All About Radiation Cystitis

You may have received a diagnosis of radiation cystitis or heard it as a consequence of prostate cancer therapy.

In this article, we are going to cover radiation cystitis in detail. You will also learn about different types of therapy, including hyperbaric oxygen therapy.

What is radiation cystitis?

Radiation cystitis is the inflammation of the urinary bladder caused by radiation.

Cancer therapy applied to the pelvis causes damage to the bladder. Radiation cystitis is one of the most feared radiation health effects in this type of therapy.

So, if your doctor diagnosed radiation cystitis, you probably were under treatment for tumors in the pelvic area.

It is a complication that develops when radiation causes damage and inflammation to healthy tissues. The urinary bladder is sensitive to inflammation, which causes distinctive signs and symptoms. In some cases, it may even cause severe hematuria (1).

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What kind of changes does the body undergo when you have radiation cystitis?

Radiations used to treat tumor cells acts on the intracellular level by producing free radicals. These free radicals interfere with DNA synthesis and cause cell death and radiation injuries. Among other things, there are gene mutations, cell membrane damage, and alterations in the cell cycle.

Inflammation is the initial process in this chain of events. Besides tissue damage, there is a depleted blood supply in the bladder of these patients. Tissue injury and ischemia follow closely after. The consequence is collagen deposition, scarring, and eventually necrosis of the tissue (2).

What is cystitis?

Cystitis is the clinical name of the Inflammation of the urinary bladder. The most common cause is infections of the urinary tract.

Bacteria typically travel upwards through the urethra and irritate the bladder. Other causes of cystitis are certain drugs and radiation. Further, cystitis can be acute or chronic, depending on the duration of the disease.

Causes of radiation cystitis

As the name implies, the cause of this type of cystitis is radiation therapy. The symptoms are similar to those found in interstitial cystitis. But how does it happen?

Radiation used to treat malignant tumors has dangerous rays that affect diseased and healthy cells. These radiations produce free radicals, and they act on the surrounding tissues and act intracellularly. They cause DNA synthesis alterations and gene mutations.

Once the cell cycle is halted, there are no new cells, and blood vessels are damaged. As a result, the tissues undergo ischemia, and this ongoing injury causes inflammation.

Additionally, the vascular changes cause collagen deposition and more hypoxia. In the end, epithelial damage to the bladder lining accounts for the symptoms. One of the alternative treatments that usually help is using hyperbaric oxygen therapy (2).

What medical problems that require radiation treatment may lead to radiation cystitis?

The medical problems that require radiation therapy include cancers of the pelvic cavity (3).

For example:

  • Bladder cancer (or cancer in the urinary tract)

  • Prostate cancer

  • Cervical cancer

  • Uterine cancer

  • Vaginal cancer

  • Anal cancer

  • Endometrial cancer

  • Rectal cancer

How much radiation must you be exposed to before developing radiation cystitis?

Initially, in the early stages of radiotherapy, radiation cystitis is rare as a complication. It is more common as the duration of radiation therapy extends. In a dose rate below 0.8 Gy/hour, there are fewer chances of suffering from radiation cystitis.

When the doses exceed 2 Gy/hour, the risk of toxicity becomes even higher, and the patient can develop cystitis. “Gy” means gray, which is the unit of the ionizing radiation that is administered to the patient. Higher doses are associated with increased risk of radiation sickness.

But what is important is the cumulative dose of radiation. This type of cystitis is a possibility when cumulative doses reach 45 Gy. Higher cumulative doses can further increase the risk of complications (4).


The symptoms of radiation cystitis are not always the same as infectious or interstitial cystitis.

Bladder problems in cystitis usually include a burning sensation in the urinary tract. This is common in infectious cystitis and radiation cystitis.

However, in infectious cystitis, there are other features such as fever, flank pain radiating to the back because of the involvement of the kidneys, and rigors or chills if the infection spreads.

Radiation cystitis only features urinary symptoms — for example, a burning sensation when urinating and urinary urgency. Having a fever, back pain, or flank pain usually points to infectious causes. However, if you are going through radiation treatments, radiation cystitis is a diagnosis you should rule out (2).

How does it affect your body?

The main complications of this condition include recurrent cases of painless hematuria.

You can actually see blood in the urine, which causes an initial shock in diagnosed patients.

In some cases, inflammation is very severe and leads to the formation of fistulae. They are abnormal communications between the bladder and other organs or parts of the body.

It is common to undergo other complications such as necrosis of the bladder. But this only appears when the condition is not treated properly.

Hemorrhagic cystitis is the most feared complication because bleeding can cause shock and death when a large volume of blood is lost (2).

As mentioned above, the most severe complication of this condition includes hemorrhagic cystitis and necrosis of the bladder. Hydronephrosis is another serious complication of this condition. These are the symptoms of each one of them:

  • Hemorrhagic cystitis: The main symptom is significant blood in the urine. There may be blood clots, and other urinary symptoms common in radiation cystitis (5).

  • Necrosis of the bladder: The symptoms of necrosis of the bladder are usually non-specific. The most common symptom is pelvic pain. Patients may have pyuria along with other urinary symptoms common in radiation cystitis (6).

  • Hydronephrosis: It causes flank pain and back pain, which is often unilateral. For this reason, we should not rule out radiation cystitis right away if we have back pain (2).

How to manage it

Is it possible to manage radiation cystitis? Can you actually cure this health problem?

Urinary symptoms are treated with anticholinergic medications. Pain symptoms are relieved with painkillers and other treatments. As for hematuria and ischemia, they can be treated with Hyperbaric oxygen therapy.

This treatment promotes regaining the functions of the bladder by increasing the blood flow in ischemic areas. Bladder irrigation is also useful to prevent clot formation. But, in some cases, it will be necessary to use catheterization and other forms of urinary diversion (7).


The disease can be cured depending on the severity and extension of the tissue damage. But, in cases of fibrosis and ischemia, the benefits of this therapy are reduced. Surgery can be taken into consideration depending upon the status of hematuria (7).

The most important natural therapy for radiation cystitis is hyperbaric oxygen therapy. This type of therapy improves the condition by stimulating angiogenesis. Further, it is useful for cases of chronic radiation cystitis and may improve the symptoms and prognosis of the patient (4).


  1. Mendenhall, W., Henderson, R., Costa, J., Hoppe, B., Dagan, R., Bryant, C., Nichols, R., Williams, C., Harris, S. and Mendenhall, N. (2015). Hemorrhagic Radiation Cystitis. American Journal of Clinical Oncology, 38(3), pp.331-336.
  2. Browne, C., Davis, N., Mac Craith, E., Lennon, G., Mulvin, D., Quinlan, D., Mc Vey, G. and Galvin, D. (2015). A Narrative Review on the Pathophysiology and Management for Radiation Cystitis. Advances in Urology, 2015, pp.1-7.
  3. Schultheiss, T., Hanks, G., Hunt, M., and Robert Lee, W. (1995). Incidence of and factors related to late complications in conformal and conventional radiation treatment of cancer of the prostate. International Journal of Radiation OncologyBiologyPhysics, 32(3), pp.643-649.
  4. Villeirs, L., Tailly, T., Ost, P., Waterloos, M., Decaestecker, K., Fonteyne, V., Van Praet, C., and Lumen, N. (2019). Hyperbaric oxygen therapy for radiation cystitis after pelvic radiotherapy: Systematic review of the recent literature. International Journal of Urology.
  5. Alesawi, A., El-Hakim, A., Zorn, K., and Saad, F. (2014). Radiation-induced hemorrhagic cystitis. Current Opinion in Supportive and Palliative Care, 8(3), pp.235-240.
  6. Delanian, S., and Lefaix, J. (2007). Current Management for Late Normal Tissue Injury: Radiation-Induced Fibrosis and Necrosis. Seminars in Radiation Oncology, 17(2), pp.99-107.
  7. Smit, S., and Heyns, C. (2010). Management of radiation cystitis. Nature Reviews Urology, 7(4), pp.206-214.

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