Recognizing the early symptoms of bladder cancer can help you get treatment in the early stages of the disease. However, bladder cancer doesn’t always cause symptoms in such early stages. Many bladder cancer symptoms can be subtle and might be mistaken for other health issues. Still, there are signs you can watch for. It’s also important to be aware of symptoms that may develop when bladder cancer spreads to other parts of the body.

Learn more about some of the most common symptoms from early to advanced bladder cancer.

1. Blood in Urine

The first symptom of bladder cancer is often blood in the urine, also called hematuria. If you have blood in your urine, you may not have any other symptoms. Hematuria by itself doesn’t cause any pain.

When you have blood in your urine, it may look red, pink, or brown. If you can see a color change in your urine due to blood, it’s known as gross hematuria. About 85 percent of people diagnosed with bladder cancer experience gross hematuria. Blood in your urine may come and go, and you may not notice a change in the color of your urine every day.

You may also have blood in your urine that isn’t visible to the naked eye. This is called microscopic hematuria. Almost everyone with bladder cancer has microscopic hematuria. The only way to detect microscopic hematuria is with a urine test. If you don’t have any other symptoms, your health care provider may discover microscopic hematuria as the first sign of bladder cancer and order further testing.

Having blood in your urine doesn’t automatically mean you have bladder cancer. About 2.6 percent of those with microscopic hematuria are diagnosed with bladder cancer. However, about 20 percent of people with visible blood in their urine are eventually diagnosed with bladder cancer.

Many other conditions can also cause blood in your urine, such as:

• Urinary tract infection (UTI)
• Trauma or injury to your bladder or kidneys
• Urinary stones
• Enlarged prostate (also known as benign prostatic hyperplasia, or BPH)
• Endometriosis
• Gynecological disorders
• Sexual activity

If you notice blood in your urine, it’s important to talk to your health care provider right away to figure out the cause.

2. Painful Urination and Other Symptoms of Bladder Irritation

About 20 percent of people with bladder cancer have uncomfortable or painful symptoms while urinating. These symptoms include:

• Dysuria (painful urination) — Burning or stinging before, during, or after you urinate
• Pollakiuria (frequent urination) — Needing to pee often
• Nocturia — Needing to wake up to pee at night
• Urgent urination — Feeling as if you have to pee right away, even if your bladder isn’t full

These symptoms are associated with advanced or invasive bladder cancer where the cancer has begun to spread to other tissues or parts of the body.

These symptoms aren’t only caused by bladder cancer — they’re usually caused by another condition. Many other conditions share these symptoms, including:

• UTIs
• Bladder stones
• Overactive bladder
• Enlarged prostate

The other health conditions that can cause these symptoms are also common in the same group of people at risk of bladder cancer — men older than 55 years. For example, Cleveland Clinic states that about half of men over 60 have signs of an enlarged prostate.

3. Difficulty Urinating

Some people with advanced bladder cancer may have difficulty urinating. This may look like having trouble starting or continuing to urinate or a urine flow that isn’t as strong as usual.

Difficulty urinating can happen in bladder cancer if a tumor in your bladder presses on your ureters (the tubes connecting your kidneys and bladder) or your urethra (the tube that allows urine to leave your body). This can cause a urine blockage. Other symptoms of a urine blockage include:

• Stomach or pelvic pain
• Constant feeling of a full bladder
• Frequent urination
• Painful urination

Having an enlarged prostate or bladder stones is another common cause of difficulty urinating. Both of these conditions can also block urine flow in some cases.

4. Back Pain

Back pain can happen in bladder cancer if a tumor blocks the ureters. Your kidneys are just below your rib cage, with one on each side of your spine. You have two ureters — one for each kidney — that connect your kidneys to your bladder. If a tumor is large enough, it can block your ureters, causing pain in your lower back or sides, where your ureters are located.

Back pain related to your kidneys and ureters often feels different from other types of back pain. Kidney-related back pain is usually located just under the ribs on one side of your spine and may feel deeper than other types of back pain. Some people also have other symptoms, such as abdominal (stomach) pain, fever, or nausea and vomiting when the ureters are blocked.

Back pain from bladder cancer may begin gradually and worsen over time. You may also notice that your back pain is only on one side of your body.

Other causes of back pain from blocked ureters include:

• Enlarged prostate
• Blood clots
• Digestive tract problems
• Kidney stones

Back pain in bladder cancer may also develop if bladder cancer spreads to the spine.

5. Swelling in Legs and Feet

Advanced bladder cancer may also cause edema (swelling) in your lower legs and feet. Edema can develop if a tumor presses on the blood vessels that carry blood to the lower half of your body. This can cause a buildup of excess fluid in your lower legs and feet. Lower leg swelling can make your skin feel painful, tight, or stretched. You may also have trouble walking from the excess fluid in your legs and feet.

Several other health conditions can cause swelling in your lower legs, including:

• Heart, lung, or kidney disease
• Some medications, including blood pressure or pain medications
• A diet high in sodium (salt)
• Blood clots

6. Weight Loss

People with advanced bladder cancer may lose weight without trying. Weight loss from cancer can occur for several reasons. Cancer cells can release substances that change hormones controlling hunger, which can lead to loss of appetite.

A large tumor in the bladder or another part of the body where the cancer has metastasized (spread) may press on the stomach or digestive tract, decreasing appetite. If bladder cancer spreads to the liver, it can also cause nausea and decreased appetite. Weight loss may also be associated with fatigue (extreme tiredness), which makes it difficult to complete daily tasks and routines, like eating meals.

Another possible reason for weight loss in bladder cancer is related to treatments. Bladder cancer treatments, such as surgery, chemotherapy, radiation therapy, and immunotherapy, may cause side effects that make it difficult to eat or decrease your appetite.

7. Bone Pain

Bone pain is often one of the first symptoms when bladder cancer spreads to your bones. At first, bone pain may come and go or be worse at night. As the cancer progresses, the pain may become constant or worsen.

If you’re being treated for bladder cancer, bone pain could be a sign that bladder cancer has spread to your bones. Follow up with your cancer care team if you notice new or different symptoms.

Talk to Your Cancer Care Team About Symptoms

It’s important to have an open and honest discussion about your symptoms with your cancer care team. Many other health conditions can cause symptoms similar to bladder cancer. No matter the cause, these symptoms should be discussed with your health care provider. Even if you already have a bladder cancer diagnosis, new or worsening symptoms may help guide your bladder cancer treatment options.

Find Your Team

MyBladderCancerTeam is the social network for people with bladder cancer and their loved ones. On MyBladderCancerTeam, members come together to ask questions, give advice, and share their stories with others who understand life with bladder cancer.

If you have bladder cancer, what symptoms do you experience? Do you have any advice for others with these symptoms? Share your thoughts in the comments below, or start a conversation by posting on your Activities page.