What Is Haemorrhagic Cystitis?
Haemorrhagic cystitis is a painful and, in some cases, life-threatening complication of radiotherapy used to treat pelvic cancers, particularly cancers of the prostate, bladder, cervix and rectum.
It usually develops months or years after treatment has been completed, when progressive radiation-induced vascular injury to the bladder mucosa leads to spontaneous or recurrent bleeding.
Clinically, patients may present with haematuria ranging from mild to severe, accompanied by urinary frequency, dysuria, urinary urgency and pelvic pain.
In severe cases, bleeding may require hospital monitoring and blood transfusions. The formation of blood clots within the bladder is a serious complication that may obstruct urinary drainage.
Pathology of Haemorrhagic Cystitis
The pathology of haemorrhagic cystitis reflects the characteristic features of radiation-induced tissue injury: destruction of the mucosal blood vessels, fibrous tissue deposition, extensive telangiectasia and chronic hypoxia of the bladder epithelium.
Telangiectatic vessels are fragile and may bleed easily, even in the absence of an obvious trigger.
The process is self-perpetuating. Bleeding aggravates inflammation, inflammation worsens the vascular injury, and this cyclical progression makes the condition difficult to stabilize using conservative measures alone.
Conventional treatments address the bleeding sites but do not correct the underlying vascular pathology.
Scientific Basis
Hyperbaric oxygen therapy for haemorrhagic cystitis is one of the most extensively studied applications in the field. Multiple case series and prospective studies have reported response rates of 70% to 90%, with a substantial reduction or complete resolution of haematuria and an improvement in associated symptoms.
The Undersea and Hyperbaric Medical Society (UHMS) recognizes radiation-induced cystitis as an approved indication.
The mechanisms of action include restoration of mucosal integrity through neovascularisation, increased collagen synthesis to support repair of the mucosal layer and a reduction in the telangiectatic vessels responsible for recurrent bleeding.
The Role of Hyperbaric Oxygen Therapy
In haemorrhagic cystitis, hyperbaric oxygen therapy is used as an adjunctive treatment that addresses the underlying vascular pathology rather than merely treating the bleeding episodes, which represent only the most visible manifestation of the condition.
Repeated hyperoxygenation of the bladder mucosa gradually reverses the ischaemic state of the tissue. It promotes the formation of stable new collagen, improves epithelial integrity and reduces chronic inflammation and the fragility associated with telangiectatic vessels.
Clinical improvement usually becomes apparent after approximately 20 to 25 sessions.
A complete treatment course typically consists of 30 to 40 sessions and is planned in close collaboration with the urologist and oncologist.