Managing bladder late effects

Treatment such as surgery or radiotherapy for bowel cancer may change how the bladder works. It can also affect the muscles that support the bladder. Sometimes changes start during treatment and do not get better. Or they may develop months or years after treatment has finished (late effects).

Not all bladder symptoms are caused by cancer 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.

Surgery to the rectum (back passage) can sometimes cause long term changes to the nerves that control the bladder. This can affect your bladder control and make it difficult to hold in urine (pee). This is called urinary incontinence.

Radiotherapy to the rectum often causes bladder side effects. These usually get better within a few weeks. But some people have side effects that start months or years after treatment. Late effects caused by pelvic radiotherapy are sometimes called pelvic radiation disease (PRD).

Possible symptoms of bladder changes after treatment include:

• needing to pass urine (pee) more often (overactive bladder)
• urinary incontinence (leakage)
• blood in the urine (haematuria)
• radiation cystitis (a burning feeling when you pass urine)
• difficulty passing urine, or a feeling you still have urine left in your bladder after going to the toilet (urine retention)
• being unable to wait to empty your bladder (urgency)
• repeated urine infections
• a weak stream of urine

These changes may be caused as a late effect from pelvic radiotherapy, or as a result of late effects of bowel cancer treatment.

There are certain things that can help manage or treat your symptoms. Talking about bladder problems can be embarrassing and difficult. Some people with late effects need help from other specialists.

Your GP or cancer team can refer you to a specialist in bladder problems if needed. Or they may refer you to a continence adviser, who gives advice and support to people with bladder and bowel problems. Doctors, nurses, physiotherapists and other healthcare professionals are used to talking about them and can suggest what can help.

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.

An overactive bladder means you often suddenly feel the need to pass urine (pee). Your bladder feels full, even when there is not much in it.

There are things that can help an overactive bladder.

Pelvic radiotherapy can damage the tissue and blood vessels in the lining of the bladder. They can become weaker and bleed more easily. This can cause blood in the urine (haematuria).

You may have a test called a cystoscopy to look inside your bladder. This test will help decide if you will need treatment.

If you are having difficulty passing urine, or feel that you are not emptying your bladder completely, it is important to see your doctor. It can cause problems that are more serious if they are not treated. Your doctor or continence adviser will do tests to find out the cause so they can offer you the right treatment for your situation.

If your bladder symptoms continue or do not improve after treatments, your specialist may talk to you about other options. When symptoms are severe, an operation to remove the bladder may be an option, but this is very rare.