Managing Urinary Incontinence

CURE, Winter 2012, Volume 11, Issue 4

Urinary incontinence after a cancer diagnosis can be managed.

Cancers near the bladder, such as prostate, cervical, rectal and bladder, can increase the risk of urinary incontinence (UI). But, more often, the condition is caused by cancer treatments rather than the cancer itself.

Stress incontinence is the loss of urine due to increased pressure on the abdomen, such as that caused by coughing, laughing, exercising or lifting a heavy object. Frequent nausea and vomiting from chemotherapy can also lead to stress incontinence. If the bladder sphincter—the valve that closes tightly to hold urine in the bladder—or other bladder muscles are damaged or weakened by surgery or radiation, leaking may occur. Stress incontinence can also occur with normal aging, particularly in women who have had children, due to laxity in the ligaments that hold the bladder and uterus.

Urge incontinence is a sudden, strong urge to urinate followed by an involuntary leakage of urine. This can result from nerve damage or bladder irritation causing nerve signals, or urges, to urinate even though there may be only a small amount of urine in the bladder. Both pelvic radiation and surgery can cause nerve damage, and pelvic radiation can cause bladder irritation, as well. Peripheral neuropathy from chemotherapy may also contribute to urge incontinence.

Overflow incontinence is an inability to empty the bladder completely, causing it to overfill and leak urine. This can result from a tumor or scar tissue blocking and squeezing the urethra (the tube connected to the bladder that urine flows out of during urination), so it doesn’t open properly to release urine; or it can result from weakened bladder muscles that can’t force the urine out.

Surgeries that remove tumors or tissues near the bladder can cause UI by damaging the muscles or nerves that help control urination. Examples include surgery for gynecologic cancers (hysterectomy), prostate cancer (prostatectomy) and colorectal cancer. Radiation to the pelvic area can damage bladder muscles and nerves, irritate the bladder lining and create scar tissue, all of which can cause UI. Hormone therapies that lower estrogen can weaken the ligaments holding the bladder and cause incontinence.

Changes to diet, lifestyle and exercise habits may help in managing mild UI, whereas more invasive options, such as surgery, may be needed for severe or persistent UI.

Alcohol and caffeine act as urine stimulants, so limiting intake of these fluids may help control urge incontinence.

Kegel exercises can help strengthen the pelvic floor and sphincter muscles to improve urine control. Bladder training is a type of behavioral therapy that involves learning to delay urination until after feeling the urge to go and may help with urge incontinence. Double voiding—urinating and then trying again a few minutes later—may help with overflow incontinence. Biofeedback involves learning how to control pelvic and bladder muscles. Electrical stimulation therapy helps strengthen the pelvic floor muscles to improve urine control for those with stress or urge incontinence. It may also be helpful to urinate according to a time schedule rather than waiting for the urge to go, or use absorbent pads and garments for uncontrolled leakage.

Anticholinergic drugs, such as Ditropan (oxybutynin chloride) and Detrol (tolterodine tartrate), may be used to treat urge incontinence because they affect the bladder nerves and reduce bladder muscle contractions. Use of a self-catheter several times a day may help with overflow incontinence.

Surgical options may be most helpful for stress incontinence and include implanting an artificial urinary sphincter, creating a sling to support the bladder and urethra and injecting bulking material into tissue around the urethra to keep it closed. Surgery, however, is reserved for cases where other procedures are not effective because it can introduce other complications.