Urinary Incontinence

Approved by the Cancer.Net Editorial Board, 01/2021

Some cancer and cancer treatments can make it difficult to control your bladder. This means you may sometimes leak urine or not be able to control when you urinate. The medical term for this problem is urinary incontinence.

Types of bladder control problems (incontinence)

Anyone can have bladder control problems or incontinence. Incontinence caused by cancer or cancer treatment can last a short time or a long time, and it can be mild or severe. There are different types of bladder control problems.

Stress incontinence. Urine leaks out during activities such as coughing, laughing, sneezing, or exercising.

Overflow incontinence. Urine leaks out when your bladder is full.

Urge incontinence. You feel the urge to go to the bathroom right away and urine leaks before you can get to the bathroom.

Continuous incontinence. Urine leaks out constantly, and you cannot control it.

These bladder problems can make you feel uncomfortable or embarrassed. Sometimes, people avoid activities they enjoy because of bladder problems. That can affect your quality of life. These are reasons why it is important to tell your health care provider about your experiences. They can help you treat incontinence. The treatment of side effects is an important part of your cancer care and treatment, called palliative care or supportive care. Talk with your health care team about how to treat or manage incontinence.

What causes incontinence?

Your bladder is a hollow organ, similar to a balloon. It expands to hold the urine your body makes. Nerves in the area tell you when your bladder is full, and the bladder muscles help you store and hold urine until you are ready to release it. Cancer or cancer treatment can damage the nerves, muscles, and other systems that help control urine flow. The causes of incontinence during cancer include:

Cancer in the pelvic area. Your pelvic area includes the bladder and reproductive organs. Cancers in this area include:

Brain or spinal cord cancers. These cancers can affect nerves that help control your bladder or pelvic muscles.

Lung cancer or esophageal cancer. These cancer can cause coughing that puts pressure on the bladder. This pressure causes you to leak urine.

Certain cancer treatments. Some cancer treatments can raise your risk of urinary incontinence. These include:

  • Radiation to the pelvic area can irritate the bladder.

  • Cancer medications including chemotherapy can cause nerve damage, vomiting that puts stress on the bladder, irritation of the bladder, or hormone changes. Having less of certain hormones can make incontinence worse.

  • Surgery to the pelvic area can damage the muscles or nerves that help control urine.

  • Treatments that can cause early menopause, lower the level of the hormone estrogen, or both.

  • Medication that causes your body to make more urine or increase the amount of water in the body can make incontinence worse.

How is urinary incontinence diagnosed?

Talk with your health care team if you have a problem controlling your bladder. They will work with you to figure out the reason. They may recommend you writing down some details about your urination, including when you urinate, how often you urinate, and how much liquid is released. This is called a "voiding diary." Your health care provider may also give you the following tests:

  • Tests on a sample of your urine to look for an infection or other problems.

  • A test where you cough as hard as you can when your bladder is full.

  • Tests to measure pressure in your bladder.

  • Tests to measure how well your urine is flowing.

  • An ultrasound. This uses sound waves to create a picture of your bladder and the other body parts that control urine.

  • A cystoscopy. This test uses a small, lighted tube to look inside your bladder.

  • An X-ray of your bladder.

How is incontinence treated?

Your health care team can usually manage incontinence. The right treatment for you depends on what type you have, what caused it, how severe it is, and how long you have had it. You might need more than 1 treatment at a time.

Bladder training. Bladder training is a way to treat incontinence without medication. Health care providers may start with bladder training before trying other treatment options. Bladder training, sometimes called bladder retraining, can include these steps:

  • Learning to wait to urinate, even after you have the urge to go

  • Going to the bathroom at specific times

  • Controlling how much and when you drink and eat

  • Biofeedback, which uses a small device to learn to control the muscles that hold urine

Physical therapy. Working with a physical therapist can help you control your bladder. During physical therapy, you may do Kegel exercises to help strengthen the muscles that hold in urine. Electrical stimulation can also be used to strengthen muscles.

Medication. Medication that can help control your bladder includes:

  • Oxybutynin (Ditropan, Ditropan XL) or tolterodine (Detrol, Detrol LA). These medications calm an overactive bladder. An overactive bladder is when you have to urinate often and right away, which can cause leaks.

  • Duloxetine (Cymbalta) or imipramine (Tofranil). These medications are used to treat depression, and they can also help with bladder problems.

  • Collagen or botulinum toxin (Botox, Dysport) injections. Collagen can be injected to thicken the part of the bladder that lets urine out. An injection of botulinum toxin (Botox, Dysport) can relax bladder muscles.

Medical devices. There are medical devices that can help with bladder problems. One example is a pessary, which is worn in the vagina to support the bladder.

Estrogen cream. A vaginal cream with a low dose of estrogen can help with damage caused by menopause.

Surgery. In some cases, surgery may be needed. During surgery, a sling is placed around the bladder and urethra to keep them closed. Urine flows through the urethra after leaving the bladder.

Using a catheter. You can place a small, thin tube called a catheter through the urethra and into the bladder. This can help control leaks.

How can I manage incontinence at home?

Incontinence can be uncomfortable and disruptive. It can cause sleeping problems, make you feel ashamed or angry, or affect your daily life in other ways. In addition to working with your health care team to find the best treatment, there are things you can do at home to help make incontinence better or more comfortable.

  • Limit how much you drink, especially coffee and alcohol. Avoid foods that can irritate the bladder, including dairy products, citrus fruits, sugar, chocolate, soda, tea, and vinegar.

  • Go to the bathroom right before bedtime and any vigorous activity.

  • Wear an absorbent pad inside your underwear or disposable incontinence underwear.

  • Maintain a healthy weight. Extra weight can put pressure on the bladder and muscles that support it.

  • Go to the bathroom regularly each day. Do not wait too long or put off going.

  • Quit smoking. Nicotine can irritate the bladder. It can also make you cough and leak urine.

  • Do Kegel exercises. Ask your health care team about doing Kegel exercises at home. They can make your bladder stronger. To do Kegel exercises, first tighten the muscles you use to stop the flow of urine. Then, relax those muscles. Repeat the exercise several times. During this exercise, relax the muscles in your belly, buttocks, and thigh.

Finally, it can help to find support. Talk with your health care team or join a support group for people with bladder problems. It can help you feel better to know that other people are also dealing with incontinence.

Questions to ask the health care team

  • Who should I contact if I experience incontinence?

  • Are bladder problems common with the type of cancer I have or the cancer treatment I will receive?

  • What treatment(s) do you recommend for incontinence?

  • What can I do at home to be more comfortable?

Related Resources

Fear of Treatment-Related Side Effects

Side Effects of Chemotherapy

Side Effects of Radiation Therapy

More Information

MedlinePlus: Urinary Incontinence