After pelvic radiotherapy, some people develop urinary symptoms that affect rest and everyday life. Radiation cystitis is one possible cause. Hyperbaric oxygen may be considered in selected cases, but the first step is a medical diagnosis.

What is radiation cystitis?

It is bladder injury associated with pelvic radiotherapy. Symptoms can appear long after treatment, including years later. It should not automatically be treated as a urinary infection.

Symptoms include frequent or urgent urination, pelvic pain, leakage and blood in the urine. Guy’s and St Thomas’ NHS describes these symptoms and the role of coordinated care.

Diagnosis comes before treatment

Previous radiotherapy does not mean that all urinary bleeding is caused by radiation cystitis. The Canadian Urological Association recommends excluding other causes. Assessment may involve medical history, urine tests, imaging and cystoscopy.

Treatment depends on severity and may involve bleeding control, treatments delivered into the bladder or urological procedures. Hyperbaric oxygen is an option within that plan, not a replacement for urological assessment.

What benefit can hyperbaric oxygen offer?

The aim is to improve urinary symptoms and their impact on quality of life in selected patients. For someone whose routine revolves around discomfort or finding a toilet, progress matters in everyday terms, not just as a number of completed sessions.

The randomised RICH-ART trial, published in 2019, found greater urinary symptom improvement with hyperbaric oxygen than with standard care at 6–8 months. Participants had selected chronic radiation cystitis; these results are not an individual guarantee.

How long might improvement last?

The RICH-ART follow-up published in 2025 found that average improvement was sustained at five years in the group followed after treatment. Some people did not initially respond, and others needed additional treatment.

There was no untreated comparison group throughout those five years. This informs expectations about longer-term progress but cannot promise a permanent cure or freedom from recurrence.

How many sessions are needed, and what are the risks?

An individual assessment and review of progress should guide the treatment plan. Research protocols should not be copied automatically for anyone with similar symptoms.

The original trial reported temporary effects involving sight and hearing. Before treatment, the team should assess suitability, explain risks and answer questions about pressure, communication and preparation. Our first-session guide helps you prepare.

When to seek advice about blood in urine

Visible blood in urine needs medical assessment, even once or in a small amount. Seek urgent care if you cannot urinate, clots make it difficult to empty the bladder, or heavy bleeding makes you feel unwell. Do not wait for a hyperbaric appointment.

Assessment for patients from Estepona and Marbella

At HMCE, healthcare professionals support you before, during and after your session. Our team assesses your case, explains the treatment and answers your questions. Throughout the session, you can communicate with the staff and report any discomfort, with professional supervision throughout your care.

The FDA emphasises trained staff and supervision throughout hyperbaric oxygen treatment. Before your session, our team will explain the preparation and safety instructions you need to follow.

If your urologist has diagnosed radiation cystitis or discussed hyperbaric oxygen, contact HMCE about your case. Ask which radiotherapy and urology reports, recent tests and medication details to prepare.

The centre is at Avenida de España, 242, Estepona, and welcomes people travelling from Marbella and the Costa del Sol. Read about hyperbaric oxygen for radiotherapy-related injury or our service for patients from Marbella.

Frequently asked questions

Is radiation cystitis always an infection?

No. It is related to radiation, although other causes or associated conditions need assessment. Do not self-medicate with antibiotics.

Does hyperbaric oxygen guarantee that bleeding stops?

No. It may help selected patients, but responses vary. Urological follow-up remains necessary.

Is it a cancer treatment?

Here it is considered for selected radiotherapy-related injuries, not as a treatment for cancer or a replacement for oncology follow-up.

Educational content that does not replace an individual diagnosis or prescription.