Sometimes, women who have had pelvic radiotherapy notice changes in the way their bladder works. For some women, these changes start during treatment and don’t get better.
But they may develop months or years after treatment has finished. Changes also happen as the bladder muscles age, so the symptoms here are more common in older women.
Women are also more likely to get urinary problems as a result of pregnancy, childbirth and the menopause, which can all weaken the pelvic floor muscles.
The bladder is a stretchy, muscular bag that collects and stores urine. It’s in the lower part of the pelvis, connected to the kidneys (which produce urine) by tubes called the ureters. Urine drains from the bladder through a tube called the urethra.
The bladder is supported by the pelvic floor muscles, which act a bit like a hammock. Some of these muscles wrap around the urethra (called the urethral sphincter), keeping it sealed like a valve until you need to pass urine.
When the bladder is full, it sends a signal to the brain that you need to pass urine. When you’re ready, the brain tells the pelvic floor muscles to relax and open the urethra. The bladder muscles tighten (contract) and push the urine out.
Pelvic radiotherapy can cause scarring and hardening (fibrosis) of the bladder wall, which shrinks the bladder so it holds less urine. It can also weaken the pelvic floor muscles and the valve that holds the bladder closed. This means that small amounts of urine can leak out (incontinence).
After radiotherapy, small blood vessels in the bladder lining may be more fragile and bleed easily. This can cause blood in your urine. Sometimes radiotherapy causes the urethra (the tube that carries urine from the bladder out of the body) to narrow. This is called a urethral stricture.
Many of the symptoms of late effects are similar to the immediate side effects of radiotherapy.
The symptoms of late effects to the bladder can include:
needing to pass urine more often than usual
a burning sensation when you pass urine (like cystitis)
being unable to wait to empty your bladder (urgency)
leaking urine (incontinence)
blood in your urine (haematuria)
difficulty passing urine.
Many of these problems can be dealt with successfully.
There are lots of things that can be done to manage or treat your symptoms. Your doctor can advise you, or you may need to be referred to a specialist in bladder problems (a urologist). You can also be referred to a specialist nurse or physiotherapist for continence advice and treatment (we use the term continence adviser because it’s shorter). The treatment that’s right for you will depend on the symptoms or side effects you have and how much of a problem they are.
If you develop bladder problems after your treatment, your doctors will probably want you to have some tests to find out the cause. Your GP can test your urine to check if you have an infection, and take blood tests to find out how well your kidneys are working. Depending on your symptoms and how they respond to treatments, other tests may be arranged by a urologist or a continence adviser. These include:
A cystoscopy to look at the inside of the bladder. A thin, flexible tube with a light on the end (a cystoscope) is passed through your urethra and into your bladder. This is usually done under a local anaesthetic.
Urodynamic tests to assess how well your bladder and urethra collect, hold and release urine. These are usually done to find out the causes of incontinence.