Managing urinary incontinence every day is about focus & routine.
“Urinary incontinence is a common complication of cancer and cancer therapies that can impose long-term effects on quality of life; yet, this condition remains underemphasized in this patient population.” Dorothy Smith, RN, OCN
Bladder control problems are a common and often under-reported side effect of cancer treatment, but they can be effectively managed with the right strategies. Treatment for urinary incontinence must be personalized and involves consideration of many factors. Here are some ways to make life easier for you at work, at home and in social situations:
Try to maintain a urination schedule. Setting routine times to urinate may help retrain the bladder. Instead of waiting for your bladder to feel full, use the bathroom at regular timed intervals. Timed urination helps keep the bladder empty and prevent accidents. It may take some time to find a schedule that works for you, so be patient. Here is an example of a schedule: Empty your bladder when you first wake up in the morning. Schedule times throughout the day when you will urinate. Start by going to the washroom every hour, even if you do not need to go. Slowly increase the time between trips to the washroom.
Keep a bladder diary. A bladder diary is a simple chart which allows you to record the fluid you drink and the urine you pass during the day and night, as well as document if you have urgency (a sudden and intense need to pass urine that cannot be put off) and/or accidental urine leakages. A bladder diary may be a useful tool to identify the type of incontinence you have. The bladder diary will note the number of times you urinate, the amount of urine passed, the pad weight if you are using pads, and times when you had incontinence or urgency. This is typically done over 24 hours and for 3 consecutive days to help identify the problem. Bring the diary to your cancer care team, who may be able to see a pattern and provide treatment recommendations.
Prepare ahead. Empty your bladder (even if you don’t think you need to) before leaving the house, getting in the car, or going to bed. Locate bathrooms when you arrive at places outside of your home, such as restaurants. Also, clear your path of obstacles so you can get to the restroom faster and easier. Wear clothes that are easily removed, such as pants with elastic waistbands. Women may find it helps to wear a tampon or a sanitary pad during activities, as it puts pressure on the urethra to prevent leakage. Men can also use incontinence pads or shields inside their underwear.
Try bladder retraining techniques. Behavioral modification has been shown to be particularly successful in helping some patients control incontinence. Bladder retraining may help increase your bladder capacity so it can hold more urine for longer periods of time. Instead of urinating whenever you feel the urge, try to wait a few minutes and gradually lengthen the time between bathroom trips. You should try to urinate at set times of the day, such as once every hour, and eventually build up to once every three to four hours.
Strengthen your pelvic muscles. Because the bladder is controlled by muscles, it can be trained. Pelvic floor exercises, called Kegels, may help strengthen the muscles that control urination. Everyone should be encouraged to practice pelvic muscle exercises regularly as a preventive measure. Patients need to know that developing the pelvic muscle provides urinary support. Every woman needs to learn this before her first child is born, and every man needs to learn it before he reaches the age of an increased risk of prostate cancer. It's never too late to start though. Try to tighten the muscles you use to start and stop the flow of urination, hold for a count of three, and then release. Gradually work up to three sets of 10 repeats in different positions (lying down, sitting, or standing). Your healthcare team may advise how to perform the exercises correctly.
Balance your fluid intake. A normally functioning bladder needs to void every 3 to 4 hours. It’s important to maintain a healthy balance of fluids. Drinking too much fluid may cause bladder leakage. Not drinking enough fluid may cause dehydration, which may irritate your bladder and further aggravate urinary incontinence. Try to drink small amounts throughout the day, rather than large amounts at one time. Also, drink more at the start of the day and less before you go to bed.
Break bad habits. Alcohol and caffeine may be irritating to the bladder. To reduce urination urgency, it’s important to limit your intake of alcoholic beverages and caffeinated drinks, such as coffee, tea, and some carbonated drinks. Also, don’t smoke. Not only is smoking discouraged for health reasons, it may lead to coughing, which may exacerbate urine leakage.
Make dietary modifications. Some foods may irritate your bladder and aggravate urinary incontinence. Try to limit your intake of carbonated drinks, dairy products, acidic foods (e.g., citrus fruits, tomatoes), spicy foods, vinegar, chocolate, sugar, and artificial sweeteners. The American Urological Association recognizes some foods as potentially having a calming effect on sensitive bladders. These foods include pears, bananas, green beans, squash, potatoes, lean proteins, whole grains, nuts, bread, and eggs. If constipation is a problem, increase the amount of fibre and fluid in your diet.
Maintain a healthy lifestyle. Obesity can certainly increase the risk of urine leakage- for example, belly fat can push on the bladder. Therefore it’s important to maintain a healthy weight. There may be concern regarding vigorous or even gentle exercise for fear of urine leakage, however, it is important to get in regular physical activity at the level you are capable of and build better exercise capacity. Voicing your concerns and advocating for your health with your family and your cancer care team can get you the support you need to maintain a healthy weight.
Check your medications. Talk to your doctor about all medicines, vitamins, herbs, and supplements you’re taking. Some may affect urine control.
Try using incontinence products. Pads worn under your clothing and other products that can help with incontinence are available to help keep you active and comfortable. Adult incontinence diapers are bulkier than pads but provide more protection. Bed pads or absorbent mattress covers can also be used to protect bed linens and the mattress.
However, when choosing incontinence products, keep the questions below in mind.
- How much does the product hold or absorb?
- How long will it protect me?
- Can it be seen under my clothing?
- Is it disposable?
- Is it reusable?
- Do I feel comfortable in it when I move or sit down?
- Which stores near me carry the products?
- Can I order it online easily for home delivery?
- How much will it cost?
- Will my insurance help pay for these products?
"Both patients and physicians tend to disregard incontinence...I've seen patients, men and women, who have been wet for 10 or 11 years. Although they are frustrated, they are coping with their condition rather than discussing it because they are embarrassed."
Above all, talk with your doctor.
In order to find the best treatment for urinary incontinence, it is important to be honest with your cancer care team, even if it is an uncomfortable conversation. Talk with your doctor about the medications you are taking, as some of them may make your incontinence worse. Ask about options for treatment. These can include surgery. Surgical treatment may be done to lift the bladder, tighten the bladder valve, implant an artificial valve that goes around the urethra, inject collagen to stiffen the area around the urethra and bladder valve so it closes better, or implant a small electrical device for nerve impulse and therapy in the bladder. These procedures can help with urinary incontinence.
There are also quite a few medications that can reduce urine leakage. Some of these drugs stabilize the muscle contractions that cause problems with an overactive bladder. Other medications actually do the opposite by relaxing muscles to allow your bladder to empty completely. Hormone replacement therapies can include replacing the estrogen that has decreased during menopause, which may also help restore normal bladder function. In many cases, medications work well to restore normal function to the bladder. Often, your physician will start you on a low dose of the medication and then increase it slowly. This is done to try to reduce your risk of side effects and to keep track of how well the medication is working to treat your incontinence.
"Urinary incontinence presents an opportunity for multitask collaboration because some recommendations will be for medical intervention and some will be for preventive education and behavioural modification."
Reason to Hope
Hyperbaric oxygen therapy (HBOT) can relieve self-reported symptoms and side-effects of radiotherapy against cancer in the pelvic region, a study shows. After 30-40 sessions in a hyperbaric chamber, many patients experienced reductions in bleeding, urinary incontinence, and pain alike. The Lancet Oncology, 2019; DOI: 10.1016/S1470-2045(19)30494-2