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Bladder cancer treatment

Intravesical Chemotherapy — Placed Directly in Your Bladder

This is not a drip and not a tablet. Intravesical chemotherapy is placed inside the bladder through a thin catheter, held for a set time, then drained away. Because very little enters the bloodstream, most people are surprised by how mild the experience is.

Medically reviewed by Dr. Bharati Devi Gorantla, Medical Oncologist, MBBS · MD · DM (Adyar, Chennai) · ECMO · MRCP SCE (UK) · Last reviewed September 2026

  • Not a vein, not a tablet — The medicine goes directly into the bladder — not into your arm.
  • Done as day care — No overnight stay needed. Most people go home within a couple of hours.
  • Very few whole-body side effects — Nausea, hair loss and fatigue are not expected because the medicine stays local.
  • A manageable procedure — A trained nurse performs the instillation. Most people tolerate it well.
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Intravesical chemotherapy is placed directly into the bladder through a catheter, not into a vein. The medicine stays inside the bladder for a set time and is then drained. Because very little is absorbed into the bloodstream, side effects are almost entirely local — usually mild bladder irritation — rather than the whole-body effects of systemic chemotherapy.

How is intravesical chemotherapy given?

  1. You arrive as a day patient

    No overnight stay is needed. You come in, check in with the nursing team, and are settled into a private space for the procedure.

  2. Your bladder is emptied

    A nurse passes a thin, soft catheter through the urethra into the bladder and drains any urine. An empty bladder means the medicine is not diluted.

  3. The medicine is introduced

    The chemotherapy solution is placed into the bladder through the catheter. The catheter is then removed, or in some cases kept briefly in place.

  4. You hold the medicine inside

    Your team tells you how long to keep the medicine in before emptying your bladder. You may be asked to change position occasionally so the solution reaches the whole lining.

  5. The medicine drains out

    You urinate the solution into the toilet. Your nurse will explain how to do this safely, including what to do for the first few toilet visits if you go home with medicine still inside.

  6. You go home

    Once your team is satisfied, you leave the same day. Most people feel well enough to travel, though bringing a family member with you is always a sensible choice.

What do the medical words mean?

Intravesical
Literally 'into the bladder'. The medicine is placed inside the bladder cavity, not into a vein.
Instillation
The procedure of placing a liquid medicine into the bladder. Your team may use this word to describe the whole appointment.
Catheter
A thin, flexible tube passed gently through the urethra into the bladder. It is removed during or shortly after the medicine is given.
Urethra
The channel urine passes through when leaving the body. The catheter travels through this. Mild discomfort for a moment is common; persistent pain should be reported.
Dwell time
The period the medicine sits inside the bladder before you urinate it out. Your team sets this based on the medicine and your treatment plan.

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Is intravesical chemotherapy the same as systemic chemotherapy?

No. They are completely different in how they are given and what they do in your body.

Intravenous chemotherapy — given by drip into a vein — travels through the bloodstream to reach cells throughout the body. That is why it can cause nausea, hair loss and low blood counts: it affects fast-growing cells everywhere, not only in the tumour.

Intravesical chemotherapy does not travel through the bloodstream. The bladder wall acts as a barrier and very little of the medicine crosses into circulation. It works locally, on the bladder lining.

If you have had chemotherapy by drip before, this will feel very different. Do not expect the same experience.

Are the side effects different from systemic chemotherapy?

Yes, and significantly so. Because the medicine stays in the bladder, what your team watches for is local, not systemic.

You may notice a burning or stinging feeling when you urinate in the day or two after the procedure, and you may need to go more frequently than usual. Some people notice mild blood in the urine. These usually settle on their own.

Hair loss, nausea, vomiting and the deep fatigue of systemic chemotherapy are not expected with intravesical treatment.

Contact your team if the burning is severe, if you develop a high temperature, or if you notice heavy or persistent blood in the urine.

What else should I know before my first instillation?

Which medicines are used for intravesical chemotherapy?

The medicines most commonly used in India include mitomycin C — widely available as a generic — and epirubicin. BCG is also given into the bladder by catheter but works differently: it activates the immune system rather than acting directly on abnormal cells, so it is classified as immunotherapy, not chemotherapy. Your oncologist chooses based on your tumour and stage. Dose and schedule are decided by your treating team.

Will the catheter be painful?

Most people describe the catheter as momentarily uncomfortable rather than painful. A lubricating gel is used, and in some cases a numbing gel is applied first. Tell your nurse immediately if you feel significant pain — they can adjust. Anxiety before the procedure is very common. Your nursing team will talk you through each step before it happens, and you will not be rushed.

Can I drive home afterwards?

In most cases yes, though ask your team specifically because the answer can depend on how you feel and whether any sedation was used. If you have any doubt, arrange for a family member to bring you. The procedure does not typically leave people unwell, but there is no benefit to driving alone if you are unsure.

What if I cannot hold the medicine in for the full time?

Tell your nurse before you go to the toilet. An urgent need to urinate before the set time is something your team has dealt with many times — it does not ruin the treatment and there is no need to feel embarrassed. Your nurse will tell you what to do. Do not try to hold yourself beyond what is comfortable.

Does intravesical chemotherapy affect my kidneys or liver?

Very little, if at all. Because very little of the medicine crosses the bladder wall into the bloodstream, the kidneys and liver are exposed to minimal amounts. Your team may still monitor you with blood tests as part of standard care, but the side effects they primarily watch for are in the bladder itself — which is why intravesical treatment is generally well tolerated compared to systemic chemotherapy.

How many instillations will I need?

This depends on your treatment plan and the stage of your bladder cancer. A single instillation is sometimes given immediately after a procedure to remove bladder tumour. In other cases a course takes place over several weeks or months. Your oncologist will explain the number and schedule — there is no standard answer that applies to everyone.

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Common questions

Frequently asked questions

Is intravesical chemotherapy given at CION?

Yes. Intravesical chemotherapy is given as day care at CION centres by trained nursing staff. No overnight stay is needed. If you have questions about what to expect on the day, speak to your oncology team before your first appointment.

Will I feel sick after intravesical chemotherapy?

Nausea is not a typical side effect. Because the medicine stays in the bladder and very little enters the bloodstream, the whole-body symptoms of systemic chemotherapy — nausea, vomiting, fatigue — are not expected. What some people notice is local bladder irritation: burning or more frequent urination in the day or two afterwards. If you feel unwell in a way that surprises you, contact your team.

Do I need to take any precautions after the procedure?

Your team will give you specific instructions. Common guidance includes drinking extra water after the dwell time to help flush the bladder, handling the first few toilet visits carefully because urine may still contain traces of the medicine, and washing hands thoroughly afterwards. If family members share the same toilet, your nurse will advise on managing this safely.

Can intravesical chemotherapy be given if I have had difficulty with a catheter before?

Yes, and it is worth telling your nursing team in advance. If you have had significant discomfort or pain with a catheter previously, letting them know allows them to plan accordingly — there are ways to make the procedure more comfortable. A previous catheter for any reason does not prevent intravesical treatment from being given.

What is the difference between intravesical chemotherapy and BCG?

Both are placed into the bladder through a catheter using the same basic technique. The difference is what is placed inside. Chemotherapy medicines act directly on abnormal cells in the bladder lining. BCG uses a weakened bacterium to activate your immune system, which then targets abnormal cells. BCG is classified as immunotherapy, not chemotherapy. Your oncologist chooses between them based on your tumour type and stage.

Can I eat and drink normally before the procedure?

In most cases yes — intravesical chemotherapy does not usually require fasting. Your team will confirm any specific instructions for your appointment. Drinking normally before you arrive is generally fine, though your nurse may ask you to urinate just before the procedure begins so your bladder is empty when the catheter is passed.

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