Urinary Incontinence

Approved by the Cancer.Net Editorial Board, 04/2017

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, last for a short time or longer, and range from mild to severe.

There are different types of incontinence:

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

  • Overflow incontinence is a dribbling stream of urine that happens with a full bladder.

  • Urge incontinence is loss of urine that occurs with 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. 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 palliative care or supportive care.

Causes of incontinence

After urine forms in the kidneys, it flows down the ureter tubes into the bladder. The bladder is a hollow, balloon-like organ that holds urine. From the bladder, urine flows through 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 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. This area of the body 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 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

Cancer treatments that may increase your risk of incontinence include:

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

  • Chemotherapy, which 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, which can cause vomiting and bladder inflammation

  • Treatments that cause early menopause and/or lower estrogen levels

  • Medicine that increases hydration or urine production, which can make incontinence worse

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 to create a picture of your bladder and the other body parts that help control urination

  • Cystoscopy, during which the inside of the bladder is examined with a small tube that has a camera and light on the end

  • 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:

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

    • Scheduling toilet trips, called timed voiding

    • Fluid and diet management

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

  • Physical therapy:

    • Kegel exercises, which strengthen 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:

    • 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

  • Applying the hormone estrogen 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, in which a tube is inserted through the urethra and into the bladder to drain urine

  • Botulinum toxin type A (Botox, Dysport) injections to relax the bladder muscle

Managing incontinence

If you have incontinence, try these methods and tips to 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.

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More Information

MedlinePlus: Urinary Incontinence