Bladder Cancer Symptoms: What You Should Know

Medically Reviewed by Jabeen Begum, MD on January 29, 2024
6 min read

Bladder cancer starts in your bladder or in the lining of your bladder, a hollow organ that stores your urine before it leaves your body. As the cancer cells grow, they form a mass called a tumor that can spread to surrounding tissue and eventually to your lymph nodes (part of your body's immune system) or to other organs.

The most common -- and often, the first -- symptom of bladder cancer is blood in your urine. It may be just a little, or it can be enough to change the color of your pee. It may turn orange, pink, or darker red.

You may see blood one day but not the next. If you have bladder cancer, the blood eventually comes back. In some cases, you can’t see blood in your urine. Your doctor or lab tech will only detect it with a urine test.

Make an appointment if you have any of these other symptoms:

  • You have to pee more often than usual.
  • Your urine changes color.
  • It hurts or burns when you pee.
  • You feel like you have to pee -- even if your bladder’s not full.
  • You can’t pee, or you pee very little.

One of the problems with diagnosing bladder cancer is that the symptoms are similar to those of less-serious illnesses and infections. If you notice any of the above signs, call your doctor, but don’t panic. Having these symptoms doesn’t necessarily mean you have cancer. You could have a urinary tract infection, bladder infection, or some other condition. 

Once bladder cancer starts to spread, you may notice that:

  • You can’t pee, even when you feel like you have to.
  • Your lower back hurts.
  • You’re losing weight without trying.
  • You’re not as hungry as usual.
  • You have swollen feet.
  • Your bones hurt.
  • You often feel extremely tired or weak.

Again, see your doctor if any of these things happen to you. 

What are the 5 warning signs of bladder cancer?

There are more than five, but these are the biggest bladder cancer signs:

  1. Blood in your urine
  2. Peeing more than usual
  3. Pain or burning when passing urine
  4. Feeling the urge to pee even if your bladder is not full
  5. Frequent bladder infections

Once a doctor has diagnosed you with bladder cancer, they'll try to find out whether it has started to spread and how far. This process is called staging. Your cancer will be given a staging number depending on where the cancer is and how much it has spread. The higher the number, the more serious the cancer is.

In stage I, the cancer has spread into the connective tissue of your bladder or just below the lining, but hasn't reached the muscle layers yet.

Symptoms include:

  • Blood in your urine
  • Peeing more than usual
  • Pain or burning when passing urine
  • Feeling the urge to pee even if your bladder's not full
  • Frequent bladder infections

In stage II, the cancer has spread to the inner or outer muscle layer of the bladder wall, but it hasn't gone through the muscle to reach the fatty tissue that surrounds the bladder. If the cancer has spread to the inner layer, it's called stage IIa; if it has spread to the outer layer, it's called IIb.

Symptoms include:

  • Blood in your urine
  • Peeing more than usual
  • Pain or burning when passing urine
  • Feeling the urge to pee even if your bladder is not full
  • Frequent bladder infections

These symptoms are not unique to stage II bladder cancer.

In stage IIIa, the cancer has now spread to the bladder muscles and wall and gone into the layer of fatty tissue that surrounds the bladder. It may have spread to reproductive organs like the prostate, uterus, or vagina but not to the lymph nodes. Or it might have spread to one lymph node in the pelvis that is not near the major arteries of the pelvis, known as the common iliac arteries.

In stage IIIb, the cancer has spread to more than one lymph node in the pelvis that's not near the common iliac arteries. Or it has spread to at least one lymph node near the the common iliac arteries.

Symptoms include:

  • Blood in your urine
  • Peeing more than usual
  • Pain or burning when passing urine
  • Feeling the urge to pee even if your bladder is not full
  • Frequent bladder infections

They may also include: 

  • Being unable to pee
  • Lower back pain on one side of the body
  • Pelvic pain
  • Weight loss
  • Loss of appetite
  • Swollen feet
  • Fatigue or tiredness

These symptoms are not unique to stage III bladder cancer.

At stage IVa, the cancer has spread to the abdominal wall or the pelvic wall. Or it's spread to the lymph nodes above the common iliac arteries.

In stage IVb, the cancer has spread to other organs or body parts, such as the lungs, bones, or liver.

Symptoms include:

  • Blood in your urine
  • Peeing more than usual
  • Pain or burning when passing urine
  • Feeling the urge to pee even if your bladder is not full
  • Frequent bladder infections

They may also include: 

  • Being unable to pee
  • Lower back pain on one side of the body
  • Pelvic pain
  • Weight loss
  • Loss of appetite
  • Swollen feet
  • Fatigue or tiredness
  • Bone pain

These symptoms are not unique to stage IV bladder cancer.

If the cancer has spread to other parts of the body, you might have symptoms specific to that body part. For instance, if the cancer has spread to the lungs, you might be coughing and short of breath.

Men are four times more likely to get bladder cancer than women. But women generally are diagnosed when their cancer is more advanced. 

This is because the main symptom of the disease, blood in urine, is often associated with having a period or with menopause, so women delay going to the doctor about it. Even when they do go, the doctor may misdiagnose it as postmenopausal bleeding or a urinary tract infection, which is very common in women.

If you're a woman and seeing blood in your urine, be sure to get it checked out, particularly if you're no longer having a period. Pay attention to whether you have other signs of bladder cancer as well, like:

  • Peeing more than usual
  • Pain or burning when passing urine
  • Feeling the urge to pee even if your bladder is not full
  • Frequent bladder infections 

 

Men have a much higher risk of bladder cancer than women because they're more likely to smoke tobacco (which has a lot of toxins) and they're more likely be exposed to cancer-causing chemicals in factory work, for instance in the paint, printing, and textile industries. All these toxins have to pass through the bladder before coming out the body. 

The signs of bladder cancer are the same for both men and women.

The symptoms of urinary bladder cancer are often similar to those of less-threatening conditions like a urinary tract infection. The main bladder cancer sign is blood in your urine, but other symptoms include peeing more than usual, pain or burning when passing urine, feeling the urge to pee even if your bladder is not full, and frequent bladder infections. If you're experiencing any of these, be sure to see a doctor.  

Does bladder cancer spread quickly?

It can, depending on the type of bladder cancer. The most common type, urothelial carcinoma, also known as transitional cell carcinoma, spreads slowly. It may come back after treatment but doesn't spread. More than 90% of bladder cancers fall in this category. Other types of bladder cancer spread faster.

How long can bladder cancer go undetected?

Bladder cancer is often detected early because it has some obvious symptoms, like blood in urine. However, in women, this can be mistaken for post-menopausal bleeding or something else, so it may take a year or more before doctors make a proper diagnosis.