Losing control of your bladder or bowels can be a very frustrating experience. These symptoms are often referred to as urinary or bowel incontinence and, in relation to prostate cancer, can be difficult to predict. Occasionally, a tumor in the prostate may grow and start pressing on the urethra, causing urinary problems, including incontinence. A similar reason may be possible for bowel disruption. Other times, these issues can be a sign of advanced prostate cancer that has metastasized to the spine. In this situation, cancerous tumors can destroy spinal bones and disrupt or damage the nerves in the spinal cord that control bladder or bowel functioning. Another way these symptoms can develop, and usually the most common way, is as a result of prostate cancer treatment, such as radiation therapy, or surgery.
Bowel incontinence and prostate cancer treatment
Just as the ways to develop urinary or bowel incontinence are numerous, so are their potential outcomes. In many instances, urinary or bowel incontinence after prostate cancer treatment resolves on its own, as an individual is recovering from the treatment. For example, after radiation therapy, an individual may lose control of their bladder, but this may resolve without any intervention within a few weeks or months. On the other side, there is a possibility that during treatment (or as a result of spinal cord compression) the nerves or muscles that control these processes can get damaged permanently, and the incontinence may not subside on its own. Before treatment, and even immediately after, it’s very hard to predict if you’ll have these issues, and for how long they may last.
Losing control of your bladder
Urinary incontinence can range from uncontrolled release of a full bladder to slower leakage. Leaking urine can also present in varying ways, from leaking a few drops after coughing, exercising, or bending, to leaking large quantities or leaking during sex. This usually improves over time if it’s a result of prostate cancer treatment, however, it can be longer-lasting if it’s from spinal cord compression. The good news is, there are some ways to manage losing control of your bladder, if needed, including:
- Absorbent pads or pants
- Pelvic floor muscle exercises (these muscles are involved in the process of urinating—these can be taught to you by your doctor or a physical therapist)
- Bed protectors
- Urinary sheaths (bags that collect urine and can be hidden under clothes)
Options for managing bowel problems
If urine incontinence continues for longer periods of time, or becomes a serious impairment to quality of life, there are other additional options including:
- Artificial urinary sphincter
- Adjustable balloons
- Internal male sling
- Anti-cholinergic medications
All of these options for serious impairment require surgery with the exception of medications. Your doctor will help you determine the side effects and potential benefits for your specific case. Additional lifestyle changes may also be beneficial to help fight urinary incontinence, including eating a well-balanced diet with fiber (to prevent constipation which can push on the bladder), exercising (including the pelvic floor muscle exercises mentioned above), avoiding alcoholic, fizzy, or caffeinated drinks, quitting smoking, and retraining your bladder by creating and maintaining a urination schedule.1-4
Losing control of your bowels
It has been estimated that bowel problems, including diarrhea, constipation, incontinence, increased flatulence, rectal bleeding, and increase in the urgency or frequency of bowel movements can occur to up to 20% of all individuals who undergo radiotherapy. Although incontinence, or losing control of your bowels, is in this category, is not as common as the other symptoms in this group. It is also potentially can be one of the hardest of these symptoms to manage. Currently, there are very few treatment options available for total bowel incontinence. Losing control of your bowels as a result of spinal cord compression or prostate cancer treatment may or may not be reversible, and can range from leaking small amounts of feces to total loss of bowel control.
In some instances, bowel control will be regained after treatment and post-recovery. But if this process isn’t occurring as fast as anticipated, or isn’t happening at all, there are a few lifestyle changes that can help manage bowel incontinence. Many of these are similar to options used for urinary incontinence, and include:
- Anti-diarrheal agents (immodium, lomotil)
- Eating a well balanced diet with fiber
- Pelvic floor muscle exercises
- Absorbent and/or scented pads
- Avoiding foods that may irritate the digestive system
- Creating a bowel movement schedule and retraining your bowels
- Decreasing physical activity after meals
In rare instances, it may be possible to have surgery for bowel incontinence, including anal sphincteroplasty or anal sphincter repair, depending on the underlying cause of the incontinence.5-7
Using palliative care to ease discomfort
For both urinary and bowel incontinence that is caused by compression of nerves in the spinal cord as a result of prostate cancer that has spread to the spine or bones, palliative treatments for metastasized cancer may be of use. These treatments include radiotherapy, medication, or surgical removal of spinal cord tumors. However, these treatment options are not indicated for every situation. Your doctor will help you determine what path is right for you and to improve your quality of life. As always, coping with quality of life symptoms like these can take a toll on an individual or their caretaker both mentally and physically. For this reason, it can be a good idea to consult a therapist or counselor if needed for extra support.
