Starting Medicine Placed in the Bladder

How a treatment goes

1. Your care team places a thin, soft catheter into the bladder and puts the medicine in, then usually removes the catheter.
2. You hold the medicine in your bladder for the time you are told — often about 1 to 2 hours. You may be asked to change positions so it reaches the whole bladder.
3. When the time is up, you urinate the medicine out into the toilet.

Fluids before and after

• Before: it often helps to limit fluids and caffeine for about 4 hours beforehand so the medicine is not watered down. Your care team will tell you exactly how long.
• After the holding time: drink extra water to flush the bladder, unless you were told to limit fluids for another reason.

After you go home — post-void precautions

Some of these medicines stay active in your urine for a while, so the first few times you urinate after treatment there are simple safety steps. These steps are different for different medicines, so follow your care team's specific instructions rather than a general rule.

• Sit down to urinate to avoid splashing.
• You may be told to add household bleach to the toilet — often about 1 cup, left to sit for 15 to 20 minutes before you flush. The exact amount and wait time can vary by medicine, so use the instructions you were given.
• Wash your hands and the genital area well afterward.
• Ask your care team how long these steps last after each treatment (often about 6 hours).

BCG is a weakened germ that wakes up the immune system inside the bladder so it attacks cancer cells. It is one of the most common and longest-used bladder treatments for higher-risk, non-muscle-invasive cancer.

The usual schedule

BCG usually starts with a "induction" course of one treatment a week for about 6 weeks. If it is working and you are tolerating it, your care team may then give "maintenance" — spaced-out treatments over the following months to years to lower the chance the cancer comes back.

How you may feel

• Burning, urgency, and frequent urination for a day or so after each treatment
• A small amount of blood in the urine
• A mild flu-like feeling — low energy, aches, or a low fever — for about a day
• These often build up a little over the course of treatments

For a fuller walk-through of a BCG visit, see the BCG / intravesical therapy guide.

Gemcitabine is a chemotherapy medicine placed in the bladder. It works on the bladder lining and tends to be gentle on the rest of the body. Your care team may choose it as a first medicine or when another medicine was not the right fit.

How you may feel

• Burning, urgency, and frequent urination for a day or so
• A small amount of blood in the urine
• Most people find the bladder symptoms milder than with some other options, but everyone is different

This uses two chemotherapy medicines in one visit, given one after the other — "sequential" instillation. Gemcitabine goes in first and you hold it, then it is drained and docetaxel goes in and you hold that. The idea is that two medicines that work in different ways may do more together.

What to expect

• The visit is longer because there are two hold times.
• Bladder symptoms — burning, urgency, frequent urination — like other instillations.
• Your care team will tell you the schedule, which is often weekly for a course and sometimes spaced-out maintenance after.

Gemcitabine + docetaxel is also used when BCG has stopped working — see BCG didn't work for me.

Life happens — you may be sick, traveling, or unable to make an appointment. If you miss a treatment or think you need to move one:

• Call the office to reschedule as soon as you can.
• Do not try to make up for it by changing your own dose or timing.
• If you were unwell (for example, a fever or a urinary infection), tell your care team — sometimes a treatment is delayed on purpose until you are better.