Clinic. Cystitis. 2020. https://www.mayoclinic.org/diseases-conditions/cystitis/symptoms-causes/syc-20371306

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