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Hemorrhagic cystitis refers to an inflammation of the bladder that causes blood in the urine and unpleasant symptoms such as abdominal pain and problems with urination.

Causes

The most common cause of hemorrhagic cystitis is a weak immune system caused by chemotherapy or radiation therapy. Chemotherapy medications such as cyclophosphamide and ifosphamide used to treat blood and marrow cancers can cause hemorrhagic cystitis. As these medications break down inside the body, a byproduct known as acrolein is created. This acrolein travels into the bladder and irritates the tissues of the urinary tract. Irritation is often severe enough to cause ulcers and internal bleeding and lead to cystitis. People with lowered immunity (especially those recovering from stem cell or bone marrow transplants) are also susceptible to viruses such as adenovirus, BK virus, and JC virus that are also responsible for hemorrhagic cystitis. Extended periods of catheter use may also result in the condition. Certain medications or bacterial infections may also cause this type of cystitis.

Symptoms of hemorrhagic cystitis include:

• Blood in the urine (hematuria)
• Pink or red urine
• Abdominal pain and discomfort
• Lower back pain
• A burning sensation or pain when urinating
• Feeling of not being able to empty your bladder
• Incontinence
• Increase in the frequency of urination
• Urgent need to urinate
• Increase in nighttime urination

If you experience severe pain, feel dizzy, or have fever or the chills in addition to any of the above symptoms, contact your doctor immediately.

Treatment

Prompt treatment of hemorrhagic cystitis is important as this type of cystitis can cause major blood loss and severe scarring of the bladder. This could lead to blockage of the urinary tract or constriction of the bladder.

Before any treatment is prescribed, your doctor will run a number of tests to confirm the diagnosis. These will include a urine test, urine screening and a procedure known as cystoscopy where a camera is inserted into the urinary tract for closer investigation.

Possible treatments for hemorrhagic cystitis include:

• Postponement of cancer radiation treatment or chemotherapy until the condition clears
• Cessation of cancer treatment for a fixed period of time
• Change in medications if necessary
• Antibiotics may help treat the condition in case a bacterial infection is the cause.
• Platelet transfusion in cases where blood loss is severe or anemia has developed.
• Irrigation of the urinary tract with a saline solution to prevent clots and bladder constriction.
• In cases where treatment is not possible, the best alternative is the use of painkillers such as Pyridium until the cystitis clears on its own.
• Home remedies such as sitting in a warm sitz bath can help relieve symptoms.
• Drink plenty of water to prevent dehydration and aggravate the symptoms.
• Avoid caffeine and citrus juices as these can irritate the bladder and cause further discomfort.

Ways to Prevent Hemorrhagic Cystitis

• For lymphoma or leukemia patients, a medication known as Mesna may help protect the bladder from the harmful effects of acrolein. Mesna is usually administered intravenously either as part of the chemotherapy treatment or as a separate treatment.
• Drink plenty of water to ensure that the chemotherapy medications are flushed out of the body as soon as possible.
• Schedule chemotherapy for early in the day thus giving the body enough time to eliminate the toxins before night time.
• Speak to your doctor about taking diuretics to encourage urination and clear the toxins from the bladder.

References:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938536/

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