Causes of Hemorrhagic Cystitis: How to Prevent Lower Urinary Tract Hemorrhage

Hemorrhagic cystitis is characterized by inflammation of the urinary bladder and symptoms include hematuria (blood in urine), painful urination and difficult urination. It occurs due to damage to the urinary bladder’s transitional epithelium and the blood vessels by pathogens, lethal toxins, radiation, chemotherapy, drugs, or certain medical conditions.

Causes of Hemorrhagic Cystitis

Causes of for HC are chemotherapy (drugs, particularly, ifosfamide and cyclophosphamide), radiation therapy, or infections.

  • Ifosfamide is the commonest cause of hemorrhagic cystitis.
  • Hemorrhagic cystitis due to radiation therapy develops in a smaller number of patients.
  • Adenovirus is another very common cause of acute viral HC in children.
  • The condition may occur when vaginal products get accidentally placed in the urethra. Douching with gentian violet for the management of candidiasis is known to trigger hemorrhagic cystitis when the drug was misplaced in the urethra, however, this gets spontaneously resolved when the treatment with gentian violet is stopped. Inadvertent placement of contraceptive suppositories in the urethra also causes hemorrhagic cystitis.

How to Prevent Hemorrhagic Cystitis

The most ideal way to manage hemorrhagic cystitis is to prevent it from happening at all. If you have been identified as being at high risk for developing hemorrhagic cystitis, your healthcare provider will take preventive measures.

By and large, what is prescribed works by reducing the time during which the lining of the urinary bladder is exposed to the offending irritants.

  • In order to prevent hemorrhagic cystitis from cyclophosphamide, aggressive hydration and use of mesna is beneficial, (this will neutralize the lethal cyclophosphamide-metabolite acrolein) and will consequently diminish the probability of developing hemorrhagic cystitis. Sufficient hydration to encourage diuresis, constant irrigation of the bladder, and prophylactic dosing of mesna are important preventive measures. Regrettably mesna is useless as a treatment option once hemorrhagic cystitis has occurred. Mesna is administered intravenously, in a separate bag or it may be inserted to the chemotherapy bag itself.
  • Even though rare, once radiation induced hemorrhagic cystitis has been diagnosed, there isn’t empirically-proven treatment to manage the condition, and this can grossly affect  the patient’s quality of life and can also result in kidney failure and death.
    • Viral HC in children is difficult to prevent; nonetheless, it usually resolves within a short time.
    • Immuno-compromised patients are at great risk for developing infections, thus, they need to take added precautions to prevent gross infections.
    • In chemically induced cases of hemorrhagic cystitis, removal of the agent predisposing to cystitis is vital.
    • Another significant aspect of the management program is timely identification and treatment of urinary tract infections – a far-sighted preventive measure.
    • Most importantly, it is essential to drink 4 liters of water per day; especially those who are on to radiation therapy and chemotherapy. Water is vital to flush out all noxious wastes and pathogens effectively from the system.
    • Also, starting a cranberry supplement is advisable. Cranberries prevent the development of infections successfully. You may also take cranberry juice on a daily basis. Talk to your health care provider about it.
    • Your doctor will give you lots of IV fluids to facilitate the chemotherapy chemicals from passing through the bladder rapidly.
    • Try to take the chemotherapy early on in the day, so that have a chance of clearing it from your bladder before retiring for the night.
    • Try voiding urine every hour.

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