Radiation cystitis is an inflammation of the bladder that can develop as a side effect following radiation therapy. It occurs when healthy bladder cells are damaged during radiation treatment for pelvic cancers (e.g., prostate, bladder, uterine, colorectal). While radiation therapy is a necessary treatment for many cancers, radiation cystitis can result in bothersome urinary symptoms. Various approaches are available to manage and treat this condition.
Conservative Approaches to Management
Managing radiation cystitis often begins with conservative strategies aimed at reducing symptoms through lifestyle adjustments and simple interventions. Modifying one’s diet can significantly alleviate bladder irritation. Avoiding foods and beverages known to irritate the bladder, such as caffeine, alcohol, spicy foods, acidic fruits, and artificial sweeteners, may help improve comfort. Maintaining adequate hydration by drinking plenty of water is also beneficial, as it helps dilute urine and flush out irritants from the bladder, which can reduce the severity of symptoms.
Patients can explore additional self-management techniques. Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can help manage discomfort and inflammation. Pelvic floor exercises, often guided by a physical therapist, may strengthen the muscles supporting the bladder, potentially improving bladder control and reducing urgency. Bladder training, which involves gradually increasing the time between urinations, can also help the bladder hold more urine and reduce frequent urges.
Medications for Symptom Relief
When conservative approaches are not enough, various medications can help manage the symptoms of radiation cystitis. Oral medications work systemically to address bladder discomfort and function. Anticholinergics, for instance, can reduce bladder spasms and urgency by relaxing the bladder muscle, which is helpful for frequent, sudden urges. Pentosan polysulfate sodium is another oral medication that may help restore the protective lining of the bladder, potentially reducing pain and irritation. Other oral pain medications, ranging from mild analgesics to stronger prescriptions, are used to alleviate persistent discomfort.
In addition to oral treatments, intravesical instillations deliver medication directly into the bladder, allowing for targeted relief. These treatments are administered via a catheter inserted into the urethra. Hyaluronic acid and chondroitin sulfate are examples of agents instilled into the bladder to help replenish the bladder’s glycosaminoglycan layer, a protective barrier that radiation can damage. Corticosteroids may also be instilled directly into the bladder to reduce severe inflammation and alleviate pain.
Advanced Therapies and Procedures
When conservative measures and medications prove insufficient, more advanced therapies and procedures can be considered for radiation cystitis. Hyperbaric oxygen therapy (HBOT) involves breathing pure oxygen in a pressurized chamber. This process increases the amount of oxygen dissolved in the blood, which can promote the growth of new blood vessels and enhance tissue healing in the damaged bladder, particularly in cases of chronic radiation injury. HBOT is often considered for severe or persistent symptoms, including significant bleeding.
Cystoscopy with fulguration involves using a thin, lighted tube (cystoscope) inserted into the bladder to visualize the lining. During this procedure, a surgeon can identify and cauterize bleeding vessels or remove abnormal tissue using an electrical current or laser. This can be effective for managing persistent hematuria (blood in the urine) caused by damaged blood vessels. The procedure is performed in a clinical setting under anesthesia.
Botulinum toxin injections directly into the bladder wall can help reduce bladder overactivity and associated symptoms like urgency and frequency. The toxin temporarily paralyzes specific nerves and muscles, leading to a reduction in involuntary bladder contractions. This approach offers relief for those whose symptoms are largely driven by bladder spasms. For individuals experiencing severe, localized pain that does not respond to other treatments, nerve blocks may be an option. These involve injecting an anesthetic or other medication near specific nerves to block pain signals from reaching the brain, providing targeted pain relief.
Surgical Options
Surgical interventions for radiation cystitis are generally reserved as a last resort when all other less invasive treatments have failed to provide adequate symptom relief or when severe complications arise. These procedures are considered for individuals experiencing persistent, debilitating symptoms such as intractable pain, severe and recurrent bleeding, or significant bladder dysfunction. The decision to pursue surgery involves careful consideration due to the complexity and potential risks associated with these operations.
One surgical option is urinary diversion, which reroutes the flow of urine away from the damaged bladder. An ileal conduit, for example, involves creating a new pathway for urine using a segment of the small intestine. Urine then drains into an external collection bag, bypassing the bladder entirely. In very severe and rare cases, a cystectomy, the complete surgical removal of the bladder, may be necessary. This extreme measure is considered only when the bladder is severely damaged and non-functional, and it significantly alters a person’s urinary system.