Hemorrhagic Cystitis: Causes, Symptoms & Treatment

Instructor: Lisa Cauthen

Lisa is a Registered Nurse with a 14 years of experience and a Masters Degree in Nursing Education. She has certifications in CPN, ACLS, PALS, and NRP.

Hemorrhagic cystitis is inflammation of the bladder that is associated with blood in the urine. This lesson will review the causes, symptoms and treatment of hemorrhagic cystitis.

Hemorrhagic Cystitis

You arrive at work and take report on a patient with a history of urinary frequency, urgency, burning sensation while urinating, and blood in the urine. ''Sounds like a UTI,'' you think. But the diagnosis reads 'hemorrhagic cystitis'. What is that? And what do you need to know in order to treat it and help this patient?

Cystitis is an inflammation of the bladder and a very common form of it is a urinary tract infection (UTI). Generally, cystitis cases are mild, without complications, and occur in individuals with a normal urinary tract.

Cystitis is put into different categories based on the morphological appearance of the bladder and can include suppurative cystitis, which is associated with pus formation, and ulcerative cystitis, where ulcers form in the bladder.

More common than those, however is hemorrhagic cystitis, which is associated with bleeding of the vessels within the bladder wall.

Causes of Hemorrhagic Cystitis

Hemorrhagic cystitis is caused by damage to the bladder's epithelial cell wall and blood vessels. The bladder is affected before the other parts of the urogenital tract because it is the reservoir of the system and the contact time between the urine and bladder walls is greatest. The cause of hemorrhagic cystitis can be infectious or noninfectious.

Infectious sources are the most common causes of all forms of cystitis and include bacteria, viruses, and fungi. Infectious agents come first into the urethra, then travel to the bladder. Bacterial infections cause 80-90% of all cystitis cases, with Escherichia coli (E. coli) bacteria normally found in the rectum causing the vast majority of those.

E. coli is a very common cause of hemorrhagic cystitis.
e coli

Staphlococcus saprophyticus causes another 10%, with a few instances of other species being less common.

Viral causes of hemorrhagic cystitis are usually found in immunosuppressed individuals such as those undergoing chemotherapy or those with human immunodeficiency virus (HIV). While fungal infections are rare, the most common are from Candida.

Noninfectious hemorrhagic cystitis typically occurs in patients who have undergone pelvic surgery, chemotherapy, or pelvic radiation. The chemotherapy agent cyclophosphamide causes hemorrhagic cystitis in the oncologic population.

Radiation treatments to the pelvic area can also cause hemorrhagic cystitis. The symptoms may develop during the treatments and/or months or years later.

Medications can also be the causes of hemorrhagic cystitis. In rare cases cystic fibrosis patients taking extended penicillins and people who take danazol, an anabolic steroid, have developed it.

Cases of environmental hemorrhagic cystitis have also been reported in patients who have been in contact with certain chemicals found in dyes, pesticides, and shoe polish.

Symptoms of Hemorrhagic Cystitis

Many individuals with cystitis do not have symptoms. Of those who do the most common ones are termed irritative voiding symptoms and include the need to urinate frequently, the feeling that the bladder cannot be emptied, the sensation of burning as the urine passes through the urethra (dysuria). Lower abdomen discomfort and low back pain can also be present.

Hemorrhagic cystitis is classified by hematuria, the presence of blood in the urine. Hematuria can be categorized as microscopic or gross depending on whether it is can be seen with or without a microscope, respectively.

Treatment for Hemorrhagic Cystitis

Treatment of hemorrhagic cystitis depends on the cause and severity of the symptoms. Because the vast majority of cases are caused by a bacterial infection, antibiotics should always be considered first when assessing a patient with irritative voiding symptoms and hematuria.

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