Treatment Side Effects - Urinary Incontinence

Common urinary-related side-effects experienced by men with prostate cancer include the following:

• Leaking urine
• Complete loss of bladder control (incontinence)
• Irritation of the lining of the bladder (also called radiation cystitis)
• Changes in urinary frequency
• Changes in urinary urgency
• Difficulty urinating
• Urine infections¹

While none of these symptoms are directly life-threatening, they do have the potential to substantially affect a man’s quality of life. It is possible for one man not to feel impacted by urinary-related side-effects, while another may experience debilitating quality of life changes. Whatever way you process or treat any urinary-related issues you experience is normal.

What can lead to urinary incontinence and other urinary problems?

Many of the most common treatment options for prostate cancer, including prostatectomy, external beam radiotherapy, or brachytherapy, can cause problems with urination post-treatment. One of the main reasons for this is that despite nerve-sparing techniques, the nerves and muscles can get damaged during treatment. In many cases, these symptoms will eventually subside, however, occasionally, these symptoms may be permanent. Your healthcare team will help you determine what urinary-related side-effects you are at risk for and try to predict how long these issues may last. If urinary symptoms are especially concerning for you, your doctor may suggest a treatment option with a smaller risk of developing these issues, when possible.^2,3

Managing urinary-related difficulties

How best to manage urinary-related difficulties depends on the extent of the issue. For example, some men may leak a bit of urine when they cough, sneeze, or laugh, while others may leak continuously or have no control over their bladder. Additionally, managing infections or bladder irritation will require their own separate interventions as well. Common options for the management of urinary incontinence, urinary leakage, and changes in urinary frequency or urgency include the following:

• Absorbent pads or pants
• Pelvic floor muscle exercises (these muscles are involved in the process of urinating)
• Bed protectors
• Penile clamps
• Urinary sheaths (bags that collect urine and can be hidden under clothes)
• Artificial urinary sphincter
• Adjustable balloons
• Internal male sling
• Retraining your bladder (relearning to hold your urine that may be done under the supervision of a physiotherapist)
• Percutaneous posterior tibial nerve stimulation (targeting the nerves that control urination)
• Botox
• Anti-cholinergic medications¹

When managing difficulties urinating or emptying the bladder, the following options may be useful:

• Medications including alpha blockers or 5-alpha-reductase inhibitors
• Surgery to widen the urethral opening
• Using a catheter¹

Irritation of the bladder (radiation cystitis) or urinary-related infections may be treated by drinking plenty of clear fluids, undergoing a bladder wash (a liquid medicine, administered through a catheter into the bladder, that protects the lining of the bladder), or taking antibiotics. Your doctor will help you determine the underlying cause of your urinary-related symptoms and what the best treatment options are for your situation. In general, there are several steps you can take regardless of what your specific struggles are to help promote overall bladder health and urinary functioning, including:

• Drinking plenty of clear fluids
• Avoiding caffeinated or fizzy drinks and drinks with alcohol
• Performing pelvic floor muscle exercises
• Eating a healthy diet full of fiber
• Quitting smoking
• Developing a plan when leaving the home including bringing pads and researching where bathrooms are located
• Maintaining a healthy weight and exercise regimen¹

Communicating urinary-related difficulties

Urinary problems can be embarrassing and life changing. Because of this, it’s common for men to avoid talking about these struggles with their healthcare team or partners. By not talking about these issues, feelings of fear or inadequacy may build up and cause significant mental, emotional, or physical complications. For this reason, it is critical to talk with your doctor about potential treatment options that may be right for you, or for specific tips on how to manage what is going on. How much you share about your urinary struggles is completely up to you, however, enlisting the support of an intimate partner, spouse, or close confidant may help ease the burden and set expectations or plans to be followed in the event that you need help managing your urinary struggles outside of your home.