Dr. Sean Elliott, MD
Reconstructive Urologist
Radiation Cystitis Background Information
What is radiation cystitis?
Radiation cystitis is a condition that affects the bladder, which is a part of our body that holds pee (urine). When someone receives radiation therapy as a treatment for cancer, the rays used to kill cancer cells can also harm healthy cells in the bladder. The risk of this happening is especially high when the cancer that received the radiation is located very close to the bladder. Examples of this include prostate cancer and cervical cancer.
What does it feel like to have radiation cystitis?
Radiation cystitis can cause some uncomfortable symptoms. It might make you feel like you have to pee often, even when there's not much urine in your bladder. It can also make urinating painful or cause a burning feeling or some blood in the urine. Usually, these symptoms are mild and can be managed with minor changes in bathroom habits like going to the bathroom more often. Rarely, radiation cystitis can be so bad that there is constant pain and large blood clots in the urine.
How common is radiation cystitis?
Radiation cystitis happens in varying degrees in up to 20 or 30% of people who receive radiation therapy. The worst symptoms occur in only less than 5% of people.
What causes radiation cystitis?
Radiation works by damaging the DNA of cancer cells. Modern technology allows the radiation specialist to focus the radiation team on the cancerous organ with very good precision. However, some overlap of radiation into nearby organs can happen. Luckily, radiation is most likely to damage the DNA of cells that are dividing rapidly, like cancers cells. It is less likely to damage the DNA of cells that are dividing slowly, like normal cells. For all these reasons most people do very well with radiation therapy; however, when the DNA is damaged in the normal cells, those cells can die. When the normal cells die they are replaced by scar tissue. When the blood vessels in the normal tissue are damaged by the radiation, the new blood vessels that grow in are often more fragile and can bleed easily. The scar tissue in the wall of the bladder makes it so that the bladder cannot expand very well to hold urine. This makes you feel like you have to urinate very often. You can also make it painful to have a full bladder. The fragile new blood vessels in the wall of the bladder can break easily, leading to blood in the urine.
How do I know if I have radiation cystitis?
If you have some of the symptoms listed above, then you should see your primary care provider or a urologist. They may check your urine for infection or may measure how fast you can pee and how well you empty your bladder. Once they rule out the more common causes of your symptoms, like a bladder infection, they may recommend evaluation for radiation cystitis. A stricture is usually diagnosed by a cystoscopy (camera exam of the bladder). In this procedure a flexible camera about the size of a catheter is passed through the urethra in a urologist’s office; this takes only a minute or two. With the scope in the bladder the urologist can see scar tissue and extra blood vessels that have built up in the wall of the bladder, suggesting the presence of radiation cystitis.
What are the treatments for radiation cystitis?
Lifestyle changes
When the symptoms of radiation cystitis are mild, you can often compensate for them with Minor lifestyle changes. This might include staying close to a bathroom or limiting your fluid intake when you know you won’t have access to a bathroom for a while.
Medications
Bladder spasm pills, like oxybutynin, can relax the bladder, taking away the urge to urinate frequently and help you hold more urine in your bladder. They may even help with some of the pain in the bladder associated with bladder spasms.
Cauterization
If the radiation cystitis has become so severe as to lead to significant bladder bleeding that it might be necessary for a urologist to put a camera into the bladder and cauterize some of the bleeding vessels. At the same time, they can remove any blood clots that have built up in the bladder.
Formalin Therapy
Severe cases of bleeding from radiation cystitis, a urologist may put formalin into the bladder to stop the bleeding. This is effective at stopping the bleeding, but it also causes damage to the lining of the inside of the bladder. After formula and therapy people can often experience a reduction in the amount of urine they can hold in their bladder.
Formalin Therapy
During hyperbaric oxygen therapy, a person goes into a special chamber where they breathe in pure oxygen at a higher pressure than normal. The way this treatment works is quite interesting. When you breathe in the pure oxygen under increased pressure, your body can absorb more oxygen than usual. This extra oxygen can help heal damaged tissues, including the bladder in the case of radiation cystitis. The increased oxygen levels in the body during hyperbaric oxygen therapy promote the growth of new blood vessels, enhance the delivery of oxygen to tissues, and reduce inflammation. By doing so, it can help repair the damaged bladder tissues caused by radiation therapy. Hyperbaric oxygen therapy is usually done in a hospital or specialized center. An excellent hyperbaric oxygen therapy center is located at Hennepin County Medical Center in Minneapolis (https://www.hennepinhealthcare.org/specialty/center-for-hyperbaric-medicine/). Some of these facilities will do the therapy in a room about the size of an office and have several patients undergoing treatment in that room at the same time. Other facilities have tubes about the size of a tanning bed that accommodate one person at a time. People can relax, read, or listen to music during the treatment. The chamber is then pressurized, and the person breathes in the pure oxygen. The number of hyperbaric oxygen therapy sessions needed can vary depending on the individual and the severity of radiation cystitis. Usually, people are treated for about an hour a day, every day, for 4 to 6 weeks.
A small fraction of people with radiation cystitis will not be helped by any of the above treatments. They will often have the most bothersome symptoms of this condition, including severe pain in the bladder, urinary incontinence (leakage), the need to urinate more than once every hour, and frequent episodes of bleeding requiring hospitalization. Although we never consider bladder removal lightly, in these people it can be tremendously helpful. By removing the bladder (cystectomy), the urinary symptoms, the bleeding and the pain are all gone. Cystectomy is always a challenging surgery, and it is especially challenging in people with radiation cystitis. When the radiation damage is so severe as to cause radiation cystitis, the bladder is always scarred to the other organs around it and the blood vessels outside the bladder can bleed easily. If you are considering bladder removal for radiation cystitis it is best to have this done by someone who focuses not only on bladder removal for cancer but who is hyper-focused on bladder removal for radiation cystitis. Dr. Elliott has performed cystectomy specifically for radiation cystitis over 100 times.