Urinary incontinence

Urinary incontinence is also called loss of bladder control. It is an involuntary loss of urine or the inability to control urination.

Urinary incontinence can cause skin irritation and breakdown. It can also greatly reduce quality of life because losing urine involuntarily can cause embarrassment, fear of being ridiculed and depression. Many people who have loss of bladder control have lowered self-esteem and tend to isolate themselves from others.

People with cancer can have urinary incontinence for many different reasons. Some cancers and cancer treatments may damage, change or put stress on muscles and nerves that control the release of urine. They can also cause other changes to the body that lead to incontinence.

Cancers in or near the pelvic area can cause damage to muscles and nerves, causing urinary incontinence. These cancers include:

• prostate
• colorectal
• bladder and urethra
• cervical
• uterine

Brain or spinal cord cancers can affect nerves that help control the bladder and pelvic muscles.

Lung or esophageal cancer can cause chronic coughing, which can put stress on the bladder.

Breast cancer can cause hormonal changes that dry out the urethra. This can lead to loss of bladder control.

The following treatments can cause loss of bladder control. Urinary incontinence after some cancer treatments may gradually get better as the body recovers. Sometimes urinary incontinence is permanent.

Radiation therapy to the pelvic area can irritate the bladder and lead to urinary incontinence.

Some chemotherapy drugs can damage the nerves that control the bladder. Others can lower hormone levels or cause vomiting. High-dose chemotherapy given before stem cell transplant can cause bladder inflammation and vomiting. Damage to nerves, altered hormone levels, bladder inflammation and vomiting can lead to loss of bladder control.

Some hormone therapies can dry out the urethra, which can lead to loss of bladder control.

Surgery to the pelvis can damage muscles or nerves connected to the bladder.

Loss of bladder control occurs because the pressure in the bladder pushes the bladder sphincter open. The bladder sphincter is a ring of muscle at the lower end of the bladder that controls the release of urine. Dribbling after urinating is common but it happens more often in men.

Each type of urinary incontinence is described based when it happens and how severe it is.

Stress incontinence is when urine leaks during certain activities that increase pressure within the abdomen. These activities can include lifting, sneezing, coughing, laughing or exercise.

Urge incontinence is also called overactive bladder. You feel a strong need to urinate, which is called urgency. As soon as you feel the urge to urinate, you can’t control it and the bladder empties. People with urge incontinence usually urinate often during the day and night.

Overflow incontinence is when urine dribbles from an overly full bladder. Symptoms include frequent urination, difficulty starting to urinate, a slow stream and a feeling that the bladder has not completely emptied.

Functional incontinence occurs when cognitive or physical problems or environmental factors interfere with your ability to control urination. People who have functional incontinence may not be able to get to a toilet in time because they have trouble walking, they don’t know where a toilet is or they don’t recognize the need to urinate.

Mixed incontinence is a combination of more than one type of incontinence. The most common combinations are urge incontinence with stress incontinence or stress incontinence with functional incontinence.

Continuous incontinence is when someone has no control over urination.

Your doctor will try to find the cause of urinary incontinence. This may include talking to you about your symptoms and having you keep a journal to when, how often and how much you urinate.

You may also need to have the following tests:

• urine test to check for infection
• a stress test in which you cough as hard as you can with a full bladder
• tests that measure the pressure in the bladder, bladder capacity and urine flow
• cystoscopy
• x-ray of the bladder, called a cystogram
• ultrasound

Find out more about these tests and procedures.

Once the type and cause of urinary incontinence are known, your healthcare team can suggest ways to help you manage it. They may suggest the following measures.

Behavioural techniques can help you learn to delay urination after you get the urge. Try to schedule trips to the toilet every 2–3 hours while you’re awake. Over time, the time can be increased to every 3–4 hours.

Manage the amount and types of fluid and food you drink and eat. Avoid alcohol and caffeinated beverages because they can over stimulate the bladder and lead to urge incontinence. Avoid spicy foods, carbonated drinks, citrus fruits and juices. These can irritate the bladder. Limit fluid intake 3–4 hours before bedtime.

Some people find that biofeedback can help improve bladder control. Biofeedback uses measuring devices to monitor muscle contraction. It can help you know which muscles to use to help control urine flow and strengthen these muscles. Biofeedback can be stopped once you master these muscle strengthening exercises.

Kegel exercises strengthen the pelvic floor muscles, which help hold in urine. Tighten or squeeze the muscles around the anus as if trying to prevent gas from passing. Hold the squeeze for 10 seconds, and then relax for 10 seconds. Repeat 10 times. Do these exercise 3–5 times a day. You can also ask your healthcare team about using electrical stimulation with a low-voltage electric current to stimulate the pelvic floor muscles.

You can also use protective products. These are absorbent pads or liners designed especially for urine loss that may be used to protect clothing.

Your healthcare team may suggest medicines to treat some types of urinary incontinence. These drugs work in different ways to:

• relax the bladder muscle
• block nerve signals that can cause bladder spasms
• block nerve signals that cause contractions of an overactive bladder
• increase bladder muscle tone and bladder capacity
• strengthen the muscle that holds urine in

Other medicines may also be given with urinary incontinence. These can include antibiotics to treat infections. Some women may apply a cream with the hormone estrogen to the urethra or vagina if a lowered hormone level may be leading to incontinence.

Some people may have a collagen injection into the neck of the bladder. This adds bulk to the urethra and forces it to narrow. More than one injection is usually needed because the body slowly gets rid of the collagen. This procedure works temporarily for some people, but longer for others.

Your healthcare team may suggest different medical devices depending on the type and severity of urinary incontinence.

A urethral insert is a plug inserted into the urethra for some types of incontinence. The healthcare team will tell you how to insert the plug and release the urine.

A pessary is a stiff ring placed in a woman’s vagina to help support bladder muscles and provide better control of urine. Your healthcare team will explain how long this will be in place.

A urinary catheter is a rubber tube inserted into the bladder through the urethra. It is used to drain the bladder. The healthcare team may place the catheter several times a day or it may be left in place and connected to a drainage bag.

Condom catheters are a type of external collection product that fits over a man’s penis. It is held in place with adhesive, small straps or rings. The end of the condom is attached to a bag secured to the leg, which collects the urine.

Some people with urinary incontinence may need to have a pelvic or bladder suspension. This is a surgical procedure that pulls up the bladder and urethra to a more normal position within the pelvis.

Another surgery can be done to secure the bladder and urethra with a sling. The sling is made of abdominal tissue or synthetic mesh. It is placed below the bladder and around the urethra. It compresses the bladder sphincter and prevents urine from leaking. This surgery is used mostly to treat women. But it is sometimes used to treat stress incontinence in men.

Some people may need an artificial urinary sphincter. During surgery, a fluid-filled, synthetic cuff is placed around the urethra. When the cuff is filled with fluid, it closes the urethra and prevents urine loss. When the person needs to urinate, they release the control valve. The cuff deflates and urine passes out from the bladder. This surgery is used mostly in men and is rarely used in women.