What is Radiation Cystitis?
Radiation cystitis is condition where the bladder become inflamed because of exposure to radiation. It is rare for most people to be exposed to radiation for other than medical reasons. The bladder itself may be targeted in radiation therapy (radiotherapy) or the other pelvic organs may be irradiated for cancer at these sites with the bladder being incidentally affected due to the close proximity.
The extent of the tissue injury associated with radiation exposure can range from minor irritation, to severe inflammation and even death of a portion of bladder tissue.Better targeting and delivery methods these days has helped in minimizing more severe forms of radiation cystitis.
What Happens in Radiation Cystitis?
Radiation causes cell injury and death through several mechanisms. It is the cells that divide rapidly, the cancerous cells, which are the most prone to being damaged and destroyed with therapeutic radiation. Therefore radiation therapy is an effective approach to treating cancer. However, normal healthy cells are also injured to some degree and may be destroyed incidentally during the course of cancer treatment. Given the danger with cancerous lesions spreading and ultimately leading to death of the person, this incidental damage of healthy cells is an acceptable consequence of radiation treatment.
Picture from Wikimedia Commons
In pelvic tumors, radiation therapy is used for treating cancers of the bladder, colon and rectum. In men, it is also used for prostate cancer and among women for uterine, ovarian and vaginal cancers. Even if the bladder itself is not being treated with radiation, it may be affected when the other pelvic organs are irradiated. Apart from tissue irritation and damage, the blood vessels and nerves of the bladder and supporting tissue like collagen may be damaged with radiation exposure. Even tissue death is possible. The extent of the injury may vary from person to person depending on several factors of each individual case.
Radiation therapy for pelvic tumors leads to inflammation of the bladder wall and ulcers (open sores) in the inner lining of the bladder. Urine may then further irritate and damage the exposed bladder wall. Reduced blood flow to the bladder may lead to cellular damage known as ischemia. In rare instances there may even be tissue death of portions of the bladder wall. Scar tissue may develop in the bladder and the nerves which are irritated by radiation may malfunction thereby hampering bladder control. Ultimately these host of pathological changes caused by radiation exposure present as the condition known as radiation cystitis.
Signs and Symptoms
Inflammation of the urinary bladder (cystitis) due to radiation exposure does not differ significantly in presentation from cystitis due to other causes. Most cases of cystitis are due to urinary tract infections where the causative microbes enter through the urethra and ascend the urinary tract to the bladder. Fever is common in infectious cystitis but may be absent or low grade at the most in radiation cystitis. The initial urethritis followed by cystitis may also not be present with radiation exposure. The condition can be classified according to different grades.
- Burning pain during urination and when the bladder is full.
- Persistent urge to urinate even after emptying the bladder.
- Frequent urination due to passage of small quantities of urine.
- Blood in the urine which may be microscopic (not visible to the naked eye) or gross where it discolors the urine.
- Unusual odor of the urine.
- Incontinence where the ability to hold urine in the bladder is impaired leading to involuntary urination at times.
- Discomfort in the lower abdomen/pelvis similar to a feeling of fullness or pressure.
- Nausea and vomiting are also commonly seen but may also be associated with radiation therapy rather than cystitis.
The onset of cystitis may not always be immediately after radiation treatment. It can arise even months after exposure.
Complications of Radiation Cystitis
When left untreated and in severe cases, radiation cystitis may progress to a point where complications can develop. This includes :
- Bladder fistula
- Hemorrhagic cystitis
- Narrowing of the bladder neck
- Bladder cancer (uncommon)
Causes of Radiation Cystitis
Radiation treatment is used for the treatment of cancer. When directed at the pelvis, it can cause radiation cystitis. Radiation is used to destroy cancerous cells. Ideally the target area is only irradiated but the surrounding tissue is often affected as well. Radiation treatment (radiotherapy) may be used as a follow up to surgical removal of the tumor.
Sometimes it is the first line approach to the treatment of certain cancers. In patients where the cancer is advanced and has spread, radiation therapy may help with reducing the severity of the cancer symptoms by shrinking the tumor.
In order to limit the damage to healthy cells and unaffected organs, radiation can be delivered to the target site in various ways. These new techniques include a three dimensional conformal radiotherapy where the beam is shaped to cater for the shape of the target organ and brachytherapy (internal radiotherapy) where radioactive seeds are inserted at the target site.
These more targeted options allows for the use of lower doses of radiation thereby minimizing damage to surrounding healthy tissue and neighboring organs. However, it does not mean that conditions like radiation cystitis will not arise in the course of cancer treatment with radiotherapy.
Diagnosis of Radiation Cystitis
There are a number of investigations that can be conducted to diagnose radiation cystitis. The patient’s history of radiation treatment is one of the most important indicators that the presenting urinary tract symptoms are a result of radiation cystitis. However, this should not mislead the patient or doctor to the possibility that the symptoms can be due to other causes such as an infection, urinary stones or even bladder cancer. Tests that may be conducted includes :
- Urinalysis and urinary culture.
- Cystoscopy – endoscopic examination of the bladder.
- Computed tomography (CT) scan of the bladder.
- Intravenous pyelogram where radiocontrast due can assist with visualizing the kidney on an x-ray.
Treatment of Radiation Cystitis
The treatment of radiations cystitis depends on a host of factors such as the grade of the presenting symptom and extent of the radiation injury. There is a range of medication that may be used for treating radiation cystitis. Surgery is sometimes necessary for severe cases and this may even involve bladder removal. There is some evidence to warrant the use of substances (antioxidants) to prevent radiation cystitis in a patient undergoing radiotherapy for cancer treatment.
- Pentosan polysulfate is one of the first line treatments and can greatly reduce the symptoms.
- Hyperbaric oxygen has also shown to be effective in most cases and is a popular treatment option.
- Antioxidants like orgotein and dimethyl sulfoxide (DMSO) may be useful in preventing the condition.
- Sclerosing agents may be injected into the bladder to reduce or stop bleeding.
- Analgesics help with pain management in radiation cystitis.
- Surgeries like bladder augmentation which increases bladder volume and urinary diversion to channel urine through an alternate pathway. Surgical removal of the bladder known as a cystectomy is reserved as the last option in radiation cystitis.
Picture of hyperbaric oxygen chamber from Wikimedia Commons
Prognosis of Radiation Cystitis
The prognosis for radiation cystitis is dependent on a multitude of factors. Most cases are acute and only symptomatic treatment is necessary. It resolves spontaneously but may recur. Chronic cystitis is more difficult to manage and can be persistent or episodic. Some chronic cases may not respond to treatment thereby making the management difficult. The development of complications can further affect the treatment of radiation cystitis and ultimately the prognosis.
References :
emedicine.medscape.com/article/2055124-overview
www.merckmanuals.com/professional/genitourinary_disorders/genitourinary_cancer/bladder_cancer.html
FAQs
Radiation Cystitis (Bladder Inflammation with Radiotherapy)? ›
Inflammation of the bladder (radiation induced cystitis) is when your bladder is irritated and becomes swollen because of radiotherapy. Bladder inflammation can cause the following symptoms: a burning feeling or pain when you pass urine. a feeling that you need to pass urine urgently.
What can you do for radiation cystitis? ›Medication Summary. Pharmacologic therapy for radiation cystitis is primarily aimed at relief of symptoms. Symptomatic frequency and urgency are best treated with anticholinergic agents. Once all other causes of dysuria have been ruled out, phenazopyridine can be used to provide symptomatic relief.
How long does cystitis last after radiation? ›Acute radiation cystitis occurs either during or shortly after radiation treatment. Symptoms experienced include dysuria and increased urinary frequency and urgency. This condition is usually self-limiting, and seldom persists for longer than 3 months after radiation therapy.
Can radiation irritate the bladder? ›Radiation therapy to the pelvis (including reproductive organs, the bladder, colon and rectum) can irritate the bladder and urinary tract. These problems often start several weeks after radiation therapy begins and go away several weeks after treatment has been completed.
Is radiation cystitis curable? ›Acute radiation cystitis is usually self-limiting and is generally managed with conservative symptomatic therapy or observation. Late radiation cystitis, which can develop months to years after radiation therapy, presents principally as hematuria, which ranges from mild to life-threatening.
Is radiation cystitis progressive? ›Radiation cystitis is an uncontrollable and unpreventable chronic alteration of the bladder due to any form of radiation therapy. This may occur at any point during follow-up (immediate to 20 years) and is progressive destruction of the bladder, ureter, and urethra.
What is radiotherapy cystitis? ›Bladder inflammation (cystitis)
Inflammation of the bladder (radiation induced cystitis) is when your bladder is irritated and becomes swollen because of radiotherapy. Bladder inflammation can cause the following symptoms: a burning feeling or pain when you pass urine. a feeling that you need to pass urine urgently.
Abstract. Acute radiation cystitis occurs during or soon after radiation treatment. It is usually self-limiting, and is generally managed conservatively. Late radiation cystitis, on the other hand, can develop from 6 months to 20 years after radiation therapy.
How is radiation cystitis diagnosed? ›The diagnosis is often easy due to the patient's history of pelvic irradiation. Cystoscopy demonstrates a pale, frosted bladder mucosa with scattered telangiectasias and sometimes well defined torpid ulcerations.
Can radiotherapy damage your bladder? ›Radiotherapy can damage the tissue and blood vessels in the lining of the bladder. This can cause pain or burning when you pass urine. It can also make you feel like you need to pass urine frequently (radiation cystitis). The small blood vessels in the bladder lining may become weaker and bleed easily.
What is late radiation cystitis? ›
Radiotherapy to the pelvic area for gynaecological cancer can damage the bladder in some women. This can lead to late radiation cystitis, which can cause urinary problems (including pain), blood in the urine, reduced bladder capacity and/or bladder damage.
What causes radiation cystitis? ›Typically, radiation cystitis occurs after radiation of the pelvic region, which may be required for treatment of primary bladder cancer or treatment of tumors in regions around the bladder, colon, rectum, ovaries, uterus, and prostate.
What happens when you have cystitis? ›Cystitis is a urinary tract infection (UTI) that affects the bladder. It's common, particularly in women. It often gets better by itself, but may sometimes be treated with antibiotics. Some people get cystitis frequently and may need regular or long-term treatment.
Can your bladder repair itself? ›The bladder is a master at self-repair. When damaged by infection or injury, the organ can mend itself quickly, calling upon specialized cells in its lining to repair tissue and restore a barrier against harmful materials concentrated in urine.
What foods are good for radiation cystitis? ›- Fruits. IC Friendly. Bananas, blueberries, melons, pears, Apples (Gala, Fuji, Pink Lady) ...
- Vegetables. IC Friendly. Asparagus, avocado, celery, black olives, cucumber, green beans, bell peppers, beans (black eyed peas, garbanzo, white, pinto) ...
- Milk/Dairy. IC Friendly. ...
- Beverages. IC Friendly.
Typically, radiation cystitis occurs after radiation of the pelvic region, which may be required for treatment of primary bladder cancer or treatment of tumors in regions around the bladder, colon, rectum, ovaries, uterus, and prostate.
How do you stop the bleeding from radiation cystitis? ›Hyperbaric oxygen (HBO) is a treatment that includes breathing 100 percent oxygen while you're inside an oxygen chamber. This treatment increases oxygen, which may help healing and stop bleeding. You may need a daily HBO treatment for up to 40 sessions.
What can I do for painful urination? ›At-home care for painful urination often includes taking OTC anti-inflammatory medications, such as ibuprofen. A doctor will often encourage a person to drink more fluids as this dilutes urine, making it less painful to pass. Resting and taking medications as directed can usually help relieve most symptoms.
What drinks to avoid with cystitis? ›Coffee, soda, alcohol, tomatoes, hot and spicy foods, chocolate, caffeinated beverages, citrus juices and drinks, MSG, and high-acid foods can trigger IC symptoms or make them worse.
Is yogurt good for cystitis? ›DO eat probiotics — plain Greek yogurt and fermented food such as sauerkraut and pickles. They contain “good” bacteria that can help keep the bad bacteria at bay. DON'T eat a lot of acidic fruit, such as oranges, lemons or limes during the infection. They can irritate your bladder.
Are blueberries good for cystitis? ›
Blueberries may be functional foods that inhibit the progress of bladder remodeling and prevent the development of bladder dysfunction in obstructed bladder.
Does bladder inflammation cause bleeding? ›When a patient has IC, the bladder wall becomes inflamed or irritated. This affects the amount of urine the bladder can hold and also causes scarring, stiffening and bleeding in the bladder.
Is blood in urine Normal With cystitis? ›If blood cells remain after treatment, your doctor may recommend a specialist to determine the cause. Blood in the urine that you can see (gross hematuria) is rare with typical, bacterial cystitis, but this sign is more common with chemotherapy- or radiation-induced cystitis.
Why does it hurt when I pee but I don't have a UTI? ›Sometimes painful urination isn't due to an infection. It can also be caused by products that you use in the genital regions. Soaps, lotions, and bubble baths can irritate vaginal tissues especially. Dyes in laundry detergents and other toiletry products can also cause irritation and lead to painful urination.
Why does my urethra hurt but no UTI? ›Pain in the urethra can also be a symptom of a wide variety of underlying medical conditions, including: inflammation due to bacterial, fungal, or viral infections of the urinary tract, which includes the kidneys, bladder, and urethra. inflammation due to bacterial or viral infections of the prostate or testes.
What is the proper way to wipe for a woman after peeing? ›It's important that you wipe front to back, as wiping the opposite way — back to front — can spread bacteria. “Every time one wipes after urination, the bacteria from the gut can get transferred to the vagina or the urethra if wiping from back to front,” said Dr.