Hemorrhagic Cystitis Clinical Presentation

Updated: Dec 15, 2020
  • Author: Joseph Basler, MD, PhD; Chief Editor: Edward David Kim, MD, FACS  more...
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Patients who present with hemorrhagic cystitis usually have a history of radiation or chemical exposure. They are often inpatients or are well known to their respective services.

Noninfectious hemorrhagic cystitis is characterized by inflammation of the bladder associated with hematuria. Patients with this condition usually present with urgency, frequency, dysuria, and, in some cases, abdominal discomfort. A history of new urinary incontinence is frequently noted.

The presence or absence of clotted blood in the urine is not completely helpful in determining the etiology of hemorrhagic cystitis, but the presence of long, stringy clots suggests an upper urinary tract etiology. Symptoms include suprapubic discomfort, urinary frequency, and inability to empty the bladder due to the clots.


Physical Examination

Upon examination, the patient often demonstrates suprapubic fullness and discomfort or pain to palpation, as well as costovertebral angle tenderness if the bladder obstruction is chronic.

Patients with hemorrhagic cystitis can present with variable degrees of hematuria, ranging from slightly blood-tinged urine to massive gross hematuria with passing of clots that may cause urinary retention. Clot retention is common and can be very painful. Urinary incontinence is frequently observed.