Bladder changes

The bladder is in the lower part of the pelvis. It collects and stores urine. Sometimes, pelvic radiotherapy can cause changes to the way the bladder works. In some people, these changes will not get better after treatment finishes. Others may not develop until months or years after treatment has finished.

Pelvic radiotherapy can cause scarring and hardening (fibrosis) of the bladder wall. It may also weaken the pelvic floor muscles and valve that holds the bladder closed. Blood vessels in the bladder may become fragile and bleed easily and in some cases pelvic radiotherapy may cause the urethra to narrow. These changes can lead to late effects, such as passing urine more often or difficulty passing urine, leaking urine and blood in the urine.

Many bladder problems can be managed or treated successfully. Talk to your doctor about any symptoms you have. They can provide advice and may do some tests. They may also refer you to see a specialist in bladder problems (a urologist).

Bladder late effects

Some people notice changes in the way their bladder works after treatment. For some people, these start during treatment and don’t get better. But sometimes bladder changes may develop months or years after treatment has finished.

Changes also happen as bladder muscles age, so the symptoms here are more common in older people.

Women who’ve been through childbirth and menopause are also more likely to get urinary problems.

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.

The bladder and kidneys
The bladder and kidneys

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Possible late effects

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 (see diagram) to narrow. This is called a urethral stricture.


Symptoms

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.


Talk to your doctor

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 you have and how much of a problem they are.


Tests

If you develop bladder problems after your treatment, your doctors may arrange for you to have some tests to find out the cause. Your GP can test your urine to check if you have an infection, and do blood tests to check how well your kidneys are working.

Depending on your symptoms and how they respond to treatments, further 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 using a local anaesthetic.
  • Urodynamic tests to check assess how well your bladder and urethra collect, hold and release urine. These are usually done to find out the causes of incontinence.


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.

Managing bladder late effects

Read about the ways that bladder changes can be treated or managed.

Bowel changes

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

Managing bowel late effects

Many bowel problems can be managed or treated successfully, with exercises, drugs and other treatments.

Coping with bowel or bladder changes

Planning ahead can make it easier to cope with the day-to-day problems caused by bladder and bowel changes.

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.

Other late effects

Pelvic radiotherapy can also cause less common late effects.