Overactive bladder after pelvic radiotherapy

After pelvic radiotherapy you may need to pass urine more often than usual. This is known as an overactive bladder.

About overactive bladder syndrome

Sometimes pelvic radiotherapy can cause a long-term change called an overactive bladder. This change may start during treatment and not get better. Or it may develop months or years after treatment.

If you have an overactive bladder, you may need to pass urine more often than usual. Your bladder may be more sensitive and feel full even when there is not much urine in it.

Managing an overactive bladder after pelvic radiotherapy

There are lots of things that can help ease an overactive bladder. Your doctor or a continence adviser may suggest one or more of the following treatments for you.

Bladder retraining

This means training yourself to ignore the feeling of needing to pass urine. It will help your bladder get used to feeling fuller. This can help the bladder hold more urine, so you will not need to go to the toilet as often. It can be difficult at first, but it gets easier with time.

It is best to retrain your bladder with advice and support from a continence adviser or doctor.

Start by keeping a record of how often you go to the toilet and measure how much urine you pass each time. Your continence adviser may have a chart you can use.

Bladder retraining is done in stages. You start by ‘holding on’ for a few minutes when you need to pass urine. You 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.

Do not be tempted to cut down on fluids when you are retraining your bladder. Keep drinking fluids as normal.

You do not need to do the retraining exercises during the night. Your daytime exercises will eventually mean that you need to go to the toilet at night less often.

After a few weeks, resisting the urge to pass urine gets easier. You will eventually find you need to go to the toilet less often.

Drugs to relax the bladder

Some types of drug can help relax the bladder so it can hold more urine. There are several drugs that can help. Your doctor will check how well they are working for you. If one does not work for you, talk to your doctor. They may be able to prescribe a different drug.

Botulinum toxin A (Botox®)

This involves having injections of Botox into the bladder muscles. It is done under a general anaesthetic. It may be used if other treatments have not helped.

The drug paralyses part of the muscle, which helps relax the bladder. It should help you ‘hold on’ for longer. It may also help reduce incontinence.

You may find it becomes more difficult to pass urine after having Botox. This is usually temporary. It may last for a few days or weeks. Before you have Botox, a nurse will show you how to empty your bladder using a thin, plastic tube (catheter). Your doctor or nurse can tell you more about this.

Nerve stimulation

Nerve stimulation uses electrical pulses to help bladder control. It may be used when other treatments have not helped. There are different types:

  • Sacral nerve stimulation (SNS)

    SNS has two stages. First, your doctor places electrodes under the skin in the lower back for a few weeks. This is to check if SNS works for you. If the test is successful, you can have a small, permanent implant fitted.

  • Percutaneous tibial nerve stimulation (PTNS)

    PTNS may be used if you do not want sacral nerve stimulation or Botox treatment. A nurse places a small needle through the skin near the ankle and connects this to an electrical stimulator. Most people have 12 weekly treatments. After this, you and your doctor can decide how much PTNS has helped and if more treatments are needed.

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.