Managing urinary symptoms after prostate cancer treatment
Some treatments for prostate cancer can cause urinary symptoms. Urinary symptoms – particularly leaking urine – are most common after surgery for prostate cancer.
Many people feel upset or embarrassed by incontinence and urinary problems. You may find it affects how you feel about yourself and your dignity. Some men might avoid going out as much when they are troubled by urinary leakage because they worry about changing pads or having an accident. There are some tips to help you cope with urinary problems at the bottom of this page.
It is important to remember that you are not alone and help is available. It can help to talk to a nurse or to someone who has experienced urinary leakage.
You can also call 1800 200 700 or visit a Daffodil Centre to speak with one of our cancer nurses in confidence or to be put in contact with someone who has had treatment for prostate cancer. You can also email the nurses at email@example.com.
What urinary problems might I have?
- Passing urine frequently (more than 8 times a day).
- A sudden urge to go to the toilet quickly (urgency).
- Getting up more than twice at night to pass urine.
A slow flow of urine / Difficulty emptying your bladder fully
A slow flow of urine may be caused by a narrowing of your urethra (water pipe) after surgery or radiotherapy. If you have a slow flow of urine or you’re getting a lot of urinary infection let your urologist know, so they can find the cause and see if you need treatment.
Leaking urine (urinary incontinence)
Leaking urine is a common side-effect of prostate cancer surgery. It can also happen if cancer is growing near the muscles which control the opening and closing of the bladder, causing them to weaken.
You may leak just a few drops of urine when you cough, laugh or exercise or it can be a constant drip or trickle throughout the day. Or you may leak some urine before you get to the toilet or after you have been. This usually gets better after a few weeks.
Your doctor, nurse or physiotherapist will tell you about pelvic floor exercises you can do, which may help to speed up the return of your urine control.
Acute urinary retention
Some men have problems passing urine. Occasionally, some men find they cannot pass urine at all and cannot empty their bladder. This is called acute urinary retention. It can happen after radiotherapy and is due to the narrowing of the tube carrying urine from the bladder.
If this happens, you'll need to go to the hospital accident and emergency department where they will fit you with a small, thin tube (catheter) to drain your bladder, or your homecare team may do this for you
Some men may need a small operation to stretch the urethra and relieve the pressure on the narrowed urethra (water pipe).
Your bladder may become inflamed (cystitis) after radiotherapy. This may cause pain, discomfort or a burning sensation while passing urine. You may also feel the urge to pass urine frequently, both during the day and at night.
Sometimes you may find that you can only pass very small amounts of urine or none at all. Occasionally, blood may appear in your urine.
What you can do:
- Drink as much fluid as possible to help relieve symptoms.
- Drink cranberry juice or lemon barley water. Cranberry juice may not be advised if you are on certain medication, such as a blood thinner, so check this with your doctor first.
- Avoid alcohol, tea, coffee, carbonated drinks, acidic fruit juices such as orange juice, as they irritate your bladder.
Blood in the urine
You may notice blood in your urine (haematuria). This can happen after radiotherapy, sometimes years later. Tell your doctor if this happens so they can check out the cause. Often the bleeding is slight and no treatment is necessary.
With metastatic prostate cancer blood may be coming from your prostate gland. It can usually be controlled with surgery or radiotherapy.
Carry the card: The Irish Cancer Society have a card that you can show at shops and other public places to get urgent access to a toilet. Get one from a Daffodil Centre or by calling our Cancer Nurseline on 1800 200 700.
Coping with urinary problems
Coping with leakage
If you need advice about coping with leakage, ask your doctor, public health nurse or see if there’s a continence advisor at your local HSE health centre. There are things that can help, so don’t suffer in silence.
You may need to wear pads to absorb leaks for some weeks or months. Read some advice about incontinence pads.
Pelvic floor exercises
Pelvic floor exercises can help to strengthen the muscles around your bladder and in the pelvic floor and may improve your bladder control. Get advice from your hospital team or a local HSE continence advisor. See our instructions on how to do pelvic floor exercises.
Hints and tips – ways to help urinary problems
Your doctor can help you to manage urinary problems, but there are things you can do yourself that can help:
- Cut down on caffeine. It may irritate your bladder. Caffeine is found in tea, coffee, chocolate and cola.
- Try drinking less alcohol. Alcohol can increase the amount of urine you produce, making it more likely you’ll have to get up during the night.
- Find out your ‘triggers’. Fizzy drinks, citrus fruits like oranges and lemons, tomatoes and spicy foods affect some people. Try avoiding them for a time to see if it helps.
- Drink plenty of fluids. Not drinking enough will make your urine more acidic and this may irritate more. Aim for 2 litres a day (6-8 cups). it's best to sip or drink small amounts at a time – drinking lots at one time could make your urinary problems worse.
- Keep a healthy weight and eat a balanced diet. Having weight around your middle (the abdomen) creates pressure on your pelvic floor area and can make urinary problems worse..
- Exercise regularly if you can. Exercise helps you to keep a healthy weight and helps bowel function too. You doctor can advise you about suitable exercises.
- Try pelvic floor exercises. They may help to improve your bladder control. Get advice from your hospital team or a local HSE continence adviser.
- Go to the toilet regularly.
- Wear clothes that are easy to take off. Trousers with an elasticated waist, or using braces rather than a belt can make it easier when you want to go to the toilet quickly.
- Try having a rest in the afternoon. It may help the muscles around your bladder to tighten up and work better for you.
- Plan ahead. Keep a bag with wipes and pads with you, and make sure you know where the public toilets are if you’re going out.
- Use a bed protector if you’re worried about leaking during the night.
- Pick the right size of pads to suit you. Wear supportive underpants to help keep them in place and keep a supply with you.
- Wear dark coloured trousers. If you’re worried about urine leaks showing on your clothing.
- Keep the area clean and dry. Use a mild soap and gently pat the area dry to avoid skin irritation and stay fresh.
Travelling and urinary problems
A trip away when you have urinary difficulties may seem daunting – but a little planning can help you to feel a bit more relaxed when travelling.
- Incontinence and urinary frequency can change the activities you want to take part in, so you may need to change the type of holiday you have.
- Pack a supply of equipment that will last the length of your trip – include pads and wipes in your hand luggage to use in the event of a delay. You might want to keep a change of underwear or clothing nearby too.
- If you go abroad consider taking a written list of what you need in the language of the country you are going to. An online translation service such as Google Translate can do this for you.
- It may be useful to buy a portable urinal if you are travelling a long distance by car.
- A supply of plastic bags can help you to keep pads dry, and to store wet pads or clothing while travelling.
- If you are concerned about bed protection, contact your accommodation before you go or take a protective sheet with you.
- Find out about laundry facilities where you are going – or take a supply of washing powder so you can wash small items of laundry if needed.
Treatments for urinary problems
Slow flow of urine
Your doctor may give you tablets called alpha blockers to help. These can help to relax the muscle within the prostate and to reduce the narrowing of the water tube that runs through the centre of the prostate.
Going to the toilet frequently, needing to go quickly or leaking before you get to the toilet
Your doctor may advise lifestyle changes. You may also be given a tablet called an anti-cholinergic, as long as you are able to empty your bladder fully.
Blood in the urine
Occasionally some treatment to the bladder is needed to try to stop the bleeding.
If your incontinence continues for more than 12-18 months your urologist may discuss further treatments to help you.
- Medication. Some men may be given a medication called duloxetine (Yentreve®) to help with stress incontinence. As with all medication, some people experience side-effects, so talk to your doctor or pharmacist about this.
- Bulking agents. Using bulking agents may be useful for men who leak a small amount. It involves injecting material around the inside of your water pipe (urethra) to fill out the lining to help close over the opening a little.
This procedure can be done under local anaesthetic. The success of this procedure is variable. The injections often need to be repeated at intervals.
- Internal sling. If you leak a moderate amount, one option for you might be to have a smaller operation to have an internal sling inserted. A sling is a small piece of material that presses your water pipe (urethra) closed to try to stop urine leaking out, without squeezing it so tight that you cannot pass urine properly.
The success of this operation varies: for some men it will reduce their leakage so they do not need to wear pads, for others it reduces their leakage but they still need to use some pads.
There can be some complications with a sling operation, such as discomfort for some weeks after the operation and a risk of infection. Your urologist will discuss the advantages and disadvantages and risks of this operation with you.
- Artificial urinary sphincter. An artificial urinary sphincter is a device to treat severe incontinence. It involves an operation to put a mechanical device with an inflatable cuff around your water pipe (urethra). The cuff comes with a balloon and a small pump which is put into your scrotum. You squeeze the pump when you need to pass urine and the cuff deflates for a short time to allow your bladder to empty.
After having a sphincter put in some men will no longer need to wear pads at all while others may still have a small amount of urine leakage and may need to carry on wearing a pad. There can be complications with an artificial urinary sphincter, such as infection or failure of the device.
For more information
1800 200 700