Hemorrhagic Cystitis: Understanding Bladder Inflammation and Bleeding

Oct 14

6 min read

Updated: 2 days ago

Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026

Quick Answer

Hemorrhagic cystitis is inflammation of the bladder with bleeding. Triggers include infection, bone marrow transplant, certain chemotherapy drugs, radiation near the bladder and some workplace chemicals. It is uncommon in the general population but can affect 10% to 35% or more of people receiving certain cancer treatments. Blood clots in the urine or being unable to urinate need prompt attention. [1]

What the research says

Reported rates vary widely, and the best treatment evidence is limited. A systematic review of cancer treatment-induced hemorrhagic cystitis found a wide range of reported incidence. Pelvic radiotherapy was the most frequently reported cause, with hemorrhagic cystitis reported in up to 20% of patients, and cyclophosphamide and bacillus Calmette-Guerin treatment had reported incidence of up to 30%. Mesna, hyperhydration and bladder irrigation were the most-used preventive measures but were not always effective. The best evidence supported intravesical hyaluronic acid and hyperbaric oxygen, while the evidence for cranberry juice was very limited. (Payne et al., BJU Int, 2013)
It is a frequent complication after stem cell transplant in children. In a single-center retrospective study of children who had allogeneic stem cell transplants (2007 to 2022), 24 patients (14.7%) developed hemorrhagic cystitis, a median of 27.5 days after transplant. Acute graft-versus-host disease was more common in those who developed it (45.8% vs 19.4%), BK virus was found in 66.7% of cases, and severe cases needed several treatments, including hyperbaric oxygen (37.5%) and arterial embolization (all Grade 4 cases). No deaths were directly attributed to it. (Mazilier et al., Pediatr Blood Cancer, 2025)
Radiation-related cases are less frequent but can be severe, and care is stepwise. A 2022 review reports an incidence of about 5% to 10% for radiation-induced hemorrhagic cystitis, a late complication of pelvic radiation. With mild to moderate bleeding, hydration can be enough to prevent clots. Emergencies need clot evacuation and continuous bladder irrigation, persistent bleeding may call for intravesical agents or hyperbaric oxygen, and embolization or surgery is reserved for emergencies and refractory cases. (Nuhn & Thüroff, Urologie, 2022)

What Is Hemorrhagic Cystitis?

Hemorrhagic cystitis diagram comparing a healthy bladder lining with an inflamed, bleeding bladder lining – rinnit.com

Hemorrhagic cystitis is a medical condition that occurs when the lining of your urinary bladder becomes inflamed and bleeds. [1] Your bladder is a muscular sac in your pelvis that stores urine before it leaves your body. [1] It can cause pain during urination and blood in the urine. [1]

It occurs in people who have damage to the bladder lining, and it is usually associated with infection or cancer treatment. [1]

How Common Is It?

Hemorrhagic cystitis is not common in the general population. But it can affect 10% to 35% or more of people receiving certain cancer treatments. [1]

What Causes Hemorrhagic Cystitis?

Hemorrhagic cystitis is the result of damage to your bladder lining, including the blood vessels in it. The damage may be due to: [1]

Infection: Bacterial or viral infection.
Bone marrow transplant.
Chemotherapy: Drugs such as cyclophosphamide or ifosfamide.
Radiation therapy near the bladder.
Workplace chemicals: Occupational exposure to certain chemicals, such as aniline and toluidine.

Symptoms of Hemorrhagic Cystitis

Symptoms vary depending on how severe the case is. Signs may include: [1]

Blood in the urine (hematuria), which can make urine look pink, red or brown
Blood clots in the urine
Painful urination (dysuria)
Fever
Frequent urges to urinate
Inability to urinate
Loss of bladder control

When to Seek Medical Attention

Seek medical attention quickly if you have any signs of hemorrhagic cystitis. It is particularly urgent if you have blood clots in your urine or cannot pass urine. [1]

Severity Grades

Your healthcare provider may assign a grade based on your symptoms and test results. The grade shows how advanced or severe the condition is. [1]

Grade	Severity	What it means
Grade I	Microscopic	Minor bleeding that is visible only under a microscope.
Grade II	Visible	Visible but relatively minor bleeding.
Grade III	Clots	Bleeding with small clots.
Grade IV	Obstructive	Severe hemorrhagic cystitis with clots large enough to block urine flow.

How Is Hemorrhagic Cystitis Diagnosed?

The symptoms can be similar to urinary tract infections and bladder stones, so your provider may order tests to make a diagnosis: [1]

Urine tests: To look for microscopic blood cells, cancer cells or infection.
Blood tests: To look for infection or other conditions.
Imaging tests: Pictures of the bladder, such as a CT scan, MRI or ultrasound.
Cystoscopy: A test that uses a thin tool with a light and camera to look inside the bladder.

How Is Hemorrhagic Cystitis Treated?

Prompt treatment is important to reduce pain and prevent long-lasting bladder damage. Treatment options vary widely, depending on the cause and the severity of each case. They may include: [1]

Bladder drainage through a catheter (tube) into a bag outside the body.
Changes to medicines, such as an alternative chemotherapy or a lower dose.
Clot evacuation through a catheter or cystoscopy to remove clots from the bladder.
Continuous bladder irrigation, which flushes the bladder with fluid.
Embolization, which blocks bleeding blood vessels.
Hyperbaric oxygen therapy.
Intravesical therapy, which places medicines directly into the bladder, such as aminocaproic acid.
IV fluids to increase urine and flush the bladder.
Medicines for infections, such as antibiotics for bacteria or antivirals for viruses.

Rarely, people with hemorrhagic cystitis need a blood transfusion to replace heavy blood loss, or a cystectomy (surgery to remove the bladder). [1]

Protecting the Bladder During Cancer Treatment

Four ways to protect the bladder during cancer treatment: high hydration, frequent urination, protective medication such as mesna, and regular monitoring – rinnit.com

If you are receiving cancer treatment, ask your healthcare providers about ways to protect your bladder. Strategies include: [1]

Drinking more fluids as your care team advises (evidence that cranberry juice helps is very limited)
Emptying your bladder more often
Having your urine checked regularly for traces of blood
Limiting the area of radiation
Receiving mesna
Receiving continuous bladder irrigation regularly during cancer treatment

Follow your care team's advice on how much to drink and how often to empty your bladder, because the right plan depends on your treatment and health.

Outlook

The outlook depends on the cause and severity. The condition usually responds well to treatment and does not lead to long-term problems, especially infection-related cases. Rarely, severe cases can be fatal. Most people with cancer who develop hemorrhagic cystitis can continue cancer treatment. [1]

Conclusion

Hemorrhagic cystitis is a challenging condition, particularly for people already going through cancer treatment. Most cases respond well to treatment, and protective steps such as extra fluids, frequent urination and mesna can lower the risk. If you notice blood in your urine, or you cannot pass urine, contact a healthcare provider quickly.

Looking for clear answers on tough health questions? Browse plain-language health guides at Rinnit.com.

Frequently Asked Questions

Is hemorrhagic cystitis the same as a UTI?

No. The symptoms can look like a urinary tract infection or bladder stones, so tests are needed. Hemorrhagic cystitis means the bladder lining is inflamed and bleeding, and it is usually linked to infection or cancer treatment. [1]

Can I continue chemotherapy if I have it?

Most people with cancer who develop hemorrhagic cystitis can continue cancer treatment. Your provider may change the medicine or lower the dose. [1]

Is the blood always visible in the urine?

No. In Grade I, the bleeding can only be seen under a microscope. [1]

What is mesna?

Mesna is a medicine that may be given during some cancer treatments to help protect the bladder. Ask your care team whether it is part of your plan. [1]

Can cranberry juice help?

Cleveland Clinic lists cranberry juice among strategies that can boost bladder health. [1] A systematic review found the evidence for it is very limited, so it should not replace protective treatment. (Payne et al., BJU Int, 2013)

Is hemorrhagic cystitis fatal?

Hemorrhagic cystitis is rarely fatal. The outlook depends on the cause and severity, and it usually responds well to treatment. Rarely, severe cases can be fatal. [1]

What does Grade IV mean?

Grade IV is the most severe form, with bleeding and clots large enough to block the flow of urine. [1]

What is continuous bladder irrigation?

Continuous bladder irrigation is a treatment that flushes the bladder with fluid through a catheter to wash out blood and help prevent clots. [1]

Can radiation cause hemorrhagic cystitis?

Yes. Radiation therapy near the bladder is a recognized cause. Limiting the area of radiation is one way to lower the risk. [1]

Can an infection cause it?

Yes. Bacterial or viral infections can damage the bladder lining. Antibiotics may be used for bacteria and antivirals for viruses. [1]

What is a cystectomy?

A cystectomy is surgery to remove the bladder. It is rarely needed in hemorrhagic cystitis. [1]

When should I see a doctor?