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 and blood in the urine may be treated with drugs. Sometimes blood in the urine may be treated with heat (cauterisation) or by washing clots out of the bladder.

Radiotherapy narrows the tube that drains urine from the bladder. This makes 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 lots of things you can do to keep your bladder healthy and to manage bladder symptoms.

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.

Not drinking enough will make symptoms worse, not better. Concentrated urine 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)
  • fizzy drinks
  • drinks that contain caffeine (such as tea, coffee, cola and cocoa)
  • acidic drinks (such as fresh orange and grapefruit juice)
  • drinks with artificial sweeteners (diet or light).

Try drinking 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 won’t get used to holding more urine.

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

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.

You may find our information on Giving up smoking helpful.

Avoid putting extra pressure on your pelvic floor muscles

Keep your weight within healthy limits and avoid constipation and heavy lifting. This is especially important if you have stress incontinence.

Find ways of reducing stress

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


Needing to pass urine often and at night

Needing to pass urine often and at night

You may have to pass urine more frequently than usual after 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.

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 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’ll need to go to the toilet less often at night

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, 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, 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 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.

Sacral nerve stimulation

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


Leaking urine

You may leak urine after pelvic radiotherapy. This can happen if the valve that keeps the bladder closed and the pelvic floor muscles 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.

This page 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.

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

Pelvic floor exercises can be done while you are sitting or lying down and no one can tell you are doing them. You squeeze and relax the muscles around your back passage as if you are trying to prevent yourself passing wind. Practising this exercise slowly and quickly several times a day for at least 3 months can strengthen the muscles. This will help you to have more control over leakage of 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 provide details of your nearest adviser and can send you leaflets showing you how to do pelvic floor exercises.

Biofeedback training

If you find it difficult to learn pelvic floor 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 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:

Artificial Urinary Sphincter (AUS)

If you are leaking a lot of urine most of the time (severe incontinence) can be assessed for this treatment. While you’re under a general anaesthetic, a cuff is fitted around the urethra. Attached to the cuff is a small pump which is placed in the scrotum in men or in the tummy or leg in women. 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.

Other treatments for women

Duloxetine (Yentreve®) This drug is sometimes prescribed to help reduce stress incontinence. As with most drugs, there may be side effects. So it’s not usually prescribed until other treatments have been tried.

Tape to support the urethra-This involves inserting a tape through the vagina and placing it behind the urethra. This supports the urethra and helps prevent urine leaking when there’s increased pressure on the bladder, such as when you cough or sneeze.

Bulking agents - These are materials that are injected into the tissue surrounding the urethra to help keep it closed and make it harder for urine to leak out. You may need several injections for them to work, and they lose their effectiveness over time.


Blood in the urine (haematuria)

After radiotherapy, small blood vessels in the bladder lining may be more fragile and bleed easily. This can cause blood in your urine. If you have this, you’ll need to have a cystoscopy to find out what’s causing this.

If there’s only a small amount of bleeding that’s been caused by radiotherapy you may not need any treatment. If it’s regular, heavy or you become anaemic (a lack of red blood cells) you’re likely to need treatment. There are several possible treatments.

Tablets

Tranexamic acid (Cyklokapron®) tablets can reduce bleeding. They help to stop clots from dissolving. Your doctor may prescribe these for you.

Giving drugs into the bladder

Some drugs can be given directly into the bladder as a fluid to stop the bleeding.

For this treatment, you lie down while a nurse gently passes a thin, flexible tube (a catheter) through the urethra into the bladder. The nurse slowly passes fluid through the catheter into your bladder. They then remove the catheter and you hold the fluid in your bladder for about half an hour to give the treatment time to work. After this, you empty your bladder. You may 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 nurse or doctor passes liquid through a catheter into your bladder. The liquid then drains back out of the catheter into a bag. This can be repeated until the clots have gone

Cauterisation

If medicines don’t stop the bleeding, your doctor may suggest using heat to seal the blood vessels that are bleeding. This is called cauterisation. It’s done using a cystoscope while you’re under a general anaesthetic.

Hyperbaric oxygen therapy

This treatment increases the amount of oxygen getting to tissue in the bladder. It can encourage new blood vessels to grow and the tissues to heal which may help areas damaged by radiotherapy. It’s usually only used after other treatments have been tried. We have information about hyperbaric oxygen therapy.

Treating anaemia

Some people become anaemic because of bleeding from the bladder. This can cause symptoms such as feeling breathless or tired. Your doctor may suggest you have iron tablets which will help you produce blood cells and make you feel better. Some people may need a blood transfusion. We have more information about blood transfusions.


Difficulty passing urine

Radiotherapy can make the urethra (the tube that drains urine from the bladder) 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’s important to get checked out by 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 you can be offered the right treatment for your situation.

A urethal 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 will be awake but not feel any pain from the waist down) or general anaesthetic. A cystoscope is passed into the urethra. This allows the surgeon to 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 (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. Rarely when symptoms are severe, an operation to remove the bladder may be an option. The section on coping with bladder changes suggests practical tips that can help.


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.

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.