Problems urinating can occur as a result of prostate cancer, a result of prostate cancer treatment, or can be due to a completely different cause. The tube that carries urine from your bladder and out of your body is called your urethra. The urethra passes through the prostate gland. If a tumor in the prostate is large enough to compress the urethra, you may have difficulty urinating.
Urinary problems can include incomplete emptying of the bladder, problems beginning to urinate, increased need or frequency, pain, or a weak urine stream. In this case, the urinary symptoms will typically subside once the cancer is removed. These same urinary symptoms could also be caused by benign prostatic hyperplasia (BPH), which is the enlargement of the prostate gland but is not cancerous. Enlargement of the prostate from BPH is generally considered part of the normal aging process for men. When BPH is treated, most urinary symptoms typically subside as well.
Urination problems caused by treatment
Unfortunately, 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 used in prostate cancer treatment, the nerves and muscles can frequently get damaged during these treatments. In many cases, these symptoms will eventually subside, however, it may take up to two years, and in some instances, the nerve damage causing these symptoms may be permanent.
The main urinary symptoms that impact quality of life include leaking urine, irritation of the lining of the bladder or urethra (also known as radiation cystitis), changes in urinary frequency and urgency, difficulty urinating, and urine infections.
Although these symptoms may impact an individual’s quality of life, there are ways to manage or treat these issues if they do not subside after time.1-3
Urinary leakage
Leaking urine can 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, however, there are some ways to manage it if needed, including:
- Absorbent pads or pants
- Pelvic floor muscle exercises (these muscles are involved in the process of urinating)
- Bed protectors
- Urinary sheaths (bags that collect urine and can be hidden under clothes)
If urine leakage 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 a 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.4
Issues after radiation therapy
Radiation cystitis is essentially the irritation of the lining of the urethra and bladder as a result of radiation therapy. Symptoms of radiation cystitis include burning feeling while urinating, difficulty urinating, an increased need to urinate, or blood in the urine. These symptoms can appear at anytime post-treatment, however, they usually subside with time. Ways to manage radiation cystitis include:
- Drinking plenty of fluids
- Avoiding caffeinated, alcoholic, or fizzy drinks
- Taking a liquid medicine through a catheter called a bladder wash that acts to protect the linking of the bladder4
Changes in urgency and frequency
After treatment, you may feel the need to urinate more or that the urge to urinate is stronger than normal. This can even lead to a leakage of urine before you’re able to make it to the bathroom. This feeling is most commonly associated with radiotherapy, however, these symptoms usually subside after a few months. Ways to manage changes in urinary frequency and urgency include:
- Pelvic floor muscle exercises (also called Kegel exercises)
- Anti-cholinergic medications to control bladder muscle spasms
- 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)4
- Botox injections into the bladder wall
Difficulty urinating
Problems fully emptying the bladder can happen after treatment, especially radiation therapy. In some cases, this is due to the swelling of the prostate. The common signs of chronic urine retention include feeling like you have a swollen abdomen, feeling like your bladder isn’t fully empty, leaking urine at night, and having a weak flow when urinating. Although these symptoms may be easy to ignore, if untreated, they can cause bladder stones or infections. Ways to manage or treat chronic urine retention include:
- Medications including alpha blockers or 5-alpha-reductase inhibitors
- Surgery to widen the urethral or bladder opening
- Using a catheter4
Urinary infections
Urine infections may happen after high-intensity focused ultrasound, or as a result of chronic urine retention. When detected and reported to your doctor, you will be prescribed antibiotics, which should cure the infection.4
Tips and coping
Overall, there are a few additional steps you can take to reduce your risk of developing urinary problems, or to aid any current issues. These include:
- Drinking plenty of clear fluids
- Avoiding caffeinated, alcoholic, or carbonated drinks
- Performing pelvic floor muscle exercises
- Eating a healthy diet full of fiber
- Quitting smoking
- Maintaining a healthy weight and exercise regimen4
- Develop a plan when leaving the home including bringing pads and researching where bathrooms are located