Incontinence After Cancer

Incontinence is often associated with age-related issues like menopause and benign prostatic hyperplasia (BPH), but it can also occur due to cancer and even certain types of cancer treatment. Though incontinence after cancer is common, many people fail to discuss it with their doctors or caretakers due to feelings of shame and fear.

In an effort to educate cancer patients and minimize incontinence-related stigma, we’ve developed a guide to managing incontinence after cancer.

What is cancer?

Cancer is a group of more than 100 diseases characterized by abnormal cells that multiply uncontrollably. These cells form tumors that can infiltrate and destroy healthy tissue, spreading to other parts of the body.

Symptoms of cancer vary depending on the type, but common indications include fatigue, chronic pain, and unexplained weight loss. Another common (but frequently overlooked) sign of cancer is incontinence.

What types of incontinence does cancer cause?

Cancer can cause urinary or bowel incontinence:

Urinary incontinence

Urinary incontinence refers to the involuntary leakage of urine. The three types of urinary incontinence that commonly affect cancer patients include:

• Stress incontinence.

   

  Stress incontinence occurs due to excess pressure on the urethra. Common triggers include laughing, sneezing, coughing, or lifting something heavy. Some exercises to strengthen the pelvic floor may help this. This type of incontinence is also common during and after pregnancy.

• Overflow incontinence.

   

  Overflow incontinence prevents your bladder from fully emptying. It commonly occurs in cancer patients due to a blockage or narrowing of the urethra as a result of scar tissue.

• Urge incontinence (overactive bladder).

   

  Urge incontinence causes the bladder muscle to contract suddenly with no warning. This type of urinary incontinence is a common side effect of radiation therapy.

Bowel incontinence

Bowel incontinence refers to involuntary voids of stool and gas. Some people with bowel incontinence stop experiencing an urge “to go”; others aren’t mobile enough to make it to the toilet before having an accident.

What types of cancer cause urinary incontinence and bowel incontinence?

Many types of cancer increase the risk of urinary incontinence and bowel incontinence, including:

• Prostate cancer

• Cancer of the urethra

• Colorectal cancer

• Cervical cancer

• Uterine cancer

• Lung cancer

• Cancers of the brain

You might also experience urinary incontinence if you develop a cancerous tumor in your spine or near your bladder. As a tumor grows in size, it can place pressure on the urinary tract or bowels, increasing the risk of an involuntary void.

What types of cancer treatment increase the risk of incontinence?

There are a number of cancer treatments that affect continence in different ways:

Prescription drugs. Certain medications used in cancer treatment, like antidepressants, sedatives, and anticancer agents affect the muscles and nerves that control bladder and bowel function. Others make urinary incontinence more likely by causing vaginal and urethral dryness.

Chemotherapy. Chemotherapy uses powerful anti-cancer drugs to combat fast-growing cells. The substances used in chemotherapy often result in nerve damage, hormonal changes, and bladder irritation, three factors known to increase the risk of incontinence.

Radiation. Radiation uses energy (like X-rays, gamma rays, or electrons) to target and destroy cancerous cells. Thanks to advances in treatment, it’s possible to minimize the effects of radiation on healthy tissue. Even so, radiation increases the risk of scarring and fibrosis—two common causes of incontinence.

Surgery. Even cancer surgery can contribute to urinary incontinence or bowel incontinence. “In cases with extensive dissection, especially with radical hysterectomies, patients can experience poor nerve communication to the bladder. This can result in a neurogenic bladder with urinary retention or overflow incontinence,” said Anne Alaniz, DO, FACOG, FACOOG, an oncology specialist at Houston Methodist Willowbrook Hospital in Houston, Texas.

How can I help a loved one cope with the effects of cancer treatment and incontinence?

As a caretaker, you’re familiar with your loved one’s medical history and daily routine. If you notice any changes in their bathroom habits, such as bedwetting, difficulty making it to the toilet on time, or routine constipation, schedule an appointment with their primary care physician.

If your loved one denies there’s a problem or acts defensively, encourage them to seek outside support. “Patients and survivors should know they aren’t alone. There are support groups where others may be facing similar symptoms,” said Alaniz. “ No one understands these issues better than another person who has walked in your shoes.”

What can someone with incontinence do at home to be more comfortable?

The easiest way to make living with incontinence more comfortable is to stock up on the necessary supplies. We recommend having the following items on hand:

• Lotions, creams, and ointments to protect the skin

• Pull-ups, adult diapers, or disposable briefs for regular changes

• Fresh bedding that’s clean and dry

• Underpads (Chux)

• Booster pads to extend the life of incontinence garments

• Personal cleansing wipes

• Bedside commode so that one does not have to rush to the bathroom

If your loved one’s cancer-related incontinence is due to weak pelvic floor muscles, they might also benefit from lifestyle modifications like Kegel exercises or bladder training. Also try to limit caffeine intake, as it is a mild diuretic.

Is it possible to cope with incontinence after cancer?

Yes. Living with cancer-related urine and bowel incontinence presents challenges, but it isn’t the end of the world. “Patients should know that after cancer treatment, many people experience changes. Some of those issues improve with time, and some are altered for life. Find ways to cope and enjoy life with your new normal,” said Alaniz.

“Survivorship isn’t always about showing courage and not being disappointed that things are different. It’s about the brave decision to wake up every morning and keep living life to the fullest—even if you have to live it with incontinence.”

RECOMMENDED READ: Incontinence After Prostate Surgery