If you have blood in your urine

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After radiotherapy, small blood vessels in the bladder lining may be more fragile and bleed easily. This can cause blood in your urine. If you have this, you’ll need to have a cystoscopy to find out what’s causing it.

If there’s only a small amount of bleeding that’s been caused by radiotherapy, 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.

Tablets

Tranexamic acid (Cyklokapron®) tablets can reduce bleeding. They help stop blood clots dissolving. Your doctor may prescribe these tablets for you.

Giving drugs into the bladder

To stop the bleeding, some drugs can be given directly into the bladder as a fluid.

For this treatment, you lie down while a nurse gently passes a thin, flexible tube (a catheter) into your urethra and through to 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 couple of days afterwards.

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

Bladder wash-out

If you’re passing blood clots in your urine, these may need to be flushed out to make sure they don’t 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.

Cauterisation

If medicines don’t stop the bleeding, your doctor may suggest using heat to seal the blood vessels that are bleeding. This is called cauterisation. It’s done using a cystoscope while you’re under a general anaesthetic.

Hyperbaric oxygen therapy

This treatment increases the amount of oxygen that gets to tissue in the bladder. It can encourage new blood vessels to grow and the tissue to heal, which may help areas damaged by radiotherapy. It’s 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.

Treating anaemia

Some people become anaemic because of bleeding from the bladder. This can cause symptoms such as feeling 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.

If bladder problems don’t improve

If your bladder symptoms continue or don’t improve after these treatments have been tried, 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.

We have more information on practical ways to cope with bladder changes.

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