Some cancers and cancer treatments may cause incontinence. Incontinence is a person's inability to control the bladder. It can occur in men or women, last for a short or long time, and range from mild to severe.
Types of incontinence
Incontinence comes in various forms:
Stress incontinence. This is urine leakage during activities such as coughing, laughing, sneezing, or exercising.
Overflow incontinence. This is a dribbling stream of urine that happens with a full bladder.
Urge incontinence. This is loss of urine that occurs with a sudden, urgent need to urinate.
Continuous incontinence. This is the inability to control the bladder.
Incontinence can cause discomfort and 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 out of the body through a tube called the urethra. Sphincter muscles act like a valve that holds urine in or releases it. These muscles work with nerves that carry signals to the bladder to control urination.
Some cancers and their treatment 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 risk of incontinence
Certain types of cancer increase risk of incontinence:
Cancers in or near the pelvic region. The pelvic region holds the bladder and reproductive organs.
Cancers in this area include:
Cancer of the urethra
Gynecological cancers, such as cervical cancer and uterine cancer
Brain or spinal cord cancers. These can affect nerves that help control the bladder or pelvic muscles.
Lung or esophageal cancer. These can cause chronic coughing that places stress on the bladder.
Treatments that may increase risk of incontinence
Certain types of treatment raise the risk of incontinence, including:
Radiation therapy to the pelvic area. This may irritate the bladder.
Chemotherapy. This may cause nerve damage, vomiting that strains the muscles controlling urination, or loss of hormones.
Surgery to the pelvic area. This may damage muscles or nerves that help control urination.
Bone marrow/stem cell transplantation with high-dose chemotherapy. This may cause vomiting and bladder inflammation.
Treatments that cause early menopause and/or lower estrogen levels.
Medicine that increases hydration or urine production. This can make incontinence worse.
Talk with your health care team if you have problems controlling your bladder. They will work with you to figure out the reason.
One step may include keeping a bladder journal. This will help track when you urinate, how often, and how much.
Tests that may be used to diagnose incontinence include:
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
Tests that measure pressure in the bladder and urine flow
An ultrasound, which uses sound waves to create a picture of your bladder and the other body parts that help control urination
A cystoscopy, which uses a small tube with a camera and light to look inside of the bladder
A cystogram, which is an x-ray of the bladder
Commonly, doctors can treat incontinence. Treatment options depend on the type, causes, how long it lasts, and severity. You may need more than one treatment at a time.
Treatment options for incontinence
Bladder training. This may include the following steps:
- Learning to delay urination after you get the urge to go
- Scheduling toilet trips, called timed voiding
- Managing fluid intake and diet
- Using biofeedback, which involves devices to help you improve control over muscles that hold in urine
Physical therapy. Examples include:
- Kegel exercises, which strengthen muscles used to hold in urine
- Electrical stimulation
Medication. These are drug options for urinary incontinence:
- Oxybutynin (Ditropan, Ditropan XL), a drug that calms an overactive bladder
- Tolterodine (Detrol, Detrol LA), a drug that calms an overactive bladder
- Imipramine (Tofranil), an antidepressent
- Duloxetine (Cymbalta), an antidepressent
Medical devices. These may include:
- 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
Collagen. Injections of collagen into the neck of the bladder reduce leaking.
Estrogen. Women may apply the hormone estrogen to the urethra or vaginal tissue.
Surgery. A doctor inserts an artificial urinary sphincter or creates a “sling” around the neck of the bladder and urethra to keep it closed.
Catheterization. A person inserts a tube through the urethra and into the bladder to drain urine.
Botulinum toxin type A (Botox, Dysport). Injections of this substance relax the bladder muscle.
Tips to manage incontinence
If you have incontinence, consider taking these steps:
Limit how much you drink, particularly coffee and alcohol.
Urinate before bedtime and before strenuous activity.
Wear an absorbent pad inside your underwear.
Practice Kegel exercises. To perform these exercises, tighten or clench the muscles you use to stop the flow of urine. During this exercise, relax the muscles in your abdomen, buttocks, and thighs.
Lose extra weight, which can place pressure on the bladder and supporting muscles.
Stick to a schedule to urinate regularly.
Avoid foods that can irritate the bladder. These include dairy products, citrus fruits, sugar, chocolate, soda, tea, and vinegar.
Quit smoking. Nicotine can irritate the bladder and cause excessive coughing.
Get support. Talk with your health care team or a support group. You will likely feel reassured, learning that this is a common problem.