Bladder cancer is the 7th most common type in the UK. It is estimated that over 100,000 people are living with it in the UK. However, the link between incontinence and bladder cancer is something we hardly hear about.
The most common symptom of bladder cancer is hematuria, or blood in the urine. It is therefore the symptom that is most commonly discussed. Urinary incontinence is a discussion that is often avoided, with few people associating it with bladder cancer. If a man has bladder leakage, for example, he is more likely to be told he has a prostate condition. As incontinence is associated with aging, it is therefore more likely to be brushed off as a symptom of aging as opposed to cancer. A woman may be told her leakage is caused by a lack of oestrogen during menopause. The embarrassment around incontinence means people are less likely to discuss it with others. Too many people are therefore left to manage urinary incontinence alone, as they feel too embarrassed to find support. The Alzheimers Society is one organisation passionate about stopping this problem, stating “incontinence is one of the biggest issues for those with serious health problems, but the taboo around it forces those effected to struggle in silence”. They state, “as well as practical solutions we need to tackle the stigma”.
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Incontinence Caused by Bladder Cancer
Incontinence can occur due to the tumour or structural changes to the urethra. More frequently, it can occur due to the bladder sphincter or other bladder muscles becoming damaged by surgery. Surgery for invasive bladder cancer in particular can cause someone to lose normal bladder function. Invasive bladder cancer surgery is called a cystectomy, and involves removing some or the entire bladder. Sphincter muscles act like a valve that holds urine in or releases it when necessary. When treatment affects these muscles that carry signals to nerves, this affects your control over urination. Some people also experience a burning pain when passing urine.
Chemotherapy can cause cystitis and neurotoxicity, which may also affect the bladder control. Additionally, side effects of chemotherapy such as frequent nausea and vomiting can lead to stress incontinence. This occurs due to a combination of dehydration and straining the muscles.
You can read about managing stress urinary incontinence here.
Improving Bladder Function
Incontinence surgery is often required to compensate for the loss of bladder function after a radical cystectomy. A urostomy is a common type of urinary division operation, in which a surgeon makes a hole in your abdominal wall. A waterproof pouch is connected to the stoma to allow you to collect urine. A continent urinary diversion is a similar operation, except you are not required to use a pouch.
If possible, surgeons can also create an artificial bladder for treatment. This is often known as a neobladder, which is created from a section of your bowel and attached to your urethra. It is estimated that 25% of people with a neobladder will experience incontinence in the early stages after their operation. Often, patients experience Nocturnal Enuresis.
Although it might seem embarrassing, it is vital to make an appointment to see your Doctor, continence nurse or specialist physiotherapist. Specialists see people every day with incontinence, so explaining your story is nothing new to them.
For advice on managing incontinence in daily life, read our living with incontinence section.