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Bladder damage and chemotherapy

Some chemotherapy drugs break down into substances that irritate the lining of the bladder (cystitis) when they are passed in the urine. These substances can cause inflammation and bleeding. In rare cases, this irritation can become quite severe and lead to permanent damage.


Chemotherapy drugs that most commonly cause bladder irritation are:

  • cyclophosphamide (Cytoxan, Procytox)
  • ifosfamide (Ifex)

Bacillus Calmette-Guérin (BCG) vaccine and other drugs that are instilled into the bladder can also cause irritation.

Bladder damage occurs more often in people who have:

  • received radiation therapy to the bladder or pelvis
  • a history of persistent bladder or urinary tract infections
  • low platelet counts (thrombocytopenia)


Symptoms of bladder damage include:

  • blood in the urine (hematuria)
  • burning or pain during urination
  • pain above the bladder (suprapubic pain)
  • intense need to urinate (urgency)
  • need to urinate often (frequency)
  • fever or chills

Bladder irritation may occur shortly after chemotherapy is given. It often improves several days after the drug has been given and usually goes away within 2–6 weeks after the drugs are stopped.

Occasionally, chemotherapy drugs cause permanent damage to the bladder, which can result in chronic bleeding, scarring of the bladder wall and smaller bladder size.


Bladder irritation is diagnosed by the appearance of reddish brown or bright red blood in the urine. It may also be found by testing the urine for blood that can only be seen using a microscope.

Prevention and management

To help prevent the bladder from becoming irritated during chemotherapy, the healthcare team may:

  • give extra fluids intravenously (into a vein)
  • give a drug called mesna (Uromitexan) to help protect the bladder before, during or after chemotherapy
  • control severe bleeding by:
    • irrigating or flushing out the bladder
    • doing a cystoscopy to remove blood clots and cauterize the site of bleeding
    • giving medicines to stop bleeding or treat inflammation and infection
  • stop chemotherapy if severe bleeding occurs

Tell the doctor or healthcare team about reddish brown or bloody urine, fever, chills or pain with urination.

To help prevent bladder irritation during chemotherapy, you can try the following:

  • Drink extra fluids before and for at least 24 hours after receiving cyclophosphamide and ifosfamide.
  • Empty the bladder often.

For more detailed information on specific drugs, go to sources of drug information.


The body’s protective response to injury or infection that includes redness, swelling, pain and warmth of the affected area.


A procedure that uses an endoscope (a thin, tube-like instrument with a light and lens) to examine or treat the bladder and urethra.

Cells or tissue may be removed for examination under a microscope. Doctors may also use cystoscopy to remove the prostate or small tumours or stones from the bladder.

The type of endoscope used for this procedure is called a cystoscope.


A procedure that uses heat or a chemical to burn and destroy tissues.

When the tool used for cauterization is heated with electricity, it is called electrocautery. When chemicals are applied directly to the tissue, it is called chemical cautery.

Cauterization is used to destroy abnormal tissue or cancer cells. It is also used to seal off blood vessels to stop bleeding.


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