Bladder changes after pelvic radiotherapy

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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

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The male bladder and kidneys
The male bladder and kidneys

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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.


Symptoms

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.


Tests

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.

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