Incontinence, defined as the involuntary loss of urine or stool, can be a consequence of cancer and its treatments. It is a common concern for many individuals with a cancer diagnosis.
How Cancer Directly Affects Bladder Control
Cancers situated in or near the pelvic area, such as those of the prostate, bladder, colorectal region, cervix, or uterus, can damage or exert pressure on the muscles and nerves essential for urinary function. A growing tumor might obstruct urine flow, leading to incomplete bladder emptying and leakage.
Tumors affecting the nervous system, particularly those in the brain or spinal cord, can disrupt the nerve signals that regulate bladder and pelvic muscle control. This disrupts communication between the brain and bladder, making urination difficult to control. Even cancers in distant areas, like lung or esophageal cancer, can contribute to incontinence indirectly through chronic coughing, which places stress on the bladder.
Incontinence Caused by Cancer Treatments
Surgical procedures, especially those in the pelvic region, can alter anatomy or damage nerves and muscles involved in bladder control. Radical prostatectomy, which removes the prostate gland, often leads to incontinence by affecting the urinary sphincter complex. Similarly, hysterectomies can damage pelvic floor muscles and nerves, or alter bladder position, contributing to incontinence.
Radiation therapy directed at the pelvic area, used for cancers like prostate, bladder, gynecological, or colorectal cancers, can irritate and inflame the bladder and surrounding tissues. This inflammation, known as radiation cystitis, can reduce the bladder’s capacity and elasticity, leading to urgency and reduced control. Radiation can also damage nerves and weaken pelvic floor muscles, contributing to incontinence.
Certain chemotherapy drugs can cause nerve damage, known as neuropathy, which may affect bladder control. Chemotherapy can also lead to general muscle weakness or bladder irritation, increasing incontinence risk. Hormone therapies, particularly those used for prostate cancer, can decrease muscle mass and weaken pelvic floor muscles, impacting control. For breast cancer, hormonal changes induced by therapy can dry out the urethra, potentially leading to incontinence.
Understanding Types of Cancer-Related Incontinence
Cancer patients may experience different types of incontinence. Stress incontinence involves involuntary urine leakage during physical activities that put pressure on the bladder. It is common after prostate surgery due to urinary sphincter damage.
Urge incontinence, also known as overactive bladder, is characterized by a sudden, strong need to urinate followed by involuntary leakage. Bladder irritation from radiation therapy or nerve damage can contribute to urge incontinence. Overflow incontinence occurs when the bladder does not empty completely, leading to frequent dribbling. This can result from a blockage or nerve damage that prevents bladder contraction.
Functional incontinence describes urine leakage due to physical or cognitive impairments that hinder a person’s ability to reach the toilet in time. While not directly caused by cancer, factors like fatigue, pain, or mobility limitations common in advanced illness can contribute.
Strategies for Managing Incontinence in Cancer Patients
Managing incontinence often involves a combination of approaches. Discussing symptoms with a healthcare team is important for personalized care. Lifestyle adjustments can play a role in symptom control. Pelvic floor exercises strengthen the muscles that support the bladder and urethra, improving bladder control. Bladder training, which involves adhering to a scheduled urination routine and gradually increasing the time between voids, can help.
Fluid management and dietary modifications can reduce bladder irritation. Limiting intake of caffeine, alcohol, carbonated beverages, and acidic or spicy foods can alleviate symptoms. Maintaining adequate hydration remains important.
Medical interventions may include medications designed to relax an overactive bladder. For severe or persistent cases, medical devices like absorbent pads or external clamps can manage leakage. Catheters may be used in situations where the bladder cannot empty. Surgical options, such as sling procedures or artificial urinary sphincters, may be considered for specific types of incontinence, particularly stress incontinence.