How To Handle Incontinence After 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).

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.