Acute Hemorrhagic Cystitis - Causes, Features, and Management

Introduction:

Acute hemorrhagic cystitis is a condition that causes inflammation and bleeding in the bladder, resulting in a range of uncomfortable and potentially dangerous symptoms. Various factors, including viral infections, bacterial infections, radiation therapy, chemotherapy, and certain medications, can cause this condition. Acute hemorrhagic cystitis is most commonly seen in children and older adults but can occur at any age.

What Are the Causes of Acute Hemorrhagic Cystitis?

Acute hemorrhagic cystitis can be caused by a variety of factors, including:

• Viral Infections: The most common cause of acute hemorrhagic cystitis is a viral infection, such as adenovirus, responsible for up to 80 % of cases. Other viruses that can cause acute hemorrhagic cystitis include coxsackievirus, cytomegalovirus, and herpes simplex virus. These viruses can damage the bladder's lining, leading to inflammation and bleeding.

• Bacterial Infections: Bacterial infections can also cause acute hemorrhagic cystitis. This is more common in people with a weakened immune system or who have recently undergone a medical procedure involving the urinary tract. Examples of bacteria that can cause the condition include E. coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa.

• Radiation Therapy: Radiation therapy can also cause acute hemorrhagic cystitis. This is because the radiation damages the cells in the bladder, leading to inflammation and bleeding. This acute hemorrhagic cystitis usually occurs several weeks after starting radiation therapy.

• Medications: Certain medications can also cause acute hemorrhagic cystitis. These include Cyclophosphamide, a chemotherapy drug, and some non-steroidal anti-inflammatory drugs (NSAIDs). These medications can irritate the lining of the bladder, leading to inflammation and bleeding.

• Other Factors: Other factors that can increase the risk of developing acute hemorrhagic cystitis include a history of bladder problems, such as bladder stones or bladder cancer, and certain medical conditions, such as diabetes or kidney disease.

What Are the Risk Factors of Acute Hemorrhagic Cystitis?

• Medications: Some medications, such as Cyclophosphamide or Ifosfamide, can increase the risk of developing acute hemorrhagic cystitis.

• Age: Acute hemorrhagic cystitis is more commonly seen in children and older adults, although it can occur at any age.

• Gender: Women are more likely to develop acute hemorrhagic cystitis than men, although the reasons for this are not well understood.

• Bladder Obstruction: Obstructions in the urinary tract, such as bladder stones, can increase the risk of acute hemorrhagic cystitis.

• Genetics: In rare cases, acute hemorrhagic cystitis can be caused by an inherited genetic mutation that affects the immune system.

What Are the Symptoms of Acute Hemorrhagic Cystitis?

Acute hemorrhagic cystitis is a condition that causes inflammation and bleeding in the bladder, leading to a range of symptoms. The most common symptoms of acute hemorrhagic cystitis include the following:

• Hematuria: This is the presence of blood in the urine. The urine may be pink, red, or brown.

• Pain or Discomfort: People with acute hemorrhagic cystitis may experience pain or discomfort in the lower abdomen or bladder area. This pain may be dull or sharp and may be accompanied by a feeling of pressure or fullness in the bladder.

• Frequent Urination: People with acute hemorrhagic cystitis may need to urinate more often than usual, sometimes even waking up in the middle of the night to use the bathroom. Also people with acute hemorrhagic cystitis may suddenly need to urinate, even if they have just gone to the bathroom.

• Difficulty Urinating: Some people with acute hemorrhagic cystitis may experience difficulty urinating, such as a weak or interrupted stream or the need to strain to urinate.

• Incontinence: In some cases, acute hemorrhagic cystitis can cause a loss of bladder control, leading to incontinence.

How to Make a Diagnosis of Acute Hemorrhagic Cystitis?

Diagnostic tests used in diagnosis of acute hemorrhagic cystitis include are as follows:

• Urinalysis: In urinalysis, a urine sample is examined for the presence of blood, bacteria, and other substances. If blood is present in your urine, it may be a sign of acute hemorrhagic cystitis.

• Cystoscopy: In cystoscopy, a small tube with a camera is inserted in the bladder. This allows the doctor to examine the inside of your bladder for any signs of inflammation, bleeding, or other abnormalities.

• Imaging Tests: Imaging tests, such as a CT (computed tomography) scan or MRI (magnetic resonance imaging), may be used to get a more detailed view of the bladder and urinary tract to identify any structural abnormalities or signs of damage.

• Biopsy: In rare cases, a biopsy may be necessary to confirm a diagnosis of acute hemorrhagic cystitis. In biopsy, a small tissue section is taken from the bladder and examined under a microscope to find abnormalities.

What Are the Treatments for Acute Hemorrhagic Cystitis?

The following are some common treatments for acute hemorrhagic cystitis:

• Pain Management: Pain due to acute hemorrhagic cystitis treated with over-the-counter medicine, including Ibuprofen or Acetaminophen. If the pain is severe, the doctor may prescribe stronger pain medication.

• Fluids and Rest: Drinking plenty of fluids and getting rest can help the body heal and reduce the risk of complications. The doctor may also recommend avoiding activities that can exacerbate the condition, such as sexual activity.

• Antibiotics: If the underlying cause of the acute hemorrhagic cystitis is a bacterial infection, your doctor may prescribe antibiotics to treat the infection.

• Bladder Instillation: In some cases, medication may be instilled into the bladder through a catheter to help reduce inflammation and relieve symptoms.

• Cystoscopy with Clot Evacuation: In cases of significant bleeding in the bladder, a cystoscopy may be performed to remove any blood clots causing urinary obstruction.

• Surgical Intervention: In rare cases, surgery may be necessary to remove any bladder stones, tumors, or other blockages causing the bleeding.

Conclusion:

Acute hemorrhagic cystitis is a condition that can cause significant discomfort and distress to those affected. However, with proper diagnosis and treatment, most cases can be managed effectively, and patients can return to normal activities. It is essential to take medical attention if anyone experiences symptoms, as prompt treatment can help prevent complications and promote healing. While various factors can cause the condition, many cases are related to underlying infections or medical treatments. Therefore, taking steps to prevent these factors, such as maintaining good hygiene, seeking prompt infection treatment, and following medical treatment plans, may help reduce the risk of developing acute hemorrhagic cystitis.