Hemorrhagic Cystitis (Bleeding from the Bladder)

What is hemorrhagic cystitis?

Hemorrhagic cystitis is when the lining of the bladder becomes inflamed and starts bleeding. This causes blood in the urine and pain with urination. Depending on the cause, blood in the urine should be treated right away. 

What causes hemorrhagic cystitis?

In cancer patients, it can be caused by: 

• Some chemotherapy medications (such as cyclophosphamide or ifosfamide) that cause damage to the bladder.
• DIC, a clotting disorder that leads to bleeding. 
• It can also be a late effect (occurring years after therapy) of pelvic radiation. 

What are the symptoms of hemorrhagic cystitis?

In some cases, your urine will turn pink, red or brown, depending on how much blood is in your urine. Sometimes the blood can only be seen using a microscope. You may also have pain with urination, may need to pee often, have a fever, blood clots in the urine, or you may lose control of your bladder. 

How is it treated?

Protecting your bladder when receiving chemotherapy with cyclophosphamide or ifosfamide is very important. You may be told to drink more fluids or empty your bladder more often. You may be given IV fluids and medications that protect the bladder. Your care team may check your urine for traces of blood. If you develop hemorrhagic cystitis, treatment can include intravenous (IV, into a vein) fluids, bladder irrigation (fluids infused into the bladder), and having a catheter placed (a tube is placed through the urethra and into the bladder to drain urine from the bladder into a bag outside the body).

When should I contact my care team?

When receiving cyclophosphamide and ifosfamide, your urine will be checked for blood. If you have recently been given these and notice pink, red or brown-tinged urine, or you have pain with urination, or feel the need to go to the bathroom more often, contact your care team right away.