There is no way to completely prevent HC.
Overview
Hemorrhagic
cystitis is damage to the lining of the bladder and the blood vessels that
supply the inside of the bladder.
Bleeding
is bleeding. Cystitis is when the bladder becomes inflamed. If you have
hemorrhagic cystitis (HC), you will develop signs and symptoms of bladder
inflammation and blood in your urine.
Depending
on the amount of blood in the urine, there are four types or grades of HC:
- · Grade I is microscopic bleeding (not
visible)
- · Bleeding may be seen in grade II
- · Grade III bleeding with small clots
- Grade IV bleeding, a blood clot large
enough to block the flow of urine and needs to be removed
Causes
of hemorrhagic cystitis
The
most common causes (1)
of severe and persistent HC are chemotherapy and radiation therapy. Infections
may also cause HC, but these causes are less serious, do not last long, and are
easier to treat.
An
uncommon cause of HC is working in an industry where you are exposed to aniline
dyes or pesticide toxins.
Chemotherapy
A
common cause of HC is chemotherapy, which may include the drug cyclophosphamide
or ifosfamide. These drugs are broken down into the toxic substance acrolein.
Acrolein
enters the bladder and causes damage, which leads to HC. It may take weeks
or months (2)for
symptoms to appear after chemotherapy.
Treating
bladder cancer with BCG's vaccine (BCG) can also cause (3) HC.
BCG is a drug that is put into the bladder.
Other
anti-cancer drugs, including busulfan and thiogiper, are less common causes of
HC.
Radiation therapy
Radiation therapy to the
pelvic region causes HC because it damages the blood vessels that supply the
lining of the bladder. This can lead to ulcers, scarring, and bleeding. HC can
occur months or even years after radiation therapy.
Infect
Common
infections that can cause HC are viruses, including adenovirus, polyomavirus,
and herpes simplex type 2. Bacteria, fungi, and parasites are less common
causes.
Most
people who have HC due to infection have weakened immune systems due to cancer
or cancer treatment.
Risk factors
People who require
chemotherapy or pelvic radiation therapy are at higher risk of developing HC.
Pelvic radiation therapy treats prostate, cervical, and bladder cancers.
Cyclophosphamide and ifosfamide can treat a variety of cancers, including
lymphoma, breast cancer, and testicular cancer.
People
who require bone marrow or stem cell transplants have the highest risk of
developing HC. These people may require a combination of chemotherapy and
radiation therapy. This treatment will also reduce your resistance to
infection. All of these factors increase the risk of HC.
Symptoms
of hemorrhagic cystitis
The main hallmark of HC
is blood in the urine. In phase I of HC, the bleeding is microscopic, so you
won't see it. In later stages, you may see bloody urine, bloody urine, or blood
clots. In the fourth stage, blood clots may fill your bladder and block the
flow of urine.
Symptoms
of HCs are similar to those of urinary tract infections (UTIs), but they may be
more severe and last longer. They include:
- Pain when urinating
- Must urinate frequently
- Feeling in desperate need of urination
- Bladder out of control
If you
experience any symptoms of HC, consult your doctor. Urinary tract infections
rarely cause hematuria.
If you
have blood or clots in your urine, you should contact your doctor immediately.
If you are unable to urinate, seek emergency medical attention.
Diagnosis
of hemorrhagic cystitis
Your doctor may suspect
HC based on your signs and symptoms and whether you have a history of
chemotherapy or radiation. To diagnose HC and rule out other causes, such as
bladder tumors or bladder stones, your doctor may:
- Order blood tests to check for
infections, anemia, or bleeding disorders
- Order a urine test to check for
microscopic blood, cancer cells, or infections
- Imaging your bladder using CT, MRI, or
ultrasound imaging
- Observe your bladder through a slender
telescope (cystoscopy)
Treatment
of hemorrhagic cystitis
Treatment of HC depends
on the cause and grade. There are many treatment options, some of which are
still in the experimental phase.
Antibiotics,
antifungals, or antivirals can be used to treat HC caused by infection.
Treatment
options for chemotherapy or radiation-related HCs include:
- For early HC, treatment may begin with
intravenous fluids to increase urine output and flush the bladder.
Medications may include painkillers and medications to relax the bladder
muscles.
- If the bleeding is severe or a blood
clot blocks the bladder, treatment involves putting a tube called a
catheter into the bladder to flush the blood clot and flush the bladder.
If the bleeding persists, the surgeon may use cystoscopy to look for the
area of bleeding and stop the bleeding with an electric current or laser
(electrocautery). Side effects of electrocautery may include bladder
scarring or perforation.
- If your bleeding persists and you lose
too much blood, you may receive a blood transfusion.
- Treatment can also include putting
medication into the bladder, called intravesical therapy. Sodium
hyaluronate is an intravesical therapeutic drug that reduces bleeding and
pain.
- Another intravesical drug is
aminocaproic acid. A side effect of this drug is the formation of blood
clots that can pass through the body.
- Bladder astringents are drugs that are
put into the bladder and can cause irritation and swelling around the
blood vessels to stop bleeding. These drugs include silver nitrate, alum,
phenol, and formalin. Side effects of astringents may include swelling of
the bladder and decreased urine flow.
- Hyperbaric oxygen (HBO) is a treatment
that involves breathing 100% oxygen in an oxygen chamber. This treatment
increases oxygen, which may help with healing and hemostasis. You may need
up to 40 HBO treatments per day.
If
other treatments do not work, another option is embolization. During
embolization surgery, the doctor puts a catheter into a blood vessel, causing
bleeding from the bladder. The catheter has a substance that blocks blood
vessels. You may feel pain after this procedure.
The
last resort for high-grade HC is surgery to remove the bladder, called
cystectomy. Side effects of cystectomy include pain, bleeding, and infection.
Prospects
for hemorrhagic cystitis
Your prospects depend on
the stage and the reason. HC from infection has a good outlook. Many patients
with infectious HC respond to treatment and do not have long-term problems.
HCs
from cancer treatment may have different prospects. Symptoms may begin to
appear weeks, months, or years after treatment and may persist for a long time.
There
are a variety of treatment options for radiation- or chemotherapy-induced HCs.
In most cases, HC responds to treatment, and your symptoms will improve after
cancer treatment.
If
other treatments do not respond, cystectomy can cure HC. After cystectomy,
reconstructive surgery is an option to restore urine flow. Keep in mind that it
is very rare for HC to require cystectomy.
Prevention
of hemorrhagic cystitis
There is no way to
completely prevent HC. Drinking plenty of water while receiving radiation or
chemotherapy may help keep urinating frequently. Drinking a large glass of
cranberry juice during treatment may also be helpful.
Your
cancer treatment team may try to prevent HC in several ways. If you are
receiving pelvic radiation therapy, limiting the radiation area and radiation
levels may help prevent HC.
Another
way to reduce the risk is to put the drug into the bladder before treatment to
strengthen the lining of the bladder. Two medicines, sodium hyaluronate, and chondroitin sulfate have
achieved some positive results.
Reducing
the risk of chemotherapy-induced HC is more reliable. Your treatment plan may
include the following precautions:
- Excessive hydration during treatment to
keep the bladder full and flowing; The addition of diuretics may also help
- Bladder irrigation is continued during
treatment
- Before and after administration of Mesna as an oral or intravenous
drug therapy; This drug binds to acrolein and allows acrolein to pass
through the bladder without damage
- Quit smoking during cyclophosphamide or
ifosfamide chemotherapy