Managing bladder late effects
Sometimes cancer treatments can cause long-term changes in the way the bladder works. It can also affect the muscles that support the bladder.
About bladder late effects
Late effects are side effects that do not go away, or that start months or years after treatment.
Bladder problems may be caused as a late effect from pelvic radiotherapy, or as a result of late effects of bowel cancer treatment.
Not all bladder symptoms are caused by the treatment. As you get older, the bladder and pelvic floor muscles naturally become weaker. Giving birth and going through the menopause can also affect these muscles.
Possible late effects to the bladder
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Overactive bladder
Treatments can cause the bladder to shrink. This means it cannot hold as much urine (pee) as before. This happens when the bladder walls become scarred and the tissue becomes less stretchy.
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Urine incontinence
Leaking urine (incontinence) can happen if the pelvic floor muscles and the valve that keeps the bladder closed (urethral sphincter) are weakened. This makes them less effective and this can cause you to leak urine or you may find that you cannot hold your urine for long. Bladder lining changes.
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Bladder lining changes
Radiotherapy can damage the tissue and blood vessels in the lining of the bladder. This can cause pain or burning when you pass urine. It can also make you feel like you need to pass urine frequently (radiation cystitis). The small blood vessels in the bladder lining may become weaker and bleed easily. This can cause blood in your urine (haematuria).
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Difficulty passing urine (urine retention)
Sometimes, radiotherapy damages the nerves near the bladder and affects how the bladder muscles work. This may mean the bladder does not empty completely. Treatment may also make the urethra narrow. This can make it more difficult to pass urine. The narrowing is called a urethral stricture.
Tests to check for bladder problems
If you have bladder problems after your treatment, your doctor or nurse may arrange some tests. Your GP or practice nurse can test your urine for infection.
An infection can cause similar symptoms and make you feel unwell. They can also do blood tests to check how your kidneys are working.
Further tests after treatment
You may need some of the following further tests. These are arranged by a urologist or continence adviser:
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Scans
You may have scans to look at your kidneys, ureters and bladder. These could be an ultrasound scan, an MRI scan, or a type of CT scan which using dye (contrast).
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Cystoscopy
A cystoscopy to look inside 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, but sometimes a general anaesthetic is used.
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Urodynamic tests
Urodynamic tests check how well your bladder and urethra collect, hold and release urine. These are often done if you have symptoms of urgency or incontinence. Sometimes you have them after other tests, if more information is needed.
You may be asked you to complete a diary of how much you drink and how much urine you pass, or complete questionnaires about your symptoms. These can find out the cause of your problems so you are given the correct advice and support from the right healthcare specialist.
Overactive bladder
An overactive bladder means you often suddenly feel you need to pass urine (pee). Your bladder feels full, even when there is not much in it.
There are lots of things that can help ease an overactive bladder. Your doctor or a continence adviser may suggest treatments, including bladder retraining and Botulinum toxin A (Botox®).
Urinary incontinence
Exercises to strengthen the pelvic floor muscles (Kegel exercises) is the most important treatment for leaking urine (incontinence). A continence adviser can teach you how to do the exercises correctly.
Blood in the urine
You may have a test called a cystoscopy to look inside your bladder. This test will help decide if you will need treatment for blood in the urine (haematuria).
Radiation cystitis
If you have pain or burning when you pass urine (pee), drinking plenty of fluids and the right types of fluids may help. But your specialist may also talk to you about treatments that can help.
We have more information about radiation cystitis.
Difficulty passing urine (urine retention)
If you have difficulty passing urine, it is important to get this checked. Your doctor or continence adviser will do tests to find out the cause so they can offer you the right treatment for your situation.
Bladder management tips
There are some practical things you can do to manage bladder problems. You can make small lifestyle changes such as increasing your fluid intake, cutting down fizzy drinks or avoiding constipation.
We have more information and tips for coping with bladder or bowel problems.
If bladder problems do not improve
If your bladder symptoms continue or do not improve after having these treatments, 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 very rare.
About our information
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References
Below is a sample of the sources used in our pelvic radiotherapy information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk
Andreyev HJN, Muls AC, Norton C, et al. Guidance: The practical management of the gastrointestinal symptoms of pelvic radiation disease. Frontline Gastroenterology, 2015; 6, 53-72.
Dilalla V, Chaput G, Williams T and Sultanem K. Radiotherapy side effects: integrating a survivorship clinical lens to better serve patients. Current Oncology, 2020; 27, 2, 107-112.
The Royal College of Radiologists. Radiotherapy dose fractionation. Third edition. 2019. Available from: www.rcr.ac.uk/system/files/publication/field_publication_files/brfo193_radiotherapy_dose_fractionation_third-edition.pdf [accessed March 2021].
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Reviewers
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Chief Medical Editor, Professor Tim Iveson, Consultant Medical Oncologist.
Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.
Date reviewed
Our cancer information meets the PIF TICK quality mark.
This means it is easy to use, up-to-date and based on the latest evidence. Learn more about how we produce our information.
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