Urinary Incontinence

Some survivors may experience the uncontrollable loss of urine from the bladder. By identifying the causes of urinary incontinence, you can take steps to manage it and reduce its effect on your daily activities.

Detailed Information

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Urinary Incontinence: Detailed Information

This information is meant to be a general introduction to this topic. The purpose is to provide a starting point for you to become more informed about important matters that may be affecting your life as a survivor and to provide ideas about steps you can take to learn more. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Suggestions and Additional Resources sections for questions to ask and for more resources.

Urinary incontinence is the uncontrollable loss of urine from the bladder. This problem affects more than 25 million Americans including many cancer survivors. Because this is such a personal and private matter, it can cause embarrassment. It can also affect self-esteem, lifestyle and quality of life.

The bladder is a muscular organ that stores urine that is produced by the kidneys until it is time to empty. It expands as it fills, and nerves from the bladder send a message to the brain when the bladder is full. The brain then sends a message back to the bladder to release the urine.

What causes urinary incontinence?

There may be a number of causes for urinary incontinence during cancer. Pelvic floor muscles support the bladder. Muscles also create a valve that opens to release and closes to hold urine. They help the bladder close tightly because they surround the urethra tube. If these muscles stretch or weaken, they may not be able to close completely. This may allow urine to leak.

In some cases, the drying affects of hormonal changes on the vaginal and urethral tissues may affect the urethra's ability to make a tight closure and prevent urine leaks

Surgery in the pelvic area can injure the nerves going to the bladder. This might occur during treatment such as for prostate, uterine or colon surgery. If the nerves are injured, the signals may not be sent or the bladder might be signaled to contract at the wrong times.

Some of the most common causes of incontinence include:

• The valve closing the bladder is too loose
• The valve closing the bladder is too tight
• The bladder is too relaxed
• The bladder is too active

Factors that can contribute to urinary incontinence include:

• Pregnancy
• Childbirth
• Menopause
• Smoking
• Diabetes
• Neurologic diseases, such as Parkinson's
• Obesity
• Chronic constipation
• Lifting or exercising
• Pelvic surgery or radiation
• Enlarged prostate gland
• Some medications, such as diuretics, sedatives, anti-depression medicines and chemotherapy

What types of urinary incontinence exist?

Different types of urinary incontinence have different symptoms. Some people have more than one reason for this problem. The main types of urinary incontinence are.

• Stress incontinence: People with stress incontinence may experience problems while they are laughing, coughing, sneezing, lifting, exercising, or standing up. The valve and the pelvic floor muscles for controlling urine cannot close tightly enough to prevent leakage.
  
• Urge incontinence: Those with urge incontinence experience the need to urinate frequently. They must get to a restroom quickly to prevent leaking. The urge sensation can be uncomfortable or even painful. When the bladder is overactive, it responds by signaling the need to urinate even though there may be only a small amount of urine in the bladder.
  
• Mixed incontinence: Individuals with mixed incontinence commonly experience a combination of stress and urge symptoms.
  
• Overflow incontinence: Overflow incontinence occurs when some obstruction to the urine flow causes the bladder to overfill and leak small amounts. This can occur if the prostate is enlarged and squeezes the urethra or if the bladder valve does not open properly. There may be the feeling of having to urinate every few minutes because the bladder usually does not empty completely.
  

Which types of cancers and treatments can contribute to incontinence?

Most of the studies on cancer survivors that include urinary incontinence have generally focused on those with prostate cancer. However, there are other cancers or treatments that can also affect urinary incontinence.

The types of cancer that put a survivor at risk for urinary incontinence include:

• Cancers in the pelvis such as prostate, cervix, rectum, urethra and bladder
• Tumors in the brain, spinal cord or those affecting the nerves to the bladder or pelvic muscles
• Lung or esophageal cancer because of a chronic cough
• Breast cancer because of the drying affects of hormonal changes

Cancer treatments can also contribute to the risk for urinary incontinence in different ways such as:

Surgical changes to the bladder outlet such as removing the prostate

Side effects of treatments such as nausea and vomiting that can contribute to stress incontinence

• Bladder irritation that results in urinary frequency and urgency
• Changes to the nerves or blood vessels that are responsible for urinary control
• Chemotherapy can contribute to nausea and vomiting, nerve damage and ovarian failure with loss of hormones
• Hormonal therapies can cause dryness to vaginal and urethral tissues
• Radiation to the pelvis for bladder, prostate, cervical or rectal cancer can cause bladder irritation and an overactive bladder (urge incontinence)
• Bone marrow transplant with high dose chemotherapy can have side effects of vomiting and bladder cystitis

Cancer or treatment sometimes affects the ability to walk quickly and without assistance for a time. In some cases, help may be needed because of weakness, pain or medications. This can interfere with the ability to quickly respond to the need to urinate.

Is there a cure for urinary incontinence?

There are many options for successfully treating urinary incontinence. These may include behavioral therapy, medications, and surgery. These types of treatments may be used alone or together.

• Behavioral therapy
  
  Behavioral therapy treatment options address a behavior or activity that can be changed.  These may include emptying the bladder on a schedule, delaying the urge to go to the bathroom, strengthening the pelvic floor muscles or modifying diet and intake of fluids. About 80 percent of those with incontinence are able to improve symptoms with behavioral treatments.
  
  The advantages of behavioral therapy include:
  
  • May improve several symptoms
  • No side effects
  • It is the least expensive method of treating urinary incontinence
  • It is usually recommended as the first method to try
  • You play a major role in your treatment
    
• Surgeries
  
  Surgeries are performed by urologists and gynecologists to reduce stress incontinence symptoms. 
  
  Surgical treatment may be done to:
  • Lift the bladder
  • Tighten the valve
  • Implant an artificial valve that goes around the urethra
  • Inject collagen to stiffen the area around the urethra and bladder valve so it closes better
  • Implant a small electrical device for nerve impulse and therapy to the bladder
    
• Medications
  
  Medications for urge incontinence decrease how much the bladder muscles contract. They help with urgency and frequency. However, they may have side effects such as dry mouth or constipation, and they are not suitable for individuals with glaucoma. Medications for stress incontinence are being researched and are expected to be available in the near future.
  
  Some individuals may be embarrassed and reluctant to seek treatment for urinary incontinence. Yet, this is a problem that may easily be managed or cured. If the quality of your life is affected by this condition, talk with your health care team about getting help. You do not need to suffer with this problem.

This document was produced in collaboration with:

Dorothy B. Smith, RN, MS, FAAN, CWOCN
Vice-President, Clinical Affairs
DesChutes Medical Products, Inc.

Works Cited

Smith, Dorothy B. “Urinary Continence Issues in Oncology.” Clinical Journal of Oncology Nursing 3(4) (1999):161-7.

Gray, Mikel. “Functional Alterations: Bladder.” Handbook of Oncology Nursing Eds. Bonny Johnson and Judy Gross. Boston: Jones and Bartlett, 1998.

Shultz, Jean. “Urinary Incontinence: Solving a Secret Problem.” Nursing 2002 (November 2002): 53-5.

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Urinary Incontinence: Suggestions

The suggestions that follow are based on the information presented in the Detailed Information document. They are meant to help you take what you learn and apply the information to your own needs. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Additional Resources section for links to more resources.

• Talk to your health care team about urinary incontinence symptoms:
  
  
  • Ask your health care team for help, even if you are embarrassed. This is a medical problem, it may easily be corrected, and it is not your fault.
  • If your health care provider does not treat urinary incontinence, ask for a referral to someone who does.
  • The National Foundation for Continence has educational materials and a list of continence practitioners.
    
• What things can be done to improve urinary incontinence?
  
  
  • Diet: Sometimes the solution is as easy as changing your foods and drinks or learning to correctly exercise your pelvic floor muscles. Some foods and drinks irritate the bladder and cause urgency and frequency.
    
    The effect of diet varies with each person, but some foods and drinks known to affect some people include:
    
    
    • Chocolate
    • Caffeine
    • Tea
    • Cola
    • Alcohol
    • Tomatoes
    • Citrus fruits and juices
    • Spicy foods
    • Artificial sweeteners
      
      If you eliminate all of these for three days and re-introduce them one at a time, you may discover which ones cause your bladder symptoms or incontinence.
      
  • Exercise: Pelvic muscle exercises strengthen the support of the bladder and help reduce symptoms of stress, urge and mixed urinary incontinence. It may be best to ask an expert for help to learn the correct ways to do these exercises. Although they are not difficult to perform, these exercises can be challenging to learn to do correctly.
    
• Examine your lifestyle to see if there are things you can do to improve incontinence problems.
  
  
  • Nicotine from smoking is an irritant that can affect the bladder contractions and make them more frequent. If you have a chronic cough from smoking, this adds stress and can weaken bladder and pelvic floor muscle supports.
  • Being overweight adds extra stress to the tone of the pelvic floor muscles and affects their support of pelvic organs.
  • Lifting and high impact exercises, without first developing the strength of your pelvic floor muscles, can increase pressure on bladder supports.
  • Generally, when there is chronic constipation, increase fiber and fluids. Straining to have a bowel movement pushes against the bladder’s pelvic floor muscle support. If needed, talk with your health care team about using a stool softener.

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Urinary Incontinence: Additional Resources

The previous sections of this document provide detailed information, suggestions, and questions to ask related to this topic. This section offers a listing of additional resources that are known to provide support and quality services that may be helpful to survivors during the cancer journey.

LIVESTRONG SurvivorCare Program
www.livestrong.org/survivorcare

LIVESTRONG SurvivorCare offers assistance to anyone affected by cancer, including the person diagnosed, loved ones, caregivers and friends. The program provides information about treatment options and matching to clinical trials or treatments in development. Counseling services and assistance with financial, employment and insurance issues are also available. To provide these services, LIVESTRONG SurvivorCare has partnered with several organizations including CancerCare, Patient Advocate Foundation and EmergingMed.

Cancer Hope Network
www.cancerhopenetwork.org

Cancer Hope Network is a not-for-profit organization that provides free and confidential one-on-one support to cancer patients and their families.  They offer support by matching cancer patients or family members with trained volunteers who have already undergone and recovered from a similar cancer experience. You can submit your request by phone or by email. A volunteer will try to contact you within 24 hours.

National Association for Continence
www.nafc.org

The National Association for Continence provides information on care, products and treatment options for people who are living with incontinence. The website includes a searchable database for finding health care professionals in your area who specialize in incontinence. There is also a message board to post questions or read about other people's experiences. Tips on choosing a treatment provider, finding products, and managing symptoms are available on the site, and booklets can be ordered for a fee. Some information is available in Spanish.

Shop Well with You
www.shopwellwithyou.org

The Shop Well with You website offers a number of resources, including articles on body image and information on clothing-specific needs of cancer survivors. The site provides general tips on fabrics, styles and cuts that offer the most comfort for specific physical conditions. Some of the conditions addressed include mastectomy, ostomies, lymphedema and post-surgical recovery. In addition, contact information is provided for stores, catalogs and online retailers that carry these clothing items. Although the site is written for women, some of the stores listed carry items for men and children.

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