What Are Early Symptoms of Bladder Cancer?

Bladder cancer is the most common type of urinary tract cancer. An estimated 550,000 new cases are diagnosed annually around the world.

Like many cancers, the earlier this cancer is caught and treated, the better the prognosis will be, so it's important to recognize symptoms as early as possible.

The most common early symptom is blood in the urine (either blood that can be detected by eye or under a microscope). Less often, symptoms of bladder irritation such as burning, frequency, or urgency may occur.

This article will look at the early and later symptoms of bladder cancer, as well as important differences in how the disease affects the different sexes, and when you should see your healthcare provider.

Woman with bladder pain

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Early Symptoms of Bladder Cancer

In the earliest stages of bladder cancer, most people do not have symptoms. When early symptoms do occur, they can have many other potential causes that are more likely than bladder cancer. Early symptoms include:

Blood in the Urine (Hematuria)

Blood in the urine (hematuria) is the most common early symptom of bladder cancer. This blood in the urine occurs due to bleeding of the tumor, which is usually on the surface of the bladder and in direct contact with urine. This can be:

  • Visible to the naked eye (gross hematuria): Most often appears pink or orange. A brownish appearance suggesting old blood is uncommon unless a person has not been urinating regularly. An estimated 20% of people with this symptom are found to have bladder cancer.
  • Only visible under a microscope (microscopic hematuria): This is defined as three or more red blood cells per high-power field on a urine sample under a microscope in at least two of three specimens collected at different times. Only 0.4% to 6.5% of people with this symptom will have bladder cancer.

Hematuria may be visible or microscopic, or both. It may be continuous or may come and go. It is usually painless but may be associated with discomfort.

Other Causes of Blood in the Urine

Blood in the urine (hematuria) is common. At any one time, between 1% and 18% of the population will have asymptomatic microscopic hematuria, but only 1.3% of patients with this symptom have bladder cancer. Other causes of hematuria include:

  • Certain foods (such as beets, rhubarb, berries, aloe, and fava beans)
  • Some medications (including Pyridium (phenazopyridine), Rifadin (rifampin), certain blood thinners, laxatives. and chemotherapy drugs
  • Bladder and/or kidney infections
  • Long-distance running (known as "march hematuria")
  • Kidney stones
  • Trauma
  • Polycystic kidney disease (causes fluid-filled sacs in the kidneys)
  • Other bladder or kidney tumors (both cancerous and benign)
  • Menses (period bleeding) in women
  • Benign prostatic hypertrophy (enlarged prostate) in men


Bladder Irritability/Abnormal Urination

Other symptoms can be subtle in their presentation and vary by individuals, so it's important to compare against what's normal for you. Symptoms of bladder irritability or abnormal urination may include:

  • Painful urination (dysuria): Often described as aching, burning, or simply a sensation that something is wrong
  • Frequency: Urinating more often than usual
  • Urgency: The need to run quickly to the bathroom to urinate
  • Nocturia: The need to get up and urinate during the night, which is especially common in men who have an enlarged prostate.
  • Urinary hesitancy (weak or slow stream): May feel like the stream of urine is simply slow (like having a water faucet on low), or in some cases, having to strain in order to pass urine
  • Difficulty urinating: May include problems with starting to urinate, continuing to urinate once started, or stopping the stream when desired
  • Feeling of incomplete emptying: The sensation of still needing to urinate after urinating
  • Incontinence: Passing urine involuntarily
  • Lower back pain: Usually only occurring on one side of the body

Other Causes of Bladder Irritation

Symptoms that describe problems with urination are more likely to be something other than bladder cancer, including:

Later Symptoms of Bladder Cancer

Other symptoms are much less common or may occur later during bladder cancer. Some of these symptoms may be due to the spread of a bladder cancer to other regions of the body, and include:

  • Inability to urinate (complete obstruction)
  • Blood clots in the urine
  • Low back or flank pain on one side
  • Perineal pain (pain between the penis and rectum or between the vagina and rectum)
  • An abdominal or pelvic mass
  • Enlarged lymph nodes in the groin
  • Swelling in the feet or legs
  • Fatigue (cancer fatigue)
  • Loss of appetite
  • Weakness
  • Unintentional weight loss
  • Bone pain or fracture with minimal trauma (due to bone metastases)
  • Nausea and vomiting, jaundice (yellowish color to the skin), abdominal pain, and itching (due to liver metastases)
  • Shortness of breath or a chronic cough (due to lung metastases)

Bladder Cancer in Men vs. Women

Bladder cancer is 3 to 4 times more common in people assigned male at birth than in people assigned female at birth.

Researchers believe the increased prevalence of bladder cancer in those assigned male at birth may be due to differences in how carcinogens (cancer-causing substances) are metabolized before they pass through the bladder (where they can cause cellular damage). Or it may be that male sex hormones (androgens) promote tumor formation in the bladder, whereas female sex hormones (estrogens) inhibit this progression.

In contrast, people assigned female at birth tend to be diagnosed at later (less curable) stages of the disease, do not respond as well to treatment, and have a higher cancer-specific mortality rate, so it's especially important for those assigned female at birth to be aware of early symptoms and seek prompt evaluation.

One study looked at the prevalence of the early cancer symptoms in both sexes, concluding that:

  • Visible hematuria (blood in the urine) was present in 65% of men and 68% of women.
  • Dysuria (painful urination) was present in 32% of men and 44% of women.
  • Urgency was present in 61% of men and 47% of women.
  • Nocturia (need to urinate in the middle of night) was present in 57% of men and 66% of women.

Painful urination is often dismissed as due to a bladder infection or friction (from tight undergarments, intercourse, etc.) and may be less likely to be investigated, particularly in women. One study found that 47% of female bladder cancer patients were treated for symptoms up to a year before a diagnosis was made, without receiving any further evaluation. A lower percentage of females than males saw a urologist (bladder specialist) as well.

Complications

There are very few complications during the earliest stages of bladder cancer. These may include:

  • Bleeding: This is very rarely heavy or life-threatening.
  • Inability to urinate: If a tumor is large enough and in certain locations, it may obstruct the flow of urine out of your bladder. Urgent treatment is needed to prevent kidney damage. That said, unless you have a neurological condition that limits bladder sensation, bladder distention is usually very painful and would alert you to the problem.

When to See a Healthcare Provider

There are currently no guidelines or recommendations for screening people at risk of bladder cancer, including those who have significant risk factors. Clinical trials are ongoing to see if screening may detect bladder cancer early in some populations.

You should talk to your healthcare provider if:

  • You notice any blood in your urine, even if you aren't certain its blood, especially if persists, worsens, or is accompanied by other symptoms.
  • You have any symptoms of abnormal urination, whether that means pain or burning, frequency, urgency, losing urine, difficulty starting or stopping your stream or just a sensation that something has changed.
  • You have any other symptoms that just don't feel right.

Summary

The most common early symptom of bladder cancer is blood in the urine. The blood either may be visible to the naked eye or only able to be seen under a microscope. Other common symptoms include painful urination, increased frequency or urgency to urinate, needing to urinate in the middle of the night, and pain in one side of the lower back. Bladder cancer is very treatable if caught early, so it's important to see your healthcare provider for evaluation if you notice any of these symptoms.

A Word From Verywell 

Catching bladder cancer in the earliest stages greatly increases your chance for a cure. Since there's not currently a screening test, the best way to do this is to be aware of your risk factors (such as being male, smoking, having occupational exposure to certain chemicals, or having certain genetic conditions) and getting a prompt evaluation from your healthcare provider if symptoms, such as blood in the urine or painful urination, do develop.

The most important symptom is anything that seems atypical or abnormal to you. Listen to your body. And make sure you have a healthcare provider who listens to you. You know yourself much better than any healthcare provider, however. So, if your concerns aren't taken seriously, get a second opinion. Be your own advocate for your health.

Frequently Asked Questions

  • Do the symptoms of bladder cancer come on suddenly?

    They might. The symptoms of bladder cancer can come on suddenly or develop over time. The most common presentation is the onset of painless blood in the urine.

  • What are the common warning signs of bladder cancer?

    By far, the most common warning sign of bladder cancer is blood in the urine (hematuria). This can be visible as a person is urinating or detected only under the microscope. Less often, people may have symptoms of bladder irritation, such as painful urination, frequency, urgency, or needing to urinate more frequently at night (nocturia).

  • Can early detection of bladder cancer symptoms save someone’s life?

    Yes. The earlier bladder cancer is detected, the more effective treatment can be in either curing the tumor or extending life. More than 50% of cases are caught "in situ" (in a precancerous stage). These patients have a 96% survival rate after five years. The overall five-year survival rate for all stages of bladder cancer is 77%.

  • Why are men more likely to get bladder cancer?

    One theory is that men's livers may break down carcinogens (cancer-causing substances) less efficiently, which means these compounds are more damaging when they reach the bladder.

    Another theory is that male sex hormones (androgens) promote tumor formation in the bladder, whereas female sex hormones (estrogens) slow or stop this progression.

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