Side Effect: Inflammation of the Bladder (cystitis)

Inflammation of the lining of the bladder is called cystitis. An infection in the bladder is the most common cause of bladder inflammation and it can also be a side effect of certain cancer treatments.

Symptoms of bladder inflammation may include:

• Pain or discomfort in the lower abdomen
• Burning sensation while urinating, also called dysuria
• Increased frequency of urination
• Urgency to urinate
• Blood in the urine
• Cloudy urine
• Urine with a foul odor

• Inflammation of the bladder is a common condition with the most common cause being a bacterial infection, however viruses and fungi can also cause bladder infections leading to cystitis. 
• Certain cancer treatments such as ifosfamide (Ifex©) and cyclophosphamide (Cytoxan©) can cause a specific type of bladder inflammation called hemorrhagic cystitis where the lining of the bladder can be inflamed and bleed. Hemorrhagic cystitis from ifosfamide and cyclophosphamide is caused by a compound called acrolein which is made when the body breaks down (metabolizes) these medications.

Intravesical Bacillus Calmette-Guérin (BCG), which is used for the treatment of certain types of bladder cancer, can also cause bladder inflammation.

Lastly, radiation to the pelvis can cause damage to the bladder leading to inflammation.

• Preventing bladder inflammation in patients with cancer involves proper hygiene and avoiding harsh soaps and scented products in the genital area that can irritate the bladder and increase risk of infection.
• For patients receiving ifosfamide (Ifex©) or cyclophosphamide (Cytoxan©), you may be given a medication called mesna (Mesnex©) to prevent the toxic effects of these chemotherapy agents to the bladder.
  • Mesna works by inhibiting the toxic effects of acrolein on the lining of the bladder. Patients with frequent cystitis from infection may be prescribed antimicrobials to prevent future bladder infections causing inflammation.

Treatment of bladder inflammation may involve antimicrobials to treat an underlying infection as well as medications to manage pain and discomfort. In severe cases, hospitalization may be necessary for intravenous antimicrobial therapy and fluids. In most cases, symptoms of bladder inflammation from infection resolve after antimicrobials are given.

If the bladder inflammation is caused by cancer treatment such as ifosfamide (Ifex©) or cyclophosphamide (Cytoxan©), chemotherapy may be held until symptoms resolve. In severe cases, hospitalization may be required for supportive care and possibly a procedure called bladder irrigation where a urinary catheter is placed to directly flush the bladder with sterile liquid.