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Loss of Bladder Control at Home and Work

How cancer treatment affects bladder control and what you can do about it.

UI is a common side effect of some cancers and treatments, especially those involving the prostate, bladder and reproductive organs.

Bowel and bladder problems are among the most upsetting issues people face during and after cancer treatment. Cancer patients with bladder problems can often feel anxious and fearful to go out in public. It can come as a surprise and totally upend your quality of life. Fear of having an accident may keep you from being physically active, enjoying outdoor hobbies such as sports, or spending long periods outside your home like when you are traveling. Being intimate or having sex can be scary because you are afraid of urine leakage.

This loss of control can happen either due to or after treatment for bladder, prostate, colon, rectal, ovarian, uterine, cervical or other cancers. Brain and spinal cord cancers can also affect the nerves that regulate bladder function.

When it comes to cancer treatment, the bladder can be affected in several ways. Radiation to the pelvic area can irritate the bladder. Certain types of chemotherapy can cause nerve damage and irritation of the bladder wall. Hormonal changes can affect bladder function and surgery to the pelvic area can damage the muscles or nerves that help control bladder function.

In women there are several other factors that can contribute to bladder weakness including changes to urinary or vaginal tissue from hormonal changes related to menopause, pelvic prolapse where the bladder, uterus, and or rectum may slip backward or downward into the vaginal canal because of weak pelvic wall muscles, multiple pregnancies, and prior history of hysterectomy where the uterus has been removed. In men, having an enlarged prostate can also affect bladder control.

Certain medications can cause your body to make more urine or increase the amount of water in the body which can worsen incontinence. Having other comorbidities such as cardiac dysfunction or kidney issues can add to bladder issues including increased risk of incontinence due to decreased muscle tone in the bladder or a decrease in cardiac output, which means patients have more urinary output at night when they lie down and when there is less demand on the heart. The risk is further increased in older patients who form a large percentage of cancer patients. Another issue to consider is that many patients and caregivers think urinary incontinence is a natural progression of age thus minimizing reporting it to their physicians causing it to be frequently under-assessed and undertreated.

Sometimes, cancer and its treatment may affect bladder function by changing the nerves and muscles used to control urine flow. A prostatectomy (removal of the prostate), for instance, may affect the valves of the bladder and disrupt the way it holds urine.

Incontinence (which means lack of bladder control ranging from accidental loss, leaking, or dribbling of urine) caused by cancer or cancer treatment can last a short or a long time, and it can range from mild or severe. Cancer patients may feel symptoms that range from leaking a little urine to a total lack of urination control including:

  • Leaking urine during daily activities

  • Getting up often during the night to urinate

  • Not being able to hold urine

  • Taking a long time to urinate

  • Urinating small amounts

  • Feeling the bladder is never empty

  • Having a weak urine stream

These symptoms can arise due to different types of bladder control problems which include:

  • Stress Incontinence. It is the most common type of urinary incontinence. It is estimated half of women over age 65 have stress urinary incontinence. Mild stress incontinence may cause you to leak drops of urine during activities like heavy exercise, laughing, coughing or sneezing. With moderate to severe stress incontinence, you may leak more than a tablespoon of urine even during less strenuous activities like standing up or bending over. You may even leak urine while having sex.

  • Overflow Incontinence. Overflow incontinence is usually caused by a blockage or narrowing caused by scar tissue. It also may happen when the bladder muscle can’t squeeze well enough to get all the urine out. Signs of overflow incontinence might be getting up often during the night to go to the bathroom, taking a long time to urinate, or having a weak, dribbling stream with little force. You might pass small amounts of urine but not feel empty. Or you may feel like you have to go to the bathroom but cannot. You might leak urine throughout the day. Men with enlarged prostate issues are usually the most likely to develop overflow incontinence. Prostate cancer can block the urethra, allowing only small amounts of urine to come out when you pee. After prostate cancer surgery, radiation or other surgery on the urethra, you can develop scar tissue that causes a blockage, called a stricture. People with diabetes and nerve damage are also more prone to overflow incontinence.

  • Urge Incontinence. Urge incontinence is a type of urinary incontinence that causes an urgent, uncontrollable need to pee several times during the day and night. You may leak urine before you get to the bathroom. Other signs of urge incontinence include frequent peeing more than twice at night, leaking urine before you can make it to the bathroom or just after you peed and sometimes wetting the bed at night. An overactive bladder causes urge incontinence. An overactive bladder causes your muscles in your bladder to squeeze more often than they should. This makes you feel like you have to pee before your bladder is actually full. The squeezed bladder also causes your sphincter muscle inside your urethra (the tube that carries urine out of your body) to relax. When this muscle opens, it lets urine leak out. Women are twice as likely as men to develop urge urinary incontinence.

  • Overactive Incontinence. This occurs when the bladder's muscle contracts involuntarily. It increases urinary frequency and urgency. This occurs when the bladder muscle contracts and urine leaks (often in large amounts) without any warning or urge. This can happen as a result of damage to the nerves that normally warn the brain that the bladder is filling. This type of incontinence usually appears in people with serious neurological damage, spinal cord injury, other injuries, or damage from surgery or radiation treatment.

  • Continuous Incontinence. Urine leaks out constantly, and you cannot control it. This can be very debilitating and seriously affect your quality of life. You may be left with little or no bladder control at all. Even if you have some control, the frequency and length of your bathroom visits can be debilitating including affecting your ability to get a full night’s sleep which is essential for recovery.

There are many different factors that your cancer care team will consider when creating a treatment plan for your specific type of incontinence. The type of incontinence and the ways it affects your life are important considerations which will help decide what types of treatment are right for you and also what you are most comfortable with.

There are three main types of treatment you can explore for incontinence — medications, lifestyle changes and surgery. Each option has pros and cons that your team will discuss with you. The next blog will discuss these options in some detail so you have a better understanding of what to expect and how to be a better advocate for your health.

Reason to Hope

One of the most commonly performed surgeries to treat stress urinary incontinence in women may have better long-term results than another common surgical technique, according to a new study. The retrospective study of more than 1,800 cases at Mayo Clinic from 2002 to 2012 found that the need for additional surgery was twice as high after a transobturator sling surgery compared with a retropubic sling procedure. Obstetrics & Gynecology 134(2):p 333-342, August 2019. | DOI: 10.1097

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Reason to Hope

There is new research from Brigham and Women’s Hospital that indicates a Western-style diet that is rich in red and processed meat, sugar and refined grains/carbohydrates is tied to higher risk of colorectal cancer through the intestinal microbiota.  Gastroenterology, 2022;DOI:10.1053/j.gastro.2022.06.054 

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