Bladder changes after pelvic radiotherapy

  • Long-term and late effects

    Not everyone has or gets long-term or late effects and many get better over time.

  • Breathlessness

    Cancer can cause breathlessness. We have tips on relaxation and other techniques to help.

  • Tiredness (fatigue)

    The term often used for extreme tiredness is fatigue. Look at our information on managing tiredness through relaxation and other techniques.

  • Fertility in men

    Cancer can affect fertility in men. Support and treatment is available.

  • Fertility in women

    Learn more about what cancer means for fertility in women, and what help is available.

  • Hair loss

    Cancer treatment can cause hair loss. Find ways to cope, and to look after your hair and scalp.

  • Mouth problems

    Cancer treatment such as chemotherapy can cause mouth problems. We have tips for keeping your mouth healthy.

  • Eating problems

    Cancer and its treatment can cause problems with eating including sickness, appetite loss and a sore mouth. Find ways to deal with them.

  • Pain

    If you're dealing with pain caused by cancer, we can tell you about treatment and other support.

  • Lymphoedema

    If you're living with lymphoedema we have information and support for you.

  • Other side effects

    Cancer has a range of side effects. Find out more about them and how to ease them.

  • Cancer treatment and your heart

    Cancer treatment may cause problems with your heart. Find out more about how this is monitored and tips to keep your heart healthy.

The bladder is in the lower part of the pelvis. It collects and stores urine. Sometimes, pelvic radiotherapy can cause changes to the way the bladder works. In some people, these changes will not get better after treatment finishes. Others may not develop until months or years after treatment has finished.

Pelvic radiotherapy can cause scarring and hardening (fibrosis) of the bladder wall. It may also weaken the pelvic floor muscles and valve that holds the bladder closed. Blood vessels in the bladder may become fragile and bleed easily and in some cases pelvic radiotherapy may cause the urethra to narrow. These changes can lead to late effects, such as passing urine more often or difficulty passing urine, leaking urine and blood in the urine.

Many bladder problems can be managed or treated successfully. Talk to your doctor about any symptoms you have. They can provide advice and may do some tests. They may also refer you to see a specialist in bladder problems (a urologist).

Late effects on the bladder

Sometimes, people who have had pelvic radiotherapy notice changes in the way their bladder works. For some people, these changes start during treatment and don’t get better.

But sometimes bladder changes may develop months or years after treatment has finished.

Changes also happen as the bladder muscles age, so the symptoms below are more common as people get older. Women who’ve been through childbirth and menopause are also more likely to get urinary problems.

The bladder is a stretchy, muscular bag that collects and holds urine. It is in the lower part of the pelvis. It is connected to the kidneys (which produce urine) by tubes called the ureters. Urine drains from the bladder through a tube called the urethra.

The female bladder and kidneys
The female bladder and kidneys

View a large version

Read a description of this image

The male bladder and kidneys
The male bladder and kidneys

View a large version

Read a description of this image

The bladder is supported by the pelvic floor muscles. Some of these muscles wrap around the urethra. This is called the urethral sphincter, which keeps it sealed like a valve until you need to pass urine.

When the bladder is full, it sends a signal to the brain that you need to pass urine. When you’re ready, the brain tells the pelvic floor muscles to relax and open the urethra. The bladder muscles tighten (contract) and push the urine out.

Possible late effects to the bladder

Pelvic radiotherapy can cause scarring and hardening (fibrosis) of the bladder wall. This shrinks the bladder so it holds less urine. It can also weaken the pelvic floor muscles and the valve that holds the bladder closed. This means that small amounts of urine can leak out. This is called incontinence.

After radiotherapy, small blood vessels in the bladder lining may be more fragile and bleed easily. This can cause blood in your urine.

Sometimes radiotherapy makes the urethra narrow. This is called a urethral stricture.


Many of the symptoms of late effects to the bladder are similar to the immediate side effects of radiotherapy.

The symptoms of late effects to the bladder can include:

  • needing to pass urine more often than usual
  • a burning sensation when you pass urine (like cystitis)
  • being unable to wait to empty your bladder (urgency)
  • leaking urine (incontinence)
  • blood in your urine (haematuria)
  • difficulty passing urine.

There are ways to deal with many of these problems successfully.

Talking to your doctor

There are lots of things that can be done to manage or treat your symptoms. Your GP can advise you, or they may need to refer you to:

  • a specialist doctor in bladder problems (a urologist)
  • a specialist nurse or physiotherapist who gives continence advice and treatment (a continence adviser).

The treatment that’s right for you will depend on the symptoms or side effects you have and how much of a problem they are.


If you get bladder problems after your treatment, your doctors will usually arrange some tests to find out the cause. Your GP can test your urine to check for infection, and do blood tests to check how your kidneys are working.

Some people may need further tests arranged by a urologist or a continence adviser. These include the following tests:

  • 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.
  • Urodynamic tests to check how well your bladder and urethra collect, hold and release urine. These are usually done to find out the cause of incontinence.

Back to Coping

Getting support

Find out more about our free support line, Macmillan nurses, information services and support groups near you.

Your emotions

Get help with the emotional issues you and your loved ones might face.

Relationships and sex

Understanding what is happening and getting the right support can help you in your close relationships.

Advanced cancer

Get help with treatment decisions associated with advanced cancer, and find ways to cope with symptoms, side effects, and emotional impacts.