Ketamine it’s not just for the operating room anymore. Used primarily as a surgical sedative, this drug has made headlines in recent years for its role in treating depression, PTSD and chronic pain – as well as a more controversial reputation as a party drug. But alongside its increasing medical use and misuse, a new concern has emerged: ketamine’s effect on bladder.
Our goal is to help people understand urological health. With so much in the news, we wanted to shed some light on what ketamine is, the bladder dysfunction it can cause, and how these pathologies can be treated.
Why the Sudden Buzz?
With the help of media attention, ketamine use by celebrities has made headlines. Public interest was piqued when they were rumored to have had medical issues related to ketamine. Whether these reports are accurate or not, they have highlighted the potential consequences of ketamine (mis)use.
Ketamine has also gained traction in psychiatry, supported by a growing body of research and clinical trials.1 Legitimate clinics follow strict protocols and are staffed by certified health professionals. Within these structured medical settings, ketamine has shown promise for treating conditions such as treatment-resistant depression, PTSD, and chronic pain. But not all clinics meet these standards – some operate on the fringes, blurring the line between evidence-based care and risky experimentation.
With wider availability comes more exposure, and not always through the right channels. Some people even choose to self-medicate without medical guidance. While therapeutic use can be life-changing, misuse can pose real risks.
What is ketamine?
Originally developed in the 1960s, ketamine hydrochloride (ketamine) was approved by the United States Food and Drug Administration (FDA) for use as an anesthetic in emergency medicine and medical, surgical, dental, and pediatric procedures.
Pharmacologically, ketamine works as an NMDA receptor antagonist – meaning it blocks receptors in the brain involved in pain perception, memory and mood regulation. This blockade increases levels of glutamate (a neurotransmitter), which triggers synaptogenesis (the formation of new connections between neurons) and brain-derived neurotrophic factor, or BDNF (important for cognitive function). These actions contribute to ketamine’s rapid onset of action in relieving symptoms of depression and chronic pain.
Ketamine also acts as a “dissociative anesthetic” by disconnecting the brain from sensory input. This allows for sedation and pain relief without completely stopping breathing or muscle function, making it particularly useful in certain medical settings such as emergencies and surgeries.
Despite its accepted medical uses, ketamine is classified as a Schedule III controlled substance, meaning it has legitimate clinical applications, but also carries the potential for psychological dependence and misuse. When taken outside of supervised care, especially in high doses, ketamine can cause serious side effects.
According to the National Institute on Drug Abuse2ketamine can distort the perception of sight and sound and can create feelings of detachment from the body – a phenomenon sometimes referred to as a “k-hole”. Short-term side effects may include dizziness, nausea, blurred vision, and changes in blood pressure or heart rate. Long-term, frequent, or large doses have been linked to memory problems, anxiety, depression, and in some cases, psychosis (a mental condition where a person loses touch with reality). Using ketamine with other substances, such as opioids or “club drugs,” can further increase the risk of life-threatening complications.
Another concern – and the topic of this blog – is the effect of ketamine on the bladder. Frequent recreational use has been associated with ketamine-induced uropathy, a condition that can cause symptoms similar to a urinary tract infection (UTI). We will explore this in more detail next.
How does ketamine affect the bladder?
The exact mechanism by which ketamine damages the bladder is not fully understood, but research suggests that the drug and its metabolites are excreted in the urine, where they come into prolonged contact with the bladder lining.3 This contact appears to cause inflammation, fibrosis (scarring) and ulceration, leading to progressive damage over time.
Ketamine-induced cystitis is specific to the bladder and otherwise known as ketamine cyst syndrome (KBS). KBS is characterized by inflammation, ulceration and scarring of the bladder lining. People with KBS usually experience urinary frequency, urgency, dysuria (painful urination), nocturia (frequent urination at night), and pelvic or suprapubic pain. Bladder capacity often shrinks significantly due to fibrosis, causing patients to urinate frequently and suffer from incomplete bladder emptying. There may also be blood in the urine (haematuria) and urinary incontinence.
While the bladder bears the brunt of attention, ketamine can also affect the kidneys and ureters (the tubes that connect the kidneys to the bladder). Ketamine-induced uropathy is an umbrella term that encompasses the entire spectrum of urinary tract damage, from bladder irritation to kidney dysfunction. As mentioned earlier, it may have similar symptoms to a UTI – but it doesn’t respond to antibiotics like a UTI would. In advanced cases, the flow of urine can be obstructed, leading to hydronephrosis (swelling of the kidneys) and possibly kidney failure. The severity of uropathy usually depends on how long and how often ketamine has been used, with prolonged use increasing the risk of serious complications.
Treatment of Ketamine-Induced Urological Disorders
Although the exact biological mechanisms remain under investigation, the toxic effect of ketamine on the urinary system is well documented. Continued use significantly increases the risk of chronic bladder and kidney problems.
If caught early, ketamine-related bladder damage can be reversible or at least manageable. But the first and most important step is to stop using ketamine. Continued exposure can worsen the damage and accelerate functional decline.
It is important to note that medically supervised use of ketamine administered in therapeutic doses, such as for surgical procedures, is usually not associated with the same risks. The exception to this would be any underlying medical concerns or history that would be discussed with your healthcare provider.
Here’s what treatment might look like:
Diagnosis: If someone presents with urinary tract symptoms and has a history of ketamine use, a urologist may perform several tests:
- Urinalysis and urine culture to rule out infection
- Cystoscopy for visual inspection of the bladder lining
- Urodynamic examination to assess bladder function
- Imaging to check for structural abnormalities
Management for mild cases:
- Oral medications such as anticholinergics (to block nerve signals) or β-3 agonists (to stimulate bladder capacity) can help reduce bladder spasms.
- Pain management may include oral analgesics (painkillers taken by mouth) or bladder instillations (medicine given directly into the bladder).
- Increased hydration is often recommended to help dilute the urine, flush out irritants, and minimize bladder inflammation.
Advanced Treatments If symptoms persist or damage is more severe:
- Bladder instillations with hyaluronic acid or chondroitin sulfate—substances found naturally in healthy connective tissue—may help restore the lining of the bladder.
- Botox injections into the bladder wall can reduce muscle hyperactivitycalming spasms and improving bladder control.
- Neuromodulation therapies, such as speripheral nerve stimulationuse mild electrical impulses that can regulate the nerves that control bladder function.
- Surgery, in extreme cases, may include bladder augmentation (enlargement of the bladder) or even urinary diversion (re-routing urine through a new pathway) if the bladder is no longer functional.
The success of treatment depends on timely action. Once the bladder wall is severely scarred or the capacity is significantly reduced, conservative options become less effective and surgery may be the only way forward.
Ketamine Crossroads
Bladder problems from ketamine use may reflect a complex overlap between behavioral health, substance use, and access to care. For people who use ketamine recreationally, these symptoms can serve as a wake-up call. And for those using it medically, it’s still important to stay informed and communicate openly with your care team, especially if something feels off.
Although this article focuses on the bladder, we would be remiss not to acknowledge a potentially deeper issue: substance use disorder. If you or someone you know is struggling, there are hotlines, therapists, clinics and support groups available to help. You don’t have to have all the answers before you reach out – just take the first step, make the call and learn the details as you go.
Dr. Natale takes his patients’ urinary health seriously. If you are experiencing urinary symptoms and have a history of ketamine use, whether medical or recreational, don’t wait. We can help identify the problem and offer treatment options before the condition worsens or becomes unmanageable. We’re here to help you get back on track – no judgement, just support.
1 Rosenbaum, SB, Vikas, Patel, P., & Palacios, JL (2024, January 30). Ketamine. nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470357/.
2 National Institute on Drug Abuse (NIDA). (2024, April). Ketamine. Nida.nih.gov. https://nida.nih.gov/research-topics/ketamine#health-risks.
3 Tsai, YC, & Kuo, H.-C. (2015). Ketamine-induced cystitis: Its urologic impact and management. Urological Science, 26153–157. https://doi.org/10.1016/j.urols.2014.11.003.
