Urinary Incontinence

Approved by the Cancer.Net Editorial Board, 02/2016

Some cancers and cancer treatments may result in incontinence. Incontinence is when a person is not able to control his or her bladder. It can occur in men or women and last for a short time or longer.

There are different types of incontinence, ranging from mild to severe.

  • Stress incontinence can cause a person to leak urine during activities such as coughing, laughing, sneezing, or exercising.

  • Overflow incontinence means it takes a long time to urinate and there is a dribbling stream of urine.

  • Urge incontinence is a sudden, urgent need to urinate.

  • Continuous incontinence is not being able to control the bladder at all.

Incontinence can cause discomfort or affect your quality of life. It is important to talk with your health care team about how to treat or manage this condition. Relieving side effects is an important part of your cancer care and treatment. This is called symptom management or palliative care.

Causes of incontinence

After urine forms in the kidneys, it flows into the bladder, a hollow, balloon-like organ. From the bladder, urine flows down a tube called the urethra and out of the body. Sphincter muscles act like a valve that holds urine in or releases it. These muscles work together with nerves that carry signals to them and the bladder to control urination.

Some cancers and cancer treatments may damage or change these muscles and nerves. Or, they may cause other changes to the body that lead to incontinence.

Cancers that may increase your risk of incontinence include:

  • Cancers in or near the pelvic region. The pelvic region is the area of the body that holds the bladder and reproductive organs. Cancers in this area include:

    • Prostate cancer

    • Colorectal cancer

    • Cancer of the urethra

    • Bladder cancer

    • Gynecological cancers such as such as cervical cancer and uterine cancer, which affect a woman’s reproductive system

  • Brain or spinal cord cancers, which can affect nerves that help control the bladder or pelvic muscles

  • Lung or esophageal cancer, which can cause chronic coughing that places stress on the bladder

  • Breast cancer, which can cause hormonal changes that dry out the urethra

Cancer treatments that may increase your risk of incontinence include:

  • Radiation therapy to the pelvic area, which can irritate the bladder

  • Chemotherapy, because it may cause nerve damage, vomiting that strains the muscles controlling urination, or loss of hormones

  • Surgery to the pelvic area, which can damage muscles or nerves that help control urination

  • Bone marrow/stem cell transplant with high dose chemotherapy because it can cause vomiting and bladder inflammation

  • Hormone therapies, which can dry out the urethra

Diagnosing incontinence

Talk with your health care team if you are having problems controlling your bladder. They will work with you to find out why. Diagnosis may include:

  • A bladder journal where you keep track of when you urinate, how often, and how much

  • Urine testing to look for signs of infection or other causes

  • A stress test in which you cough as hard as possible with a full bladder

  • Techniques that measure pressure in the bladder and urine flow

  • Ultrasound, a test that uses soundwaves create a picture of your bladder and body parts that help control urination

  • Cystoscopy, which uses a tiny camera is inserted into the bladder

  • Cystogram, which is an x-ray of the bladder

Treating incontinence

Incontinence is often treatable. The best treatments for you depend on the causes, the type, how long it has occurred, and severity. You may need more than one treatment at a time. Options include:

  • Bladder training, which includes:

    • Learning to delay urination after you get the urge to go

    • Scheduling toilet trips

    • Fluid and diet management

    • Biofeedback, which is using devices to help you gain control over the muscles that hold in urine

  • Physical therapy, which includes:

    • Kegel exercises, an exercise that strengthens muscles used to hold in urine

    • Electrical stimulation

  • Medicines, such as oxybutynin (Ditropan, Ditropan XL) and tolterodine (Detrol, Detrol LA), or the antidepressants imipramine (Tofranil) and duloxetine (Cymbalta)

  • Medical devices, including:

    • A urethral insert, which is a plug inserted into the urethra

    • A pessary, which is a stiff ring placed in a woman’s vagina to help support bladder muscles

  • Injections of collagen into the neck of the bladder to reduce leaking

  • The hormone estrogen applied to the urethra or vaginal tissue for women

  • Surgery to insert an artificial urinary sphincter or to create a “sling” around the neck of the bladder and urethra to keep it closed

  • Catheterization, a procedure in which a tube is inserted through the urethra and into the bladder to drain urine

Managing incontinence

If you have incontinence, the following methods and tips may help you manage it:

  • Limit the amount of fluids you drink, particularly coffee and alcohol.

  • Urinate before bedtime and before strenuous activity.

  • Wear an absorbent pad inside your underwear. You can buy pads at your local grocery store or drugstore.

  • Practice Kegel exercises. To perform these exercises, tighten or clench the muscles you use to stop the flow of urine. During this exercise, keep the muscles in your abdomen, buttocks, and thighs relaxed.

  • Lose extra weight, which can place pressure on the bladder and supporting muscles.

  • Stick to a schedule for relieving your bladder.

  • Avoid foods that can irritate the bladder, including dairy products, citrus fruits, sugar, chocolate, soda, tea, and vinegars.

  • Quit smoking. Nicotine can irritate the bladder and cause excessive coughing.

  • Get support. This is a common problem, don’t be embarrassed to talk with your health care team or a support group.

More Information

Managing Emotions

How Cancer is Treated

Tests and Procedures

Additional Resource

MedlinePlus: Urinary Incontinence