Managing bladder late effects

Late effects on the bladder can be successfully managed or treated. There are things you can do. Drinking plenty of fluids and avoiding drinks that irritate the bladder will help. Talk to your doctor about giving up smoking as this can make symptoms worse.

Try to maintain a healthy weight as this will relieve pressure on your pelvic floor muscles. Reducing stress may also help to ease some symptoms.

Leaking urine, and needing to pass urine often, or urgently can be helped with bladder training and pelvic floor exercises. Leaking urine that doesn’t improve may be treated with drugs.

Radiotherapy narrows the tube that drains urine from the bladder. This may make passing urine difficult. Small strictures can be widened (dilated) using a tube. Larger strictures may need to be treated with an operation.

Talk to your doctor if you have any of these symptoms. They will be able to give you advice and may refer you to a continence advisor.

What you can do

There are things you can do to help reduce symptoms caused by the late effects of pelvic radiotherapy. These things will also help keep your bladder healthy.

Drink plenty of fluids

Try to drink at least two litres (four pints) of fluids a day. This is about eight glasses. And if it’s hot or if you’re exercising, it is important to drink even more. It’s best to drink small amounts regularly throughout the day.

Drinking too little will make your symptoms worse. Urine that’s concentrated irritates the bladder. Drinking more reduces bladder irritation and trains 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)
  • fizzy drinks
  • drinks that contain caffeine (such as tea, coffee, cola and cocoa)
  • acidic drinks (such as fresh orange or grapefruit juice)
  • drinks with artificial sweeteners (‘diet’ or ‘light’ drinks).

Try to drink water, diluted fruit juice and herbal teas.

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 it won’t get used to holding more urine.

Give up smoking

If you smoke, ask your GP about getting help to give up.

The chemicals in cigarette smoke irritate and damage the lining of the bladder. This can make your symptoms worse. Smoking is also a major risk factor for cancer and for other serious health conditions.

Avoid putting extra pressure on your pelvic floor muscles

The following will help avoid putting extra pressure on your pelvic floor muscles:

It is especially important to do this if you have stress incontinence.

Find ways of reducing stress

Feeling anxious can make you feel as if you need to pass urine. It can also make your symptoms worse.


Needing to pass urine often and at night

After having pelvic radiotherapy, you may need to pass urine more often than usual. 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 lots of things that can help ease this. Your doctor or continence adviser may suggest one or a combination of the following treatments for you.

Bladder retraining

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 start by keeping a record of how often you go to the toilet and how much urine you pass each time. Your continence adviser may have a chart you can use.

Bladder retraining is done in stages. You start by ‘holding on’ for a few minutes when you need to pass urine. You 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 you’re retraining your bladder. Keep drinking fluids as normal. 

You don’t need to do the retraining exercises during the night. 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 gets easier and you will go to the toilet less often.

Drugs to relax the bladder

Some types of drug 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 for you, talk to your doctor. They may be able to prescribe a different drug to try.

Treatment with botulinum toxin A (Botox®)

This involves having injections of Botox into the bladder muscles. It’s done under a general anaesthetic.

The drug paralyses part of the muscle, which helps relax the bladder. It should help you ‘hold on’ for longer. It 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 it has any drawbacks.

Sacral nerve stimulation

Women may be offered this treatment. It uses a mild electrical current. It stimulates the sacral nerve, which carries messages from your brain to your bladder muscles. This can reduce the urge to pass urine. It involves having a small operation, and it’s not suitable for everyone.


Leaking urine

Some people leak urine after pelvic radiotherapy. This can happen if the pelvic floor muscles and the valve that keeps the bladder closed are weakened.

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.

Below there are some ways that incontinence can be treated and managed. If you have urge incontinence, some of the treatments listed in the above section on an overactive bladder can also help.

Urine can irritate the skin, so you will need to take extra care to look after your skin.

Pelvic floor exercises

The most common way to improve urinary incontinence is to do exercises to strengthen the pelvic floor muscles.

You can do pelvic floor exercises while you are sitting or lying down. No one will know you are doing them. You squeeze and relax the muscles around your back passage (anus), as if you are trying to stop yourself passing wind.

Practising this exercise slowly then quickly, several times a day for at least three months can strengthen the muscles. This will help you have more control over leaking urine.

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 give you details of your nearest adviser and can send you leaflets about pelvic floor exercises.

Biofeedback training

If you find it difficult to learn pelvic floor exercises, you may be offered biofeedback training to help you learn. As you squeeze your pelvic floor muscles, sensors measure the pressure. This helps you know when you are squeezing in the right way.

Ask you continence adviser for more information about this.

Other treatments

If incontinence problems don’t improve with the treatments we’ve mentioned, there are other options. Your doctor may talk to you about these.

AUS (artificial urinary sphincter)

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. A small number of women may also be offered this treatment, if other treatments haven’t helped.

While you’re under a general anaesthetic, a cuff is fitted around the urethra and a small pump is placed under the skin in the scrotum, for men. Women have the pump placed under the skin of the tummy or leg. The cuff closes off the urethra to stop urine leaking. When you want to pass urine, you squeeze the pump under the skin by pressing it between your fingers. This deflates the cuff. It takes pressure off the urethra, allowing it to open so you can pass urine.

Other treatments for women

Duloxetine (Yentreve®)

This drug is sometimes prescribed to help improve stress incontinence. Like with most drugs, there may be side effects.

So it’s not usually prescribed until other treatments have been tried.

Surgery

Occasionally, some women may need to have an operation to improve incontinence. If this could help you, your doctor will discuss it with you. You’ll be referred to a specialist surgeon for an assessment and you may need to have tests before any treatment. Operations may include:

  • Tape to support the urethra This is the most common type of operation to improve incontinence. The surgeon inserts a tape through the vagina and puts it behind the urethra. This supports the urethra. It helps stop urine leaking when there’s increased pressure on the bladder, for example when you cough or sneeze.
  • Bulking agents A doctor can inject these into the tissue surrounding the urethra. This helps keep it closed and makes it harder for urine to leak out. You may need several injections for them to work, and they lose their effectiveness over time.


Difficulty passing urine

Radiotherapy can make the urethra narrow. This is called a urethral stricture. You may have difficulty passing urine or find yourself straining to release it.

If you’re having problems passing urine, it is important to see your doctor. If urine builds up in the bladder, it can cause infections and damage the kidneys. Your doctor or continence adviser will do tests to find out the cause so they can offer you the right treatment for your situation. A urethral stricture can be treated in several ways, depending on its size.

Small strictures can be treated by passing a thin, plastic tube through the urethra to widen (dilate) it. This can be done under a general or local anaesthetic. Sometimes it may need to be repeated.

Another possible treatment for smaller strictures is an operation called a urethrotomy. This is done under a spinal anaesthetic (where you are awake but don’t feel anything from the waist down) or general anaesthetic. The surgeon passes a cystoscope into the urethra. This lets them make small cuts to widen the urethra.

A larger stricture may need to be treated with an operation that uses tissue from another part of the body to repair the urethra. This is called a reconstruction.


If bladder problems don’t improve

If your bladder symptoms continue or don’t improve after these treatments have been tried, your specialist may talk to you about other possibilities. When symptoms are severe, an operation to remove the bladder may be an option, but this is rare.

We have more information on practical ways to cope with bladder changes.

Back to Late effects of pelvic radiotherapy

About late effects

Some people may have long term or late effects of pelvic radiotherapy. These can usually be treated or managed successfully.

Bladder changes

Late effects on the bladder can usually be managed or treated successfully. Talk to your doctor about any symptoms.

Bowel changes

Late bowel effects of pelvic radiotherapy are usually managed or treated successfully. Talk to your doctor if you notice any symptoms.

Late effects and sex life

Pelvic radiotherapy can have some late effects on your sex life. Talk to your doctor for advice on how to manage these.