Blood in the urine after pelvic radiotherapy

Pelvic radiotherapy can cause long-term changes to the way the bladder works. The bladder lining may bleed easily and can cause blood in your urine.

About blood in the urine

Sometimes pelvic radiotherapy can cause long-term changes to the way the bladder works. It can weaken the small blood vessels in the bladder lining. This means the bladder lining may bleed easily and can cause blood in your urine. Blood in the urine is called haematuria. 

If you have this, you will need to have a cystoscopy to find out what is causing it. This is a thin tube with a camera on the end to look at the inside of your bladder.

Treating blood in the urine

If radiotherapy only caused a small amount of bleeding, you may not need any treatment. But if the bleeding is regular or heavy, or you become anaemic (have a lack of red blood cells), you are likely to need treatment. There are several possible treatments.


Your doctor may give you tranexamic acid (Cyklokapron®) tablets to take for a short time. These can reduce bleeding but also slightly increase your risk of having a blood clot. You can discuss this with your doctor before taking the tablets.

Giving drugs into the bladder

To stop bleeding, you may have drugs such as Cystistat® (sodium hyaluronate) given directly into the bladder as a fluid.

For this treatment, you lie down while a nurse gently passes a thin, flexible tube (catheter) through the urethra and into the bladder. The nurse slowly passes fluid through the catheter into your bladder. Then they remove the catheter and the fluid stays in your bladder for about half an hour. This gives the treatment time to work. After this, you go to the toilet to empty your bladder.

You may feel some discomfort when passing urine for a few days afterwards. You usually have this treatment weekly for six weeks and then monthly until the symptoms improve.

Your doctor will explain more about this treatment and its possible side effects.

Bladder wash-out

If you are passing blood clots in your urine, these may need to be flushed out to make sure they do not block your urethra. A nurse or doctor passes liquid through a catheter into your bladder. The liquid then drains back out of the catheter into a bag. This can be repeated until the clots have gone.


If medicines do not stop the bleeding, your doctor may suggest using heat to seal the blood vessels that are bleeding. This is done using a cystoscope (a thin tube with a camera on the end) while you are under a general anaesthetic.

Hyperbaric oxygen therapy

This treatment increases the amount of oxygen that reaches the bladder tissues. It can encourage new blood vessels to grow and the tissue to heal. This may help areas damaged by radiotherapy. It is usually only used after other treatments have been tried. Hyperbaric oxygen therapy is not available everywhere and you may have to travel to get this treatment.

We have more information about hyperbaric oxygen therapy.

Treating anaemia

Some people become anaemic because of bleeding from the bladder. This can make you feel breathless or tired. Your doctor may suggest you have iron tablets, which will help you make red blood cells. This will improve your symptoms and make you feel better. Some people may need a blood transfusion.

We have more information about blood transfusions.

If bladder problems do not improve

If your bladder symptoms continue or do not improve after having these treatments, your specialist may talk to you about other possibilities. When symptoms are severe, an operation to remove the bladder may be an option, but this is rare.

Getting support

Macmillan is here to support you. If you would like to talk, you can do the following: