Changes to bladder function after bowel cancer treatment
Some people have problems with bladder control after treatment for rectal cancer.
Changes also happen as the bladder muscles age, so these symptoms can also be due to ageing, and are more common as people get older.
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, which connects the bladder to the outside of the body.
Possible effects of surgery
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Sometimes an operation to the rectum can affect the nerves to the bladder. These nerves control the muscles that hold urine in the bladder and also tell the muscles to squeeze to empty the bladder. Nerve damage can cause loss of bladder control leading to leakage of urine (urinary incontinence) or difficulty in emptying the bladder (incomplete emptying).
Possible effects of radiotherapy
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Radiotherapy to the rectum and surrounding tissues (pelvic radiotherapy) often causes bladder symptoms that get better within a few weeks of treatment ending. It’s not common for radiotherapy to the bowel to cause long-term changes to the bladder, but a small proportion of people do notice changes to their bladder function several months after treatment.
Bladder symptoms due to the late effects of radiotherapy 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.
If you have any of these symptoms it’s important to have them checked out by your doctor. Blood in the urine should always be checked by a doctor without delay.
We have more detailed information about bladder changes due to pelvic radiotherapy, and what can help, in our sections on pelvic radiotherapy in men - possible late effects and pelvic radiotherapy in women - possible late effects.
Managing bladder changes
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Bladder problems can be embarrassing and difficult to talk about. If you’re having difficulties, you may feel worried about going out and taking part in social occasions. However, there are many things that can be done to manage symptoms.
It’s important to talk to your doctor if you’re having problems. They can refer you to a specialist in bladder control problems, such as a urologist or continence nurse, for assessment and treatment.
We also have helpful advice about coping with bowel and bladder changes.
Incomplete bladder emptying
Sometimes nerve damage means the bladder muscle can’t squeeze strongly enough to empty the bladder completely. The most common symptoms of this are:
difficulty passing urine
a delay in starting to pass urine
a weak stream of urine
straining to release urine.
If you have any of these symptoms, it’s important to get them checked out as they can lead to more serious problems if left untreated. There are other common conditions that can cause problems with bladder emptying, such as an enlarged prostate gland in men, so this may not be related to your cancer treatment. Your doctor or continence specialist will do tests to find out the cause so you can be offered appropriate treatment.
Urinary incontinence can vary in its effects. For some people it means leaking just a few drops of urine when sneezing or coughing. For others it may mean a total loss of control over passing urine.
If you have symptoms, a continence specialist can assess the severity and type of incontinence you have and recommend treatment based on this.
One of the most common treatments for urinary incontinence is exercises to strengthen the muscles that are important for bladder control (pelvic floor muscles). These exercises can also help with bowel control. The Bladder and Bowel Foundation also has a fact sheet with instructions on how to do them.
Coping with urinary incontinence
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There are specialist products and practical things that can help you to cope with urinary incontinence while you’re waiting for a diagnosis or for a treatment to work. A continence specialist can give you more information about the different products available and can help you select which type best suits your needs. The Bladder and Bowel Foundation can also offer advice and support via its helpline and website.
If you find it difficult to learn pelvic floor exercises, you may be offered a procedure called biofeedback training to help you. As you squeeze your pelvic floor muscles, the pressure is measured by sensors. The results are either shown on a computer screen or they register as a sound. This helps you to know when you’re squeezing the muscles in the right way. Your continence adviser or physiotherapist can advise you on where you can get this training.
There is a wide range of pads and pull-ups that absorb urine leaks. They have a layer that draws urine away from the surface, so your skin stays dry. There are designs for both men and women and for different types of incontinence.
You can buy pads for mild to moderate incontinence in most supermarkets, pharmacies and online. If these pads aren’t absorbent enough, you can get bigger pads from your continence nurse or district nurse.
Sheaths and leg bags may be useful for men who don’t want to use pads. A sheath fits over the penis and urine is drained into a bag that is strapped to the leg.
There are also various types of pads that you can use on your bed at night. They soak up any urine leakage, keeping your skin dry and helping you sleep through the night.
What’s available on the NHS varies from region to region. Your district nurse can advise you whether you’re eligible for continence products through the NHS. The Bladder and Bowel Foundation also provides a list of suppliers of incontinence products.