Hemorrhagic Cystitis

Hemorrhagic cystitis is the medical term to describe the sudden appearance of blood in the urine that is associated with pain in the area of the bladder and other irritative bladder symptoms. The amount of blood can range from the very minute to frank red blood that continues to bleed from the urethra. There are actually a variety of causes for the hematuria, or blood that is coming from the urethra.

One cause is urethritis or cystitis (infection of the urethra or bladder) that is severe. Other causes include chemotherapy, radiation or viral infections. A chemical cause can result from douching to treat vaginitis or when other vaginal products are mistakenly placed in the urethra.

When an individual suffers from hemorrhagic cystits as a result of chemotherapy, the onset can vary. This means that the patient may begin bleeding during treatment, immediately following treatment or it can be delayed for months following chemotherapy. Hemorrhagic cystitis is a very serious condition because it can lead to other problems, especially when an individual is already debilitated from chemotherapy and cancer.

Individuals who suffer from hemorrhagic cystitis can experience life-threatening infections when bacteria enters the body through the urethra and bladder. Significant bleeding can also present problems when individuals already have low blood counts but the majority of the patients are treated successfully.

Although patients who are undergoing chemotherapy for cancer are at greater risk for developing hemorrhagic cystitis than other individuals, there are other risks. For instance, individuals who are taking strong antibiotics or who have a viral infection can also suffer. Women who have persistent urinary tract infections will find that the urethra becomes raw and she is at greater risk for developing bleeding, hemorrhagic cystitis, because of the infection.

Although chemotherapy places an individual at high risk, so does thrombocytopenia or low platelet count. Individuals who have cancer and are undergoing other types of treatment which may not place them at a higher risk for hemorrhagic cystitis, may in fact suffer from thrombocytopenia which also places them at risk. Individuals who undergo bone marrow transplant will have much higher doses of chemotherapy then others and will be at risk. Individuals who suffer from AIDS, radiation therapy given at the same time as chemotherapy and bladder cancer will also suffer higher risk.

Hemorrhagic cystitis is often from noninfectious reasons. It happens in up to 70% of patients who are exposed to high doses of bladder chemotherapy or 15% of people who undergo pelvic radiation to treat malignancies.

Symptoms of this condition will include blood in the urine with or without clots, painful urination and burning with urination. Individuals will have the urge to urinate more frequently and with the urgency. There may be urinary incontinence and many will wake up during the night to go to the bathroom. Men and women will suffer from vague abdominal pain and fatigue. Hemorrhagic cystitis may or may not occur at the same time as a bladder infection – although both have the same symptomatology.

Individuals who have hemorrhagic cystitis may experience scarring of the bladder wall, a decrease size of the bladder or a severe systemic infection. Treatment will vary depending upon the cause of the symptoms and in cases where the symptoms occurred because of chemicals inadvertently placed in the urethra, it may result on its own. Patients benefit greatly from pain medication and analgesics which will reduce pain during urination. If the physician suspects an underlying infection antibiotics may be prescribed, or they may be prescribed as a preventative measure in individuals who are already immune compromised.

In rare cases individuals have reported hemorrhagic cystitis after taking a penicillin-based antibiotic. In most cases these individuals have been using extended spectrum penicillin. Symptoms can take up to two weeks to develop after the drug was first started. Immediate treatment is to discontinue the antibiotics.

There can be a significant blood loss in individuals who suffer from hemorrhagic cystitis so a blood transfusion may be necessary in order to support the individual. If chemotherapy or other chemicals were the cause then the treatment is stopped immediately. Urologists may recommend the installation of medications directly into the bladder to stop the bleeding from the bladder and urethra.

If the patient must receive chemotherapy that is irritating to the bladder in order to treat their cancer, then other preventative measures may be tried, such as continuous bladder irrigation with normal saline during treatment. Patients can aggressively drink fluid or receive IV fluids to flush the metabolites out of the bladder before they can irritate the wall lining. IV diuretics may be used in patients who have a low urine output in conjunction with increasing IV fluids.

If the patient is at home when symptoms began following chemotherapy they should call the doctor if their fever goes above 100.5 or if they have chills. Any time they noticed blood in the urine or if they have any symptoms of an irritation in the bladder, such as frequency, burning or difficulty urinating, they should call their physician immediately. Hemorrhagic cystitis may appear to be innocuous, and in most cases when treated appropriately and immediately it can be; but it can also cause significant negative affects to the health of an individual who already is suffering from a depleted immune system.

RESOURCE

Indian Journal of Urology: Hemorrhagic Cystitis

Medscape: Clinical Presentation of Cystitis

MayoClinic: Cystitis

BJU International: The Management of Intractable Hematuria

Clinical Infectious Diseases: Intravesical Instillation of Cidofovir in the Treatment of Hemorrhagic Cystitis Caused by Adenovirus Type 11 in a Bone Marrow Transplant Recipient

The Journal of Urology: Treatment of Radiation Induced Hemorrhagic Cystitis with Hyperbaric Oxygen