Managing bladder late effects after pelvic radiotherapy
There are lots of things you can do to keep your bladder healthy and to help with symptoms caused by the late effects of pelvic radiotherapy.
Drink plenty of fluids
Try to drink at least two litres (four pints) a day. That’s about eight glasses. Drink even more if it’s hot or if you’re exercising. Try to drink small amounts regularly throughout the day and increase it gradually.
Not drinking enough will make your symptoms worse, not better. Urine that’s concentrated irritates the bladder. Drinking more will reduce symptoms of bladder irritation and train your bladder to hold more urine. It also reduces your risk of getting urine infections.
Drink the right fluids
Some drinks can irritate the bladder and make symptoms worse. Cut down on or avoid:
alcohol (especially spirits)
drinks that contain caffeine (such as tea, coffee, cola and cocoa)
acidic drinks (such as fresh orange and grapefruit juices)
drinks with artificial sweeteners (diet or light).
Try drinking water, diluted fruit juice and herbal teas (but avoid those that contain hibiscus).
If you’re prone to urine infections, drinking cranberry juice or taking cranberry capsules may help prevent them. But don’t drink cranberry juice or take capsules if you’re on medicine to thin your blood, such as warfarin, as this can increase the effects of the medicine, which can be harmful. Cranberry juice is high in sugar, so it’s not suitable for people with diabetes.
Try not to go to the toilet ‘just in case’
If you go to the toilet as a precaution, the bladder won’t fill completely and won’t get used to holding more urine.
If you’re a smoker, try to stop
The chemicals in cigarette smoke irritate and damage the lining of the bladder and can make your symptoms worse. Smoking is also a major risk factor for cancer and for other serious health conditions. We have a section on giving up smoking that you may find helpful.
Avoid putting extra pressure on your pelvic floor muscles
Keep your weight within healthy limits, and try to avoid constipation and heavy lifting. This is especially important if you have stress incontinence.
Find ways of reducing your stress
can make you feel as if you need to pass urine and can make your symptoms worse.
We have more information on coping with bladder changes day-to-day.
You may have to pass urine more frequently than usual after having pelvic radiotherapy. Your bladder may be more sensitive and feel full even when there’s not much urine in it. This is known as an overactive bladder
. There are several things that can help ease this. Your doctor or continence adviser may suggest one or a combination of the following treatments for you.
This means training yourself to ignore the feeling of needing to pass urine, so your bladder gets used to feeling fuller. This can help the bladder hold more urine, so you won’t need to go to the toilet as often. It can be difficult at first, but it gets easier with time. It’s best to retrain your bladder with advice and support from a continence adviser or doctor.
You should begin by keeping a record of how often you go to the toilet and how much urine you pass each time. Your specialist nurse or physiotherapist may have a chart you can use.
Bladder retraining is done in stages. You start by ‘holding on’ for a few minutes and gradually increase this by a few minutes each time. Here are some things you could try to take your mind off the urge to pass urine:
sit straight on a hard seat
count backwards from 100 or recite the alphabet backwards
read a book or a newspaper.
Don’t be tempted to cut down on fluids when retraining your bladder. Keep drinking fluids as normal. Avoid retraining your bladder overnight - your daytime exercises will eventually mean you need to go to the toilet at night less often.
After some weeks, resisting the urge to pass urine straight away gets easier and you’ll have longer spells between going to the toilet.
Drugs to relax the bladder
Some types of drugs, called antimuscarines or anticholinergics, can help relax the bladder so it can hold more urine. These drugs may be used to treat an overactive bladder or stress incontinence.
There are several drugs that can help, so if one doesn’t work you can try another.
Treatment with botulinum toxin A (Botox®)
This involves having injections of botulinum toxin A (Botox®) into the bladder muscles. It’s done under a general anaesthetic. The drug paralyses part of the muscle to help relax the bladder. It should help you hold on for longer and may also help reduce incontinence. This is still quite a new way of treating bladder symptoms, so doctors are still finding out how helpful it is and whether this treatment has any drawbacks.
Some men leak urine as a result of pelvic radiotherapy. Radiotherapy can weaken the valve that keeps the bladder closed and the pelvic floor muscles that help you control your bladder. You may leak small amounts of urine when you laugh, sneeze or cough, or when you’re exercising. This is called stress incontinence
. If you have an overactive bladder, you may find that you can’t always get to the toilet in time. This is called urge incontinence.
This section covers some of the ways in which incontinence can be treated and managed. Some of the treatments mentioned in the section on an overactive bladder can also help to improve urge incontinence.
Looking after your skin is very important, as urine can irritate the skin. The section on coping with bowel and bladder changes has information on skincare, what to do when you’re not at home and getting support. There’s also advice on special products, such as pads and pull-ups, you can use while you’re waiting for treatment to work.
Pelvic floor exercises
The most common treatment for urinary incontinence is doing exercises to strengthen the pelvic floor muscles.
It’s best to ask your doctor to refer you to a continence adviser to teach you how to do the exercises correctly. The Bladder and Bowel Foundation can also provide details of your nearest adviser and can send you leaflets showing you how to do pelvic floor exercises.
Here’s a brief description of how to do pelvic floor exercises, but we recommend you get more detailed information and professional advice.
To begin with, you need to find the correct muscles to squeeze. Place your fingertips just behind your scrotum. Try to squeeze your pelvic floor muscles by tightening your back passage. Lift the muscles upwards and forwards. When you do this, you should be able to feel the skin behind the scrotum lift upwards away from your fingers.
Sit comfortably and squeeze the muscles for up to 10 seconds. Release the muscles and relax for four seconds. You should have a definite feeling of ‘letting go’. Don’t hold your breath or push down when you’re doing the exercises - make sure you’re squeezing and lifting up.
Try to repeat the squeeze 10 times, holding for up to 10 seconds each time. To begin with, you may not be able to do as many as 10 or to hold for as long as 10 seconds. Just do as many as you can manage. With time you’ll be able to do more.
After you’ve finished a set of 10, rest for a minute. Then try to repeat 10 short squeezes, lifting up as quickly and strongly as you can and letting go straight away.
It can take at least 12 weeks of practising these exercises three times a day to get the muscles back into shape.
As your muscles improve, try doing them while you’re doing everyday jobs. Squeeze them before standing up, when you’re lifting or pulling anything, for example, when you’re gardening.
Try doing them before you cough or squeeze to help prevent urine leaks (stress incontinence).
If you find it difficult to learn the exercises, you may be offered biofeedback training to help you. As you squeeze your pelvic floor muscles, the pressure is measured by sensors. This helps you to know when you’re squeezing in the right way. Ask your continence adviser for more information about this.
If incontinence problems don’t improve with the treatments we’ve mentioned, there are other options. Your doctor may talk to you about these.
This may help some people with mild incontinence. Your doctor may be able to refer you for acupuncture, or you can contact the British Medical Acupuncture Society.
Male slings are a new treatment for men who have moderate (not severe) incontinence, and they are still being evaluated. The sling is a small, soft mesh that’s placed inside the body, under the urethra, during an operation. The sling presses on and supports the urethra, helping to keep it closed without blocking it. There are different types of sling, but they work in much the same way.
AUS (artificial uriniary sphincter)
This involves fitting a circular cuff around the urethra and placing a small pump in the scrotum while you’re under a general anaesthetic. The cuff closes off the urethra to stop urine leaking. When you want to pass urine, you deflate the cuff by squeezing the pump. This takes pressure off the urethra, allowing it to open so you can pass urine.
Men who are leaking a lot of urine most of the time (severe incontinence) can be assessed for this treatment. You need to have been incontinent for at least a year after radiotherapy to have this.
If you have blood in your urine, you’ll need to have a cystoscopy to find out why. If the bleeding is a result of radiotherapy but is mild, you may not need any treatment. If it’s regular, heavy or causing anaemia (when your body produces fewer red blood cells than usual), you’re likely to need treatment. There are several possible treatments.
Tranexamic acid (Cyklokapron®) tablets can stop clots dissolving and reduce bleeding. Your doctor may prescribe these for you.
Giving drugs into the bladder
Some drugs can be dissolved in fluid and given directly into the bladder to stop the bleeding.
For this treatment, you’ll need to lie down while a nurse gently passes a thin, flexible tube (a catheter) through the tip of your penis into the bladder. Fluid will slowly be passed through it. The catheter is then removed and you hold the fluid in your bladder for about half an hour to give the treatment time to work. After this, you’ll need to empty your bladder. You might feel some discomfort when passing urine for a couple of days afterwards.
Your doctor will explain more about this treatment and its possible side effects.
Bladder wash out
If you’re passing blood clots in your urine, these may need to be flushed out to make sure the clots don’t block your urethra. A liquid is passed through a catheter into your bladder, and then drained into a bag attached to the catheter. A nurse or doctor will continue to flush out the bladder in this way until the clots have gone.
Using heat to seal off the bleeding points (cauterisation)
Sometimes, if medicines don’t stop the bleeding, heat can be used to seal up the blood vessels causing the bleeding. This is done using a cystoscope while you’re under a general anaesthetic.
Hyperbaric oxygen therapy
Hyperbaric oxygen therapy
is normally only used after other treatments have been tried. It increases the amount of oxygen getting to tissue in the bladder that’s been damaged by radiotherapy. This can encourage new blood vessels to grow and the tissues to heal.
If you have become anaemic because of bleeding from your bladder, you may feel breathless or tired. Your doctor may suggest you have a blood transfusion to replace the blood you’ve lost and make you feel better.
Sometimes, radiotherapy can cause the urethra (the tube that drains urine from the bladder) to narrow. You may have difficulty passing urine or find yourself straining to release it.
Problems passing urine can be caused by many common conditions. So if you have these symptoms it’s important to get them checked out by your doctor. If urine builds up in the bladder and it isn’t treated, it can cause infections and damage the kidneys. Your doctor or continence adviser will do tests to find out the cause so you can be offered the right treatment for your situation.
Sometimes, doctors treat a narrowed urethra (urethal stricture) by passing a thin plastic tube through to widen (dilate) it. This can be done under a general or local anaesthetic and repeated if necessary. Another possible treatment is an operation (called a urethrotomy). This is done under a general anaesthetic to allow the surgeon to make a cut along the stricture. A larger stricture may need to be treated with an operation that uses tissue from another part of the body to repair the urethra (a reconstruction).
If bladder problems don’t improve
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If symptoms continue or don’t improve with the first treatments that are tried, your specialist will be able to discuss other treatments that are available. Occasionally, surgery may be needed. If symptoms are very severe, an operation to remove the bladder may be needed. This is extremely rare, though.