Bacillus Calmette-Guérin (BCG) treatment is a form of intravesical immunotherapy used to manage high-risk, non-muscle-invasive bladder cancer. The treatment involves introducing a weakened form of Mycobacterium bovis directly into the bladder via a catheter. This stimulates an immune response against cancer cells in the bladder lining. Patients often ask about managing lifestyle habits, such as alcohol consumption, during recovery.
Why Alcohol Must Be Avoided After BCG Treatment
Patients are generally advised to abstain from alcohol for at least 24 to 48 hours following each BCG instillation. This recommendation is based on alcohol’s physiological effects on the urinary system, which interfere with recovery. BCG therapy intentionally causes localized inflammation of the bladder lining to activate the immune system, and alcohol acts as a significant bladder irritant.
Consuming ethanol can severely worsen expected post-treatment symptoms such as dysuria (painful urination), urinary urgency, and frequency. Alcohol is also a known diuretic, increasing the rate of urine production. This further exacerbates the inflamed bladder’s inability to hold urine comfortably for long periods. This combination of increased irritation and higher urine output can cause considerable distress.
While small amounts of alcohol may not affect the BCG’s efficacy, the certainty of increased symptom severity makes abstinence the standard recommendation for the first one to two days. Avoiding alcohol during this initial window ensures the localized immune response remains focused without unnecessary aggravation.
Common Side Effects of BCG Therapy
BCG treatment initiates a localized inflammatory reaction within the bladder, leading to expected side effects that typically manifest within a few hours and persist for one to three days. The most common local effects are lower urinary tract symptoms, which can feel similar to a severe urinary tract infection.
Patients frequently experience cystitis (bladder inflammation), leading to a strong urge to urinate and discomfort or burning during urination. Hematuria (blood in the urine) is also common, usually presenting as pink-tinged or red urine due to bladder wall irritation. These local symptoms are normal signs that the immune system has been successfully activated.
Beyond localized irritation, many patients report systemic, flu-like symptoms indicating a broader immune response. These include a low-grade fever, chills, generalized aches, and increased fatigue. These symptoms usually peak within 24 to 48 hours after instillation and then subside. If these symptoms persist, or if a fever rises above 101.5°F (38.6°C), it may indicate a more serious systemic reaction requiring immediate medical attention.
Optimizing Recovery and Post-Treatment Care
Following treatment, hydration is a primary part of post-treatment care to help flush the bladder. Patients are advised to drink at least two to three liters of fluids over the 24 hours following instillation. This high fluid intake helps dilute any remaining BCG bacteria and reduces the concentration of irritants on the bladder lining, potentially mitigating cystitis symptoms.
Patients should avoid strenuous activities for the first 24 to 48 hours, though most can return to work or school within one to two days. Discomfort is often managed using approved over-the-counter medications, such as acetaminophen or ibuprofen, to address flu-like symptoms and general aches. Patients must confirm with a healthcare provider which pain relievers are appropriate for individual use.
A patient should contact their doctor if they experience severe, persistent pain not relieved by approved medication or if symptoms worsen after the initial 48-hour period. High fever exceeding 101.5°F (38.6°C), or blood in the urine lasting longer than 48 hours, should also prompt a call to the care team. These guidelines ensure that potential complications, such as a severe systemic infection, are addressed promptly.