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Incontinence Advice

How To Handle Incontinence After Cancer

Having bladder or bowel cancer can be an emotionally and physically stressful time, and it can lead to incontinence. In this article, you will learn about the complexities of incontinence following cancer and explore its causes, impact, and strategies to manage it. It is important to recognise that incontinence is a common and manageable issue, and there are treatments and strategies to help individuals manage the condition effectively and regain confidence and control.  

Symptoms of Bladder Cancer

Bladder cancer often presents itself with blood in the urine (known as haematuria) which can range from visible blood to microscopic amounts only detectable through medical tests. Early-stage bladder cancer typically causes bleeding without pain, while advanced stages may lead to painful urination. Additional symptoms include frequent urination, a burning sensation during urination, difficulty starting or maintaining urine flow, a weak stream, and in some cases, an inability to urinate.

Urinary incontinence can be a symptom of bladder cancer, often overshadowed by more common urinary issues associated with ageing. It's crucial that any new or changing urinary symptoms be evaluated to exclude or diagnose bladder cancer. 


Diagnosis of Bladder Cancer

Diagnosing bladder cancer involves various tests and procedures. A cystoscopy is a common diagnostic tool where a cystoscope is inserted into the urethra to visually inspect the bladder and urethra for signs of cancer. During this procedure, small equipment can be passed down the cystoscope to remove any cancer found in the bladder, this is known as a transurethral resection of bladder tumour (TURBT). Any tumours or other tissue removed can be sent to a lab for closer examination.

Non-invasive tests, such as urine cytology, analyse urine samples for cancer cells. There are also imaging tests, such as CT urograms, that can provide detailed visuals of the urinary tract, aiding in the cancer detection process.

Moreover, treatments for bladder cancer, such as surgery, radiation, chemotherapy, and immunotherapy, can all contribute to incontinence. Radiation can lead to urethral damage, causing dryness and thinning of tissue, while chemotherapy may induce cystitis and neurotoxic effects, impairing bladder and urethral function. The combination of these treatments, especially in older patients, heightens the risk of incontinence, underscoring the importance of professional management and support for those affected.

The shock of a cancer diagnosis can lead to a rollercoaster of emotions, and the stress can affect mental and physical health. This emotional fluctuation may lead to depression, characterised by persistent sadness, loss of interest in enjoyable activities, and a sense of hopelessness. If these feelings arise, it's crucial to consult with a healthcare provider, as depression can be managed with treatments like antidepressants and cognitive behavioural therapy (CBT).

Continence and Bladder Surgery

Following a diagnosis of bladder cancer, surgery is sometimes required to remove the bladder altogether. This is called a cystectomy. After surgery, many patients face the necessity of urinary diversion. 

Following this, people do not pass urine in the same way as before. Instead, a urostomy is created, which is an opening on the abdomen, and a bag (or pouch) is attached over it to collect the urine. The bag needs to be emptied when it becomes full, like the bladder did. This is a surgical procedure to create a new urine passage using an internal pouch. This comes into play especially when the bladder is severely damaged by radiation or needs to be removed. 

The choice of urinary diversion depends on individual circumstances and medical advice, ensuring the selected method aligns with the patient’s lifestyle and health needs.

Sometimes a continent urinary diversion is created which is an internal pouch connected to an opening on the abdomen that is emptied using a tube (catheter).

Bladder Reconstruction

A new bladder (neobladder) can sometimes be constructed using a section of bowel. Over time, people can learn to control the new bladder in the same way they did before. However, this can be challenging, and sometimes self-catheterisation (a tube passed into the urethra) is required to empty the bladder to prevent accidental leakage, especially at night. 

Patients need to learn to control the neobladder through pelvic muscle manipulation, and it may lack the natural nerves of the original bladder. 

Navigating Sexual Health After Cancer

Sexual dysfunction is a common concern post-cancer treatment, with various solutions based on the individual’s specific needs.

Erectile Dysfunction in Men

Following procedures like radical cystectomy, men may experience erectile dysfunction. Treatment options include phosphodiesterase type 5 inhibitors (PDE5) , which enhances blood flow to the penis, sometimes used in conjunction with a vacuum pump. This pump helps to induce an erection by creating a vacuum around the penis, which is then maintained with a ring placed at its base.

Alternatively, try a plant based diet that aids sexual health in men affected by prostate cancer.

Vaginal Changes in Women

Women may experience vaginal narrowing and shortening after surgery, which can make sexual intercourse painful. Hormonal creams and vaginal dilators are common treatments. Dilators, used regularly, can gradually stretch the vagina and make it more flexible, improving comfort during sex. Open communication with healthcare providers about these intimate issues is vital for finding appropriate solutions and easing the emotional burden associated with these physical changes.

Regular sexual activity can also help alleviate discomfort, although it might take time for emotional readiness for intimacy to return. Both men and women are encouraged to discuss their sexual health concerns with their partners and medical teams to ensure effective management and support.

Treatment and Lifestyle for Incontinence Management

Making lifestyle adjustments can play a significant role in improving continence and overall quality of life. Some recommended lifestyle adjustments are as follows:

Modifying Diet and Fluid Intake

Adjustments in diet and fluid intake can play a significant role in reducing symptoms. Limiting foods and drinks that irritate the bladder and bowels, including caffeine, alcohol, carbonated beverages, citrus fruits, and high-sugar foods can decrease urine production and bladder irritation. 

It is essential to find a balance in fluid intake - enough to stay hydrated but not so much that it exacerbates incontinence. Aim for clear to light yellow urine as an indicator of proper hydration. (Learn more in our guide on what the colour of your urine could mean). Reducing fluid intake in the hours before bedtime can help minimise nocturnal enuresis.

Establish A Toilet Routine

Establishing a routine for toilet visits can prevent urgency and leaks, and emptying the bladder before activities that increase abdominal pressure, such as exercise or heavy lifting, can prevent leakage. Aiming for a toilet break every 2 to 4 hours is advisable, adjusting as needed to suit your body's rhythm. For those with frequent urges, bladder training techniques, such as gradually extending the time between bathroom visits, can be beneficial. For more information, browse our guide on how many times a day you should wee.

Consider Incontinence Products

Utilising continence pads or protective underwear can provide security and prevent leaks from affecting clothing. For nighttime protection, consider using protective bed sheets. These measures can offer peace of mind and improve sleep quality.

Quit Smoking

Quitting smoking is important for overall health, but quitting can also keep the bladder system healthy, as smoking can aggravate incontinence by causing cough-induced stress on the pelvic floor muscles, and it can irritate the bladder lining.

Pelvic Floor Muscle Training

Pelvic floor exercises, or Kegel exercises, strengthen the muscles that control urination. These exercises can be performed discreetly and are effective in improving incontinence symptoms. Professional guidance from a physical therapist specialising in pelvic floor rehabilitation can optimise the training regimen. Learn to perform them with our guides on strengthening the pelvic floor for women, and kegel exercises for men.

Maintaining a Healthy Weight

Excess weight can increase pressure on the bladder and pelvic floor muscles, intensifying incontinence symptoms. A balanced diet and regular exercise can help in achieving and maintaining a healthy weight, reducing the impact of incontinence. For those middle aged and above, you can find more information in our healthy lifestyle for over 50s article.

Alleviate Incontinence After Cancer

In conclusion, managing incontinence after cancer involves understanding the emotional, physical, and lifestyle impacts of the condition. Strategies such as adapting your diet, fluid intake, and establishing a routine urination schedule can alleviate symptoms. Utilising incontinence products, quitting smoking, performing pelvic floor exercises, and maintaining a healthy weight are key to improving quality of life and regaining control. With the right support, resources, and strategies, individuals can learn to manage symptoms, reclaim control over their lives, and thrive beyond cancer.


What type of cancer causes incontinence?

Prostate, bladder and colorectal cancers can cause incontinence due to their impact on the urinary and bowel systems. Brain or spinal cord cancers can also lead to incontinence, as they can affect the nerves that control the bladder and the muscles surrounding it.

Why can't I hold my pee all of a sudden?

Sudden urinary incontinence can be caused by urinary tract infections, bladder irritants, medication side effects, or neurological disorders. It is important to consult a healthcare professional for advice about any sudden changes that occur.

Is faecal incontinence a symptom of bowel cancer?

Yes, incontinence can be a symptom of bowel cancer, especially if the tumour affects the bowel's ability to function properly.