Cancer-Related Urinary Incontinence

Urinary incontinence, or accidental leaking of urine, is an unpleasant side effect experienced by some individuals with cancer. There are different causes of incontinence, including the location of the disease, and/or cancer treatment. In some cases, urinary incontinence can be temporary and will improve with time; in other situations, this is a side effect that people live with long term. Understanding the cause, treatments, and ways to manage symptoms can help relieve some of the anxiety and stress caused by loss of bladder control. 

Types of Incontinence 

  • Stress incontinence: This form of incontinence refers to urine leakage that occurs when extra pressure or stress is placed on the bladder, such as when coughing, laughing, sneezing, jumping, or exercising.  

  • Overflow incontinence: This occurs when the bladder is full, and urine leaks out. This can be due to not being able to feel when the bladder is full, or an inability to fully empty the bladder.  

  • Urge incontinence: With this type of incontinence a sudden urge to urinate may occur quickly with little warning. This urge can be frequent, and sometimes uncomfortable.  

  • Continuous incontinence: This refers to a complete lack of urinary control, not just leaking.  

Causes of Incontinence 

  • Location of your cancer 

    • Pelvic cancers: Cancers that occur in the pelvic area can put extra strain or pressure on the urinary system. This includes cancers of the reproductive system as well as gastrointestinal (GI) and genitourinary (GU) cancers such as prostate, cervix, uterus, ovaries, testes, bladder, colorectal, or urethral.  

    • Brain or spinal cord cancers: Cancers of the brain and/or spinal cord can affect the nerves that help control urinary function such as your bladder or pelvic muscles. 

    • Lung or esophageal cancer: These cancers can indirectly cause incontinence due to excessive coughing that can put pressure on the bladder and result in leaking.   

    • Breast cancer: For some women being treated with anti-hormone medications, drying of the genital area can occur causing increased pressure or irritation of the urinary system. This can increase the risk for urinary tract infections.  

  • Certain cancer treatments 

    • Radiation: Any radiation to the pelvic region increases the risk of irritation to the bladder.  

    • Surgery- Surgeries to the pelvic area can cause swelling, inflammation, or nerve damage that can result in temporary or prolonged urinary incontinence.  

    • Medications: Some chemotherapy can cause damage to nerves including those in the pelvic region. Anti-hormone medications can result in drying of the urinary and vaginal tissues.  

Treating Incontinence 

  • Physical therapy: A pelvic floor physical therapist can help you build pelvic floor strength and control through exercises called Kegels, or electrical stimulation to strengthen the pelvic floor. They can also work on bladder training through biofeedback and bladder habits/awareness. Be sure to ask your team for a referral to a certified pelvic floor PT. 

  • Medication: Medications such as Oxybutynin can help treat an overactive bladder. Additionally, some anti-depressant medications have the added benefit of treating bladder problems. These include Duloxetine (Cymbalta) and imipramine (Tofranil).  

    • A less conventional medical treatment for urinary incontinence is the use of collagen or Botox injections, however this is only helpful in certain scenarios.   

  • Surgery: A surgical sling procedure can be performed in some cases to relieve pressure on the bladder and urethra. 

    • For men with chronic urinary incontinence who have undergone a radical prostatectomy, surgical options such as urethral bulking, perineal sling, or Artificial Urinary Sphincter (AUS) placement may be an option. Men will often see a urologist and for women, a specialized urogynecologist may be available. 

  • Medical devices: A urinary catheter may be used to drain urine from the bladder. This is the process of placing a small tube into the bladder through the urethra. Depending on the situation, catheter use may be intermittent, or ongoing.  

    • For women, a device called a pessary can be inserted into the vagina to help provide added support to the bladder, vagina, uterus, or rectum. If the symptoms of incontinence are due to pelvic floor prolapse, this can be helpful in relieving pressure on the bladder and/or urethra. 

Questions to Ask Your Care Team 

  • Is incontinence a common problem with my cancer type or with the cancer treatment I will be receiving? 

  • What is the expected time frame that incontinence can last for my specific situation? 

  • Is there any treatment you would recommend for my incontinence? 

  • Is pelvic floor physical therapy appropriate for me?