Incontinence (urine leakage) after pelvic radiotherapy

Pelvic radiotherapy can cause long-term changes to the way the bladder works. You may leak small amounts of urine. This is called urine incontinence.

About urine incontinence

Sometimes pelvic radiotherapy can cause long-term changes to the way the bladder works. It may weaken the pelvic floor muscles and the valve that keeps the bladder closed. This means that small amounts of urine can leak out. This is called urine incontinence.

This may start during treatment and not get better. Or it may develop months or years after treatment.

There are different types of incontinence:

  • Stress incontinence 
    You may leak small amounts of urine when you laugh, sneeze or cough, or when you are exercising.
  • Urge incontinence 
    If you have an overactive bladder, you may find that you cannot always get to the toilet in time. We have information on treating an overactive bladder that can help.

Treating urine incontinence

Urine can irritate the skin. If you have incontinence you will need to take extra care to look after the skin around your bottom.

Pelvic floor exercises

The most common treatment for urinary incontinence is to do exercises to strengthen the pelvic floor muscles. We have more information about pelvic floor exercises after pelvic radiotherapy.

If pelvic floor exercises do not help, there are other options.


Your doctor may suggest using drugs to help you control your bladder. Your doctor or continence adviser can tell you more about this.


Occasionally, surgery to improve incontinence. If this could help you, your doctor will discuss it with you. You will be referred to a specialist surgeon for an assessment. You may need to have tests before any treatment.

It is important that you understand everything about your operation. You should be given an opportunity to discuss the operation with your surgeon. This might happen at the pre-assessment clinic. You will need to sign a consent form to say that you agree to the operation. No operation will be done without your consent.

Types of surgery include:

  • Tape to support the urethra

    This is the most common type of operation to improve incontinence. The surgeon inserts a tape either through a cut in the vagina or behind the scrotum. The surgeon then puts the tape under the urethra. This supports the urethra. It helps stop urine leaking when there is 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.

  • AUS (artificial urinary sphincter)

    This treatment is used occasionally when other treatments have not helped. It may be suitable for some people who are leaking a lot of urine most of the time. While you are under a general anaesthetic, a small cuff is inserted around the urethra. The cuff is attached to a pump that is placed either under the skin of the outer lips of the vulva (external female sex organs) or in the scrotum (sac containing the testicles). When you want to pass urine, you deflate the cuff by squeezing the pump under the skin between your fingers. This takes pressure off the urethra, allowing it to open so you can pass urine.

Some types of surgery may only be available as part of a clinical trial. Your specialist can tell you more about this.

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 rare.

Getting support

Macmillan is here to support you. If you would like to talk, you can do the following: